Hard to believe #PGY4 is here! Grateful for the opportunity to share more about #HAES and #IntuitiveEating with fellow trainees in #peds today for my senior talk. I learned so much along the way I thought I might create a brief #tweetorial of the summary of my literature review.
#HAES or health at every size is a method of nutrition counseling focused on promoting body acceptance, encouraging nutrition 🍎, and gentle movement 💪 without an aim of weight loss.
In brief: pursuing health-promoting habits at any weight/body size.
A 2013 study in @JAMAPediatrics showed children whose parents used “weight-centered” language were more likely to diet frequently, binge eat, or have eating disorders as teens.
Parents that focused on healthy eating ONLY had a protective effect on all the above for their teens.
Another review from @AmerAcadPeds in 2016 showed dieting w/ the intent of weight loss was the #1️⃣ risk factor for developing an eating disorder as well as predictive of weight gain.
In fact a normal BMI 9th grade girl who diets is more likely to be overweight by 12th grade. 🤯
The same study showed that children exposed to “weight talk” in any form—I.e.
“I have to lose 20 lbs before I can wear a swimsuit 👙”
Or
“Did you see how much weight Sarah’s mom gained this summer?”
Were more likely to have significant weight gain at 5 year follow up.
Children exposed to #weightstigma or #weightteasing via parents👨, peers 👧, or physicians 👩⚕️were more likely to develop binge eating/purging behaviors or weight gain at 5 year follow-up.
Weight teasing is also associated with decreased likelihood to exercise in children.
On the other hand eating at least one meal 🍽 with family 👨👩👧👦 7 days a week was predictive of increased 🥦🥕🥬intake, long term healthy eating patterns, and protective against EDs, bing eating, and dieting.
Patients that had healthy body image (regardless of BMI) were also more likely to pursue healthy activities like exercise ⛹️♀️🤸♀️🧘🏊♀️ and eat healthfully 🍉🥝🥑🥔🍳🍞 without the desire to change their body size.
What can we do as #pediatricians
1️⃣Use #MI to encourage behavior changes rather than weight changes.
2️⃣ 🗣 Language Matters: Use weight-neutral language in visits.
“Moving your body is a great way to have fun and strengthen your muscles!” 💪
3️⃣Explore the underlying societal determinants of health that impact your patient and advocate for systemic change!
-Access to fresh foods
-Distance to parks
-Neigborhood safety
To name a few directly correlated with #pediatricobesity.
4️⃣ Listen👂 to your patient to identify familial and personal barriers to health and address where able.
- weight teasing
- poor body image
- dieting behaviors
- binge eating
- family/personal stressors
- mental illness
- lack of family meals
Bottom line:
The factors that contribute to weight are far beyond 🍴🍔and 🏃.
Addressing systemic and familial barriers to health including #ACEs and providing stigma-free health education should be our priority as physicians—not changing children’s bodies!
One final note on BMI:
The pediatric BMI scale utilized by clinicians is based on expert recommendation only. While it can be a useful tool for screening for the above risk factors and comorbidities “healthy BMI” ≠ health nor does “obese BMI” = lack of health.
Takeaways:
🍊Avoid weight talk with pediatric patients
🍓Focusing on health behaviors > weight loss efforts.
🍍Health thinness nor does obesity=comorbidities
🍅Consider background factors contributing to weight
🥦Provide weight-neutral, evidence-based education to ALL patients
Thanks for following along!
Resources to learn more about #HAES and #intuitiveeating in pediatrics and beyond:
@IntuitiveEat @chr1styharrison @FeedingLittles @Etribole @ElyseResch to name a few!
Would love to hear what other physicians are doing in this area!
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