Working with Fat Children in Schools
By Michael I. Loewy, Ph.D.
Illustrations by Doug Dworkin
From Radiance Fall 1998
Sandy McBrayer, the 1995 national Teacher of the Year, tells of visiting an elementary school that was proud of its ethnic diversity and the integration achieved within the school’s social milieu. The principal walked her to the newly built multipurpose "cafetorium" and ceremoniously pulled open the doors to reveal children of all colors eating, talking, and laughing together.
As she entered, a contrasting scene near the door caught her eye. Separated from the rest of the student body were two large children who sat at a table eating their lunches in silence, staring directly ahead. They were not laughing. They were not talking. They were just bringing their forks to their mouths and down again, trying to be inconspicuous and to finish quickly. This day, they were too slow.
As other children finished their meals and exited the cafetorium, they threw their uneaten food at the two children. The fat children appeared oblivious as food hit their table and slid to the floor or hit their hands and fell onto their plates. They just kept eating and staring directly ahead. They behaved as if they did not know what was happening or as if this was a normal occurrence and they expected nobody to intervene.
The ridicule and torment of fat children by others is a story told again and again by fat children and by adults who were fat children. What effect does such ridicule—often accepted and endorsed by society—have on its young victims? How can educators and counselors intervene to support fat children?
Prejudice and Its Effects
The literature on prejudice reveals that fat children are the target of ridicule and disgust both by their peers and by the adults in their lives, such as teachers, counselors, and parents. This is no small problem in schools: according to the Centers for Disease Control (1994), 21 percent of people ages twelve to nineteen are overweight. As early as preschool age, children have accepted the stereotypes about and developed prejudice against fat people. Given the opportunity to play with fat or thin dolls, all children, even those who could correctly identify that the fat dolls looked more like them, preferred to play with thin dolls (Dyrenforth, Freeman & Wooley, 1978; Rothblum, 1992). Given pictures of children who were in a wheelchair, missing a limb, on crutches, facially disfigured, or obese, most children said they would least like to play with the fat child (Rothblum, 1993).
By elementary school, children describe fat children as lazy, sloppy, dirty, stupid, and ugly (Levine, 1987). Fat children are less likely than other children to receive “best friend” ratings from their classmates (Rothblum, 1992). When shown silhouettes of fat and thin males and females, nine-year-old children rated the fat figures as having significantly fewer friends, being less liked by their parents, doing less well at school, being less content with their appearance, and wanting to be thinner (Hill & Silver, 1995). A group of six- to ten-year-old boys rated fat children as most likely to be teased (Staffieri, 1967).
By adolescence, the subjective importance of physical appearance is particularly great among girls (Wadden & Stunkard, 1987). A longitudinal study of one thousand high school students revealed that more than 50 percent of the girls wanted smaller hips, thighs, or waists. Of ninth-grade girls, 63 percent wanted to lose weight. This figure rises to 70 percent for tenth- and eleventh-grade girls (Huenemann, Shapiro, Hampton & Mitchell, 1966). Canning and Mayer (1966) found lower acceptance rates into prestigious colleges for fat high school students, compared with average-weight students, even though the two groups did not differ in high school performance, academic qualifications, or application rates to colleges.
Teachers and counselors are subject to the same stereotypes and biases as parents and children. In a study of more than two hundred teachers, it was found that for such characteristics as attractiveness, energy level, leadership ability, self-esteem, and the ability to be socially outgoing, large children are consistently perceived by teachers more negatively than average-weight children (Schroer, 1985). In another study of education professionals, a picture of an average-size teenage girl received higher ratings on scholarship, while the picture of a fat girl was rated highest on risk for personal problems and recommendation for psychological referral (Quinn, 1987). A study of fifty-two mental health professionals indicated that counselors have the same biases as the general public: they tend to stereotype fat people negatively and thin people positively (Loewy, 1994).
Parents have a strong impact on children’s self-image and self-esteem. One study found that girls were less likely to receive support from their parents for college education if they were fatter than average (Crandall, 1991). Controlling for income, ethnicity, family size, and number of children attending college did not change the results. Further examination found that reluctance to pay for large daughters’ educations is a matter of parental choice, not ability (Crandall, 1995).
According to a 1994 article by Ronald Kleinman, M.D., chief of the Pediatric Gastroenterology and Nutrition Unit, Massachusetts General Hospital, and associate professor of pediatrics at Harvard Medical School, “Many parents are unnecessarily concerned with their children’s weight. They badger their high-achieving, happy kids for generally unfounded reasons. We need to communicate to parents [and other responsible adults] that a fat child does not have any more medical problems than other children the same age.”
Parents and educators often project their dissatisfaction with their own bodies on the children over whom they have influence. It cannot be stressed enough that adults must deal with their own negative body image and fear, loathing, and disgust of fat before they can stop teaching children to hate their bodies.
The cultural obsession with thinness and the stigma attached to being fat take a toll on the mental health of large people. Although they show no greater disturbance on conventional measures of psychopathology, many fat people suffer from poor body image (Wadden & Stunkard, 1987). Fat people characteristically view their own bodies as grotesque and loathsome and believe that others view them with hostility and contempt (Stunkard & Mendelson, 1967). Because poor body image is an internalization of parental and peer criticism (Wadden & Stunkard, 1987), only a cultural shift in parental concern and acceptance of fat children by peers and adults can alleviate fat children’s internalized self-hatred.
What Is Wrong with Common Strategies?
Several perceptions encourage well-meaning parents and teachers to be concerned with childhood obesity. First, it is commonly believed that being fat is a health hazard. Second, it is generally accepted that fat children grow into fat adults (Stunkard & Berkowitz, 1990). Third, parents don’t want their children to be the target of oppression and discrimination. Fourth, we know that being fat during adolescence has important social and economic consequences. For example, large adolescents and young adults remain single more often and have lower household incomes in early adult life than their average-weight counterparts, regardless of their socioeconomic origins and aptitude-test scores (Gortmaker, Must, Perrin, Sobol & Dietz, 1993).
As a result of these perceptions and misperceptions, many parents subject their children to commonly prescribed strategies for weight loss, including caloric restriction, behavior modification, and commercial weight-loss programs. Most attempts at weight loss will result in short-term success (Bennett & Gurin, 1982). Yet current research demonstrates that for many children, such methods result in increased frustration and lower self-esteem.
What is not generally accepted or understood is that efforts to control or limit the food intake of children and adults through diets (or the euphemistic term lifestyle change) do not work in the long run. There is overwhelming evidence that obesity is primarily genetically determined (Price et al., 1990; Stunkard et al., 1986; Stunkard, Harris, Pedersen & McClearn, 1990). In a study of same-sex, identical and nonidentical twins, estimated heritability of obesity was 88 percent (Borjeson, 1976). Price, Cadoret, Stunkard & Troughton (1987) found a strong relationship between body mass index (BMI) of adoptees and their biological parents, whereas no relationship was found in the BMI of adoptees and their adoptive parents.
Research has shown that metabolic rate has a genetic pattern. The metabolic rate of the four-year-old children of fat parents was 10 percent lower than the rate of the four-year-old children of parents who were not fat (Griffiths & Payne, 1976). At three months of age, the BMIs of infants of lean and obese mothers were indistinguishable. However, the energy expenditure was more than 20 percent lower in the infants who later became fat (Roberts, Savage, Coward, Chew & Lucas, 1988). The findings of Ravussin et al. (1988), who studied energy expenditure among Southwest American Indians, indicate that, although there was no difference between fat and lean children in caloric intake, the children of fat parents became fat later in life.
Fat children, as a group, do not eat more than average-size children. Withholding or restricting someone else’s food is the same as starving that person, and it feels the same: torturous. And when one withholds or restricts one’s own food intake, we call it a diet. In reality, it is self-starvation.
Several reviews of behavioral and dietary treatments of obesity have revealed the dismal failure of these methods (Bennett & Gurin, 1982; Garner & Wooley, 1991; Wadden, Stunkard & Liebschutz, 1988). Although almost all weight-loss programs appear to demonstrate moderate success in promoting at least some short-term weight loss, there is virtually no evidence that clinically significant weight loss can be maintained over the long term by the vast majority of people.
The most successful weight-loss programs studied have incorporated behavior management techniques, exercise, social influence, longer treatment duration, and continued therapeutic contact after the end of formal treatment. Although these strategies have been found to promote greater weight loss and improved maintenance during the first eighteen months after treatment, long-term follow-up studies (Garner & Wooley, 1991) show that in time, weight is gradually regained, with many participants weighing more than they did before the programs.
For example, in a five-year follow-up study, Stalonas, Perri & Kerzner (1984) reported that the average participant had gained 11.9 pounds since the end of treatment, making him or her 1.49 pounds heavier than when treatment began. Researchers studying 114 men and 38 women who had successfully completed a fifteen-week behavioral weight-loss program reported that less than 3 percent maintained their post-treatment weight loss after four years (Kramer, Jeffery, Forster & Snell, 1989). Weight rebound seems to be almost as reliable a consequence of treatment as initial weight loss (Garner & Wooley, 1991).
Not only do such methods fail to produce lasting results, but there is strong evidence that continued attempts at dieting result in increased biological resistance to weight loss. Young people are often advised to lose weight now because it gets harder to lose as one gets older. However, the earlier one starts this cycle of losing and regaining, the heavier one will be as an adult.
Teachers, parents, and other caregivers who lack understanding of the variations in growth patterns that occur during childhood may do more harm than good. Poor role modeling and attempts to limit children’s food intake are ineffective and can even be harmful in dealing with children’s body-size issues (Ikeda & Naworski, 1992). The more pressure we put on children and adolescents to conform to the ideal body type, the more we perpetuate the myth that this ideal can be achieved by everyone. Furthermore, we are sending children the message that they are damaged and need to change in order to be acceptable.
In reality, it seems that body weight is regulated by physiological mechanisms that oppose the displacement of weight caused by either over- or underfeeding. This concept, known as “set point,” accounts for the data from human and animal studies showing that there is a remarkable stability and homeostasis of body weight over time (Bennett & Gurin, 1982). Set point accounts not only for the difficulty people have in losing weight, but also for the extreme difficulty some people have in gaining weight and maintaining that weight gain.
In essence, as body weight is reduced, the resting metabolic rate is also reduced. Therefore, it takes increased restriction of caloric intake to maintain any weight loss. Furthermore, when food intake is normalized after a period of food restriction, there is a tendency for energy to be redeposited preferentially as body fat (Dulloo & Girardier, 1990).
In sum, a small percentage of children will slim down as they physically mature, and for some very few, weight-loss programs may have long-term benefits. However, the vast majority of children and adolescents who attempt to artificially control their weight will experience failure and frustration, leading to lower self-esteem.
Recommendations for Supporting Fat Children
Counselors, psychologists, physicians, and other experts suggest that a strategy more beneficial to the social and emotional well-being of fat children would be to accept them at any size and support them in building self-esteem and positive body image (Ikeda & Naworski, 1992; Kleinman, 1994; Loewy, 1994/1995). I believe this is possible by adopting an attitude of admiration, appreciation, and nurturance of fat children.
Fat children should be admired because being fat in our society takes tremendous strength. For fat children to face teasing, rejection, and discrimination on a daily basis and still thrive takes great strength of character. It is amazing that so many fat children survive adolescence, given the hatred and meanness directed at them. Indeed, some do not make it, as evidenced by the fifteen-year-old high school student in Alabama who shot and killed himself in the classroom in 1997 because he could no longer take the torment.
To appreciate fat children is to value the diversity of people and to see fat children as a valid part of that diversity. When we think of diversity in the classroom, we usually think in terms of race, ethnicity, and gender. Some of us may include physical ability and sexual orientation in our view of the diverse classroom. Fat children often have a unique perspective on life and society. It is important to validate that perspective and appreciate the richness that different perspectives bring to the classroom.
Fat children need to be nurtured, not changed. To nurture a fat child, one must see that child as indispensable. If we see fat children as indispensable, we will view them with genuine affection and delight. We will then be willing to advocate for them, love them, and nurture them just as they are.
Educational materials and instruction should be free of derogatory representations of fat people. Avoid using materials with text or illustrations that endorse negative stereotypes about fat people as lazy, sloppy, stupid, mean, or eating too much. Material should not depict fat people whose problems are solved because they lose weight. To the contrary, there should be positive images of fat people of all ages, both genders, and all ethnicities in educational materials. Those of us who are educators must demand that the publishers of educational material provide us with unbiased tools.
Here are some classroom and library materials that are supportive of fat children:
All children deserve love and respect, whatever the size of their bodies. By teaching children the value of respecting fat people, and enforcing that value, we are teaching fat children to love and respect themselves. We are also teaching average-size children the importance of embracing and including in their lives people who are different from them. We who are school personnel must advocate for all youth, especially those who need our advocacy most.
We do not need to single out fat children or ask them directly if they are having a problem being fat. Chances are, they are having a problem but will not trust anyone to be on their side. We need to speak to all children about our appreciation for fat children. In this way, fat kids will know that we are approachable, and trust will begin to build. At the same time, average-size kids are learning an important lesson about the value of people outside the dominant culture.
Our goal as child educators and child advocates is to produce healthy children who feel good about themselves. Let us take the focus off size, food, and eating, and put it back on health and self-esteem. Our children can only benefit. ©
This article is excerpted with permission from Michael I. Loewy, 1998. Suggestions for working with fat children in the schools. Professional School Counseling 1,4: 18–22. Published by the American School Counselor Association, 801 North Fairfax Street, Suite 310, Alexandria, Virginia 22314, 800-306-4722, fax: 703-683-1619, e-mail: firstname.lastname@example.org, http://www.schoolcounselor.org. Due to space limitations, the list of references cited in this article has not been included. Correspondence concerning this article can be sent to Michael I. Loewy, Deptartment of Counseling and School Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-1179, e-mail Loewy@mail.sdsu.edu.
MICHAEL I. LOEWY, Ph.D., is assistant professor of counseling and school psychology in the College of Education at San Diego State University, where he teaches cross-cultural counseling. He completed his Masters and Doctoral degrees in counseling psychology at the University of California, Santa Barbara. He currently serves on the Scientific Advisory Board of NAAFA, the National Association to Advance Fat Acceptance.