Healthy Bodies: Teaching Kids What They Need To Know
An interview with Kathy Kater, LICSW
For whom did you write Healthy Bodies Teaching Kids What They Need To Know?
Healthy Bodies contains the lessons that I found myself teaching over and over again to every adult and adolescent patient I worked with, as part of the necessary foundation for their eating disorder recovery. Many times I heard people say, “My life would have been different if I had learned this as a child.” When my daughter was 9 and came home one day asking, “Why would Lauren say she is fat?” I felt dread. I knew too well that this is when and where body comparing and dissatisfaction often starts! Then it came to me: The very same lessons I was providing to my clients in order to correct their destructive thinking were simple enough for a 4th grader to understand. I knew I wanted my daughter to learn them before problems began for her and her friends. I also didn’t want her to hear these lessons just from her mother, but in a regular classroom setting, side by side with her peers—like Lauren!
So I wrote this evidence-based curriculum for the next generation, but also for their teachers and parents, and everyone, really. I want these lessons to be part of the universal education for all. I believe if it were culturally normative for kids to get support for maintaining their body esteem through the critical developmental years and into adulthood, it could frankly put a lot of people like me who treat disordered eating problems out of business, and eventually make concerns about obesity a thing of the past. Both would be a very good thing!
To be clear, I am not suggesting Healthy Bodies or any single curriculum could magically prevent all body image, eating and weight concerns given all of today’s harmful pressures. But without lessons teaching kids to care for instead of compare their bodies, most of them will not experience any cognitive dissonance at all in the face of the pervasive “right size/wrong size” mentality that is so harmful. And so it is that most kids at ever younger ages today unquestioningly feel they, like adults, should judge themselves by standards that are unrealistic for most—whether this be the “thin ideal” for appearance, a “normal BMI” for health, or the “perfect size” for athletic performance—and that they should do “whatever it takes” to try to achieve those standards. Naturally most feel bad when they fail. Sadly this is the status quo, and it needs to be changed.
In the Healthy Bodies closing lesson the kids discuss this question: What if the swan had stayed with the ducks? I wanted boys and girls together to consider this, and how perhaps they, like the “ugly duckling,” could turn their backs on cultural pressures that make them feel “ugly,” turning instead to a more realistic, happier way.
Can you please elaborate on your comment “the role of educators is to present the facts without flinching, even if and when these conflict with advice based on dated paradigms about weight?”
Conventional approaches to weight, whether for appearance or for health are really very flawed. Having the “right” size (based on the “thin-ideal”) or a “normal” BMI is viewed as the end-all—it is considered to be “the” goal and it is the definition of “healthy weight,” even if the means to achieve that size or weight would never be considered healthy or sustainable. Advice arising out of weight-focused paradigms is based on the belief that a) anyone who eats well and stays fit will be at least relatively lean, and b) if you are not more or less lean, you must be doing something wrong. Given this perspective, behaviors that enhance health and well-being matter, but only if they result in the “right” size. Otherwise you are “failing,” and this is widely accepted to be a fact. Given that only 43% of females have the genetic potential to maintain thinness, 57% don’t even have a chance. (Suisman, 2012) Is this really what Mother Nature intended for us?
When educators teach the facts about this, they are challenging conventional paradigms with an approach that is “health and wellness focused” instead of “weight focused.” This means that weight itself is explicitly not the focus. Instead, weight is understood to be a result—something that happens that may be influenced but not controlled, and that will show itself differently for different people. Weight is considered to be “as healthy as it can be” for each individual when they are engaging over time in sustainable, life-enhancing choices (eating well, being active, managing sleep and stress, etc.), taking into account their physical, economic, social, spiritual, emotional, and other needs. This goal respects the fact that weights resulting from positive, sustainable self-care will vary significantly.
So why do teachers need to be unflinching? While this approach is grounded in well-established biological principles, it doesn’t change the fact that it stands in startling contrast to what most people, including ever younger children today, have learned to believe about size, shape, weight and what people should do about it. In this way teachers must prepare themselves to be a bit like those who first announced that the world is not flat; to be completely understanding of disbelief, while simultaneously confident and undaunted.
You opted to present the material of the curriculum in lesson plan form with specifics for learning objectives, outcomes, discussion topics, stories, classroom and home assignments and even materials needed. Do you think your readers were expecting how detailed and all-inclusive your curriculum is?
As I mentioned earlier, my wish was to have my daughter and her peers learn these lessons in their 4th grade classroom, so the need for it to be a curriculum, teachable by educators, dictated the format. But I also considered detailed objectives such as, “What children will learn?” and fully scripted lessons to be an opportunity to provide teachers (and parents, through take-home information) with some of the language that is helpful in conveying the lesson concepts. For example, some of the desired “take-aways” from selected lessons are listed below. Consider how these statements might be challenging to say in a resolute way for many people today, including teachers, healthcare providers, and parents, even if they knew them to be true:
- People cannot control when and how their body is set to change and grow.
- All people are naturally fatter, thinner, or in-between.
- To say someone is fatter or thinner is a way to describe, not judge, him or her.
- It is normal to gain body fat during puberty.
Biological influence on size and shape
- My normal, healthy body size could be fatter or thinner.
- You cannot make assumptions about how people eat or how fit they are based on how they look.
- Hunger feels the same to people who are fat or thin.
Why dieting is not a good idea
- Only my body knows when I am hungry and when I am full.
- You can lose weight by “dieting” for a while, but you will be fighting against nature the whole time. In the end, you will almost surely regain the weight, and maybe added pounds.
- My worth does not depend on my looks. How I look is only one small part of who I am.
How to eat
- I hope the adults in my life will provide me with a variety of wholesome food to choose from.
- I can enjoy eating just for fun, but will eat a balance of foods that give my body all the nutrients it needs.
- I eat well and am active, so I am confident this is a healthy weight for me.
The importance of movement
- I am active and eat well, so I am confident of my weight, my strength, and my stamina.
Choosing good role models
- If I feel bad when I compare myself to someone, I’ve probably chosen the wrong role model.
- It can help to have role models you admire for qualities that are deep inside.
- I can admire people who fit a certain standard of appearance without feeling I should try to imitate them.
- Looks affect first impressions, but what is most important may not be seen on the outside.
The influence of media
- Hardly anyone looks as perfect as the models in advertisements. I will be careful not to compare myself to them.
- If an advertisement makes me feel bad, I’ll remember this is part of the plan to make me buy that product.
What kind of feedback have you received, for example, on Lesson 5 “Internal Weight Regulation The Metabolism Factor?”
Teachers who have taught the lessons seem to really like the way the activities demonstrate the facts in a really common sense way that is quite compelling. For example, one teacher told me that with Lesson 5, which you have mentioned here, as she tried to save time by simply explaining the core concept, which is that people will come in all shapes and sizes even if they have identical food intake and activity levels, her students didn’t believe her! So she gave up and decided to do the recommended activity, “The Metabolism Game,” which requires a bit of prep and takes about 20 minutes in the classroom. The kids became convinced! The game is very experiential and involves everyone being assigned a different metabolism rate and then “eating” the same mock lunch (paper food cut-outs), which they put into an envelope taped to their bellies. Then they all digest and “metabolize” their lunches at their different rates and see what happens. It’s hard to explain, but it makes quite an impression when the kids line up at the end to form a bell curve. You have to see it to believe it! And believe me, it’s a real shame-reliever for the larger kids.
How does your book align with the Common Core Standards?
A chart in the back of the book shows how Healthy Bodies aligns with National Health Standards. It lines up well!
One of the criticisms educators often have is that the material in a curriculum they are asked to teach is not age or developmentally appropriate. How have you addressed this concern?
Healthy Bodies is scripted with language appropriate for grades 4 through 6, but both the concepts and the activities are easily adaptable for younger and older students. Many teachers have used the lessons “as is” with both middle school and high school age students, and it has also been used as the primary text for in a college course. I personally use many of the activities and handouts with adult clients, and I know they are used by eating disorder treatment facilities as well.
Healthy Bodies principles are pretty simple—simple enough for a 4th grader to understand—but they are not necessarily easy to grasp because they contradict what people have learned to believe about body size and shape and “what to do” about weight. Frankly, I think the fact that it is written at the 4th grade level makes it just about perfect for all ages. Young kids grasp the concepts easily, while adolescents and adults of all ages really benefit from having the concepts presented at the lowest common denominator. It’s like, “Everything you needed to know about caring for your body and realizing your personal best-weight you could have learned as a pre-pubescent child.” It’s much harder to reverse body dissatisfaction and unhelpful or disordered eating and fitness habits once these are established than to provide preventive messages from the get-go. When I am working with adults to replace destructive ways of thinking, I use the very same simple language exemplified in the bulleted objectives above.
Does Healthy Bodies address some on-going issues within society, specifically, the full spectrum of body image and weight concerns, including Eating Disorders and rising rates of obesity?
The Model for Healthy Body Image and Weight upon which the lessons are based is a universal model for promotion of health instead of size for everyone the same. As such it is a true Health at Every Size ® approach, and targets concerns about the full spectrum of body image and weight-related concerns, including concerns about higher rates of obesity.
Different approaches for different groups (people often ask, “This sounds good, but what about the really fat kids?”) have too often solved one problem only to cause another. Whether a person is large or small, fat or thin; whether they have pushed their weight above their genetic predisposition through unhealthy lifestyle habits, or starved their body into a dangerously low weight, what can be “done” about weight in a sustainable, effective way is limited to very few options:
a) Accepting their body where it is right now, for who can really care for and take care of a body they hate? No one.
b) Tuning in to, listening to, and mindfully responding to their body’s needs, particularly for wholesome, nutritious, tasty food and enjoyable movement.
c) Accepting that the size and shape that results from good self-care is the body that’s right for them.
What else can anyone do? If you know other options that are sustainable, please let me know.
Some people think this approach is “soft” on making kids eat well and getting them moving, but it is exactly the opposite. Teaching kids to care for their bodies means really care, which is about helping them learn to connect, tune-in, and respond on a deep level to their overall wellbeing. It is certainly not about giving in to the impulse of the moment, eating whatever/whenever while never leaving the couch and without regard for the whole. In her book, Self Compassion by social scientist Kristen Neff expresses it this way: “Unlike self-criticism, which asks if you’re good enough, self-compassion asks what’s good for you? It taps into your inner desire to be healthy and happy. If you care about yourself, you’ll do what you need to do in order to learn and grow. Valuing ourselves in a deep way makes us want to make choices that lead to well-being.”
So Healthy Bodies is a values-based curriculum that aims to prevent much of the shame and body dissatisfaction that so often drives not only eating disorders and rising rates of obesity, but the poor, complacent, and disordered eating and fitness habits that are rampant in kids and adults today.
You can read much more and download the entire Preface, as well as a complete sample lesson, plus many other educational handouts at www.bodyimagehealth.org
Documentation for Core Principles Presented in the Healthy Bodies: Teaching Kids What They Need to Know curriculum (the short list). An extensive reference section is included in the back of book.
Bacon L, Stern JS, Van Loan MD, Keim NL. (2005). Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association, 105: 929-936.
Bacon, L. (2010). Health at every size: The surprising truth about your weight (second edition). Dallas: BenBella Books.
Brochu, P.M. and Esses, V.M. (2011). What’s in a Name? The Effects of the Labels ‘Fat’ Versus ‘Overweight’ on Weight Bias, Journal of Applied Social Psychology, 41, no. 8.
Brownell K, Puhl R, Schwartz M, Rudd LE, (2005). Weight bias: Nature, consequences, and remedies. New York: Guilford.
Cramer, P and Steinwert, T.(1998). Thin Is Good, Fat Is Bad: How Early Does It Begin? Journal of Applied Developmental Psychology 19, no. 3: 429–51.
Crister G (2004). Fat Land: How Americans Became the Fattest People in the World. New York: Houghton Mifflin.
Daníelsdóttir S, Burgard D, Oliver-Pyatt W. (2010). AED Guidelines for Childhood Obesity Prevention. Retrieved from http://www.aedweb.org/AM/Template.cfm?Section=Advocacy&Template=/CM/ContentDisplay.cfm&ContentID=1659#.UvuoztGYZYA
Davison, K. & Birch, L. L. (2004). Predictors of fat stereotypes among 9-year old girls and their parents. Obesity Research ,12, 86-94.
Davison, K. & Birch, L. L. (2001). Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics , 107, 46-53.
Dohnt, H. & Tiggemann, M. (2006). The contribution of peer and media influences to the development of bodydissatisfaction and self-esteem in young girls: A prospective study. Developmental Psychology , 42, 929-936.
Faith M.S., Leone M.A., Ayers T.S., Heo M., Pietrobelli A. (2002). Weight criticism during physical activity, coping skills, and reported physical activity in children. Pediatrics . 110:e23.
Field A.E., Austin S.B., Taylor C.B., Malspeis S., Rosner B., Rockett H.R. et al, (2003). Relation between dieting and weight change among preadolescents and adolescents. Pediatrics , 12: 900-906.
Friedman, J.M., (2004). Modern Science versus the Stigma of Obesity; Nature Medicine 10, 563 – 569.
Friedman, J. (2009). The Real Cause of Obesity. Newsweek , Sept 10. Retrieved at http://www.newsweek.com/id/215115/page/1
Friedman, R, Puhl, R (2012). Weight Bias; a Social Justice Issue: A Policy Brief. Yale Rudd Center for Food Policy and Obesity. Yale University, New Haven, CN
Gapinski, K. D., Brownell, K. D., & LaFrance, M. (2003). Body objectification and ‘‘fat talk’’: Effects on emotion, motivation and cognitive performance. Sex Roles , 48, 377–388.
Goldberg, D. and Puhl, R., (2013).Obesity Stigma: A Failed and Ethically Dubious Strategy. Hastings Center Report 43, no. 3: 5-6.
Goss K., Allen S. (2012). Compassion focused therapy for eating disorders. Int. J. of Cognitive Therapy 3: 141-158.
Haines J., Neumark-Sztainer D., Eisenberg M.E., Hannan P.J., (2006). Weight teasing and disordered eating behaviors in adolescents: longitudinal findings from Project EAT (Eating Among Teens). Pediatrics. 117:e209-215.
Heinberg L., Matzon J., (2001). Body image dissatisfaction as a motivator for healthy lifestyle change: Is some distress beneficial? In Eating disorders: Innovative directions for research and practice. Edited by Striegel-Moore R., Smolak L. Washington, DC: American Psychological Association: 215-232
Hirschmann J.R., Munter C.H., (1995). When women stop hating their bodies: freeing yourself from food and weight obsession. 1st edn. New York: Fawcett Columbine.
Kater, K. (2008). Debate about fatness increases health risks. British Medical Journal Online , Feb. 21.
Kater, K., (2005). Healthy body image: Teaching kids to eat and love their bodies too! (second edition; curriculum guide). Seattle: National Eating Disorders Association.
Kater, K., Rohwer, J., & Levine, M. P. (1998). An elementary school project for developing healthy body image and reducing risk factors for unhealthy and disordered eating. Eating Disorders: Journal of Treatment and Prevention; Vol 8, No. 1.
Kater, K., Rohwer, J. & Londre, K. (2002). Evaluation of an upper elementary school program to prevent body image, eating and weight concerns. Journal of School Health, Vol. 72 (5), pp. 199-204.
Kaufman, G., (1992). Shame, the Power of Caring. Rochester, VT: Schenkman Books
Leary M.R., Tate E.B., Adams C.E., Allen A.B., Hancock J., (2007). Self-compassion and reactions to unpleasant selfrelevant events: the implications of treating oneself kindly. J. Pers. Soc. Psychol. , 92: 887-904.
J.C. Lumeng et al., (2010). “Weight status as a predictor of being bullied in third through sixth grades,” Pediatrics 125, no. 6: el301-7.
Mann, T.,Tomiyama, A. J, (2007). “Medicare’s Search for Effective Obesity Treatment: Diets are Not the Answer,” American Psychologist, April.
Matz J., Frankel E., (2006). The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-care Naperville, IL: Sourcebooks.
May M., (; 2009). Eat What You Love, Love What You Eat: How to Break Your Eat-Repent-Repeat Cycle. Greenleaf Book Group Press.
Neff, K., (2011). Self Compassion. NY,NY: Harper Collins.
Neumark-Sztainer D., Wall M., Guo J., Story M., Haines J., Eisenberg M. (2006). Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J. Am. Diet. Assoc. , 106: 559-568.
Neumark-Sztainer D., Falkner N., Story M., Perry C., Hannan P.J., Mulert S. (2002). Weight-teasing among adolescents: correlations with weight status and disordered eating behaviors. Int. J. Obes.Relat. Metab. Disord. , 26: 123-131.
Neumark-Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males; Journal of Adolescent Health 39.
Neumark-Sztainer, D., Wall, M., Larson, N., Eisenberg, M., Loth, (July 2011). Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study Journal of the American Dietetic Association , Volume 111, Issue 7.
Neumark-Sztainer D., Wall M., Story M., van den Berg P. (2008). Accurate parental classification of overweight adolescents’ weight status: does it matter? Pediatrics; 121(6), 1495-1502.)
Neumark-Sztainer D., Levine M.P., Paxton S.J., Smolak L., Piran N., Wertheim E.H., (2006). Prevention of body dissatisfaction and disordered eating: What next? Eat Disord , [14:26]5-285.
Niide, T., Davis, J., Tse, A., Harrigan, C. (2013) Evaluating the Impact of a School-based Prevention Program on Selfesteem, Body Image, and Risky Dieting Attitudes and Behaviors Among Kauai Youth. Hawaii Journal of Medicine & Public Health , Vol 72, No 8.
Niide, T., Davis, J., Tse, A., Derauf, C., Harrigan, R., Body Ideals and Body Dissatisfaction Among a Community Sample of Ethnically Diverse Adolescents on Kauai, Hawaii. Hawaii Journal of Public Health; Vol 3, Issue 1.
O’Rahilly, S. (2006). Genetics of Obesity in Humans, Endocrine Reviews 27 (7): 710-718.
Puhl R., Brownell K., (2001). Bias, discrimination and obesity. Obes. Res. , [9:78]8-805.
Puhl R.M., Heuer C.A. (2009). The stigma of obesity: a review and update. Obesity (Silver Spring), [17:94]1-964.141.
Puhl R.M., Moss-Racusin C.A., Schwartz MB, (2007). Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity (Silver Spring , [15:19]-23.
Puhl R.M., Brownell K.D. (2006). Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring) , [14:18]02-1815.
Puhl, R. & Heuer, C. (2010). Obesity Stigma: Important Considerations for Public Health. Am. J. Public Health , 1[00:10]19–1028.
Puhl R.M., Andreyeva T., Brownell K.D., (2008). Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes (Lond) , [32:99]2–1000.
Saguy, A. & Almeling, R. (2008)) Fat in the Fire? Science, the News Media, and the “Obesity Epidemic.” Sociological Forum, Vol 23, No. 1.
Salk, R., and Engeln-Maddox, R. (2013). If you’re fat, then I’m humongous! : Frequency, Content, and Impact of Fat Talk Among College Women. Psychology of Women Quarterly 2011 35: 18.
Satter E., (2008). Secrets of feeding a healthy family: how to eat, how to raise good eaters and how to cook. Madison, WI: Kelcy Press; 161.
Smolak, L., Levine, M., & Schermer, F. (1999). Parental input and weight concerns among elementary school children. International Journal of Eating Disorders , 25 , 263-271.
Stice, E., et al, (2005). Psychological and behavioral risk factors for obesity onset in adolescent girls: a prospective study. Journal of Consulting and Clinical Psychology, Vol 73, No. 2, 195-202
Stice, E., Cameron R.P., Killen J.D., Hayward C., Taylor C.B., (1999). Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. J. Consult. Clin. Psychol. , 67: 967-974.
Storch E.A., Milsom V.A., Debraganza N., Lewin A.B., Geffken G.R., Silverstein J.H. (2007). Peer victimization, psychosocial adjustment, and physical activity in overweight and at-risk-for-overweight youth. J. Pediatr. Psychol. [32:80]-89.
Suisman, J., et al, (2012). Genetic and environmental influences on thin-ideal internalization International Journal of Eating Disorders, 45 (8), 942-948.
Tomiyama, A.J. & Mann, T. (2012). If shaming reduced obesity, there would be no fat people. Hastings Center Report . PMID: 23650055
Tribole E., Resch E., (2010). Intuitive eating : a revolutionary program that works. 2nd edn. New York: St. Martin’s Griffin.
Tylka, (2006). Development and Psychometric Evaluation of a Measure of Intuitive Eating. Journal of Counseling Psychology. Vol. 53, No. 2, 226–240
van den Berg P., Neumark-Sztainer D.., (2007). Fat ‘n happy 5 years later: is it bad for overweight girls to like their bodies? J. Adolesc. Health . [41:41]5-417.
Vartanian L.R., Shaprow J.G., (2008). Effects of weight stigma on exercise motivation and behavior: a preliminary investigation among college-aged females. J Health Psychol , [13:13]1-138.
For an extensive list of additional research publications and other resources on the causes, prevalence and consequences of weight bias and weight stigma visit www.ruddcenter.org