In Defense of Fat Kids

Thinking through our culture of pediatric fatphobia, via Virginia Sole-Smith's new book, Fat Talk

It feels inevitable. Novo Nordisk, which has been peddling injectable semaglutide medications like Wegovy and Ozempic (off-label) for weight loss, have now announced that they’re getting into the business of obesity prevention. They want not just to make fat people thin—an aim which I’m on the record as being deeply critical of—but even to prevent us from existing in the first place. 

This seems like part of an accelerating war on fat children. And like many superficially benign “race for the cure” efforts, it is actually far from innocent. It threatens to make people psychologically and socially if not physically dependent from a young age on potentially unsafe, unnecessary, expensive drugs—which have been linked, as per the boxed warning, to thyroid cancer, as well as a whole host of unpleasant physical side-effects and a compromised capacity for pleasure. It also aims to eradicate an entire class of people—whom, I would argue, exist as a valuable and vital part of human bodily diversity. Some of us are fat, for unproblematic reasons, from childhood. And since genetics account for at least 70% of the variance we find in body mass across the human population, this is not surprising. Some people, in other words, are simply prone to fatness. I am one of them.

These issues are made beautifully clear by Virginia Sole-Smith’s New York Times bestselling tour de force, Fat Talk: Parenting in the Age of Diet Culture. I had the pleasure of being in conversation with Virginia last week, and her book demands and rewards close examination from parents and non-parents alike, inasmuch as we all contribute to the culture our children grow up into. Many of us are also re-parenting ourselves around bodies, fatness, food, health, and the many issues of social justice these topics intersect with. So I just wanted to say a few words here about some of this book’s key lessons. (This post is admittedly overdue—I’ve been hard at work finishing up my own book, which I hope you will pre-order.)

Fat Talk’s central, quietly radical, premise is that there’s nothing wrong with fat children, aside from the many ways they’re being bullied, belittled, and stigmatized. The assumption that fat children are inherently unhealthy is simply erroneous: children, like the rest of us, come in a wide variety of shapes and sizes, and this is something to be accepted, indeed celebrated. On the rare occasions when a child’s weight is an issue of concern, it’s part of a broader constellation of symptoms—and, crucially, weight loss and thinness is at least as much of a red flag as weight gain and fatness. Yet our anti-fat biases reliably lead us off-track in this regard: making one family’s daughter Phoebe the target of concern and dietary interventions, when she was perfectly healthy, and simply had a larger-than-average body. But that’s the thing about averages—pace the ultimate originator of the BMI charts, the 19th century astronomer and mathematician Adolphe Quetelet, an average is not any kind of ideal. It is merely descriptive information that says that around half the population will deviate from the average in both directions. And deviation is not deviance. 

Meanwhile, as Sole-Smith recounts, this family’s older daughter Lizzy was losing weight and getting progressively thin. She turned out to be very sick with Type 1 diabetes. But the assumption from many of those around her was that she was healthy and attractive and otherwise praiseworthy for her smaller-than-average body. It was hard for Lizzy herself to avoid the sense that her weight gain was a problem, as her health improved following appropriate treatment for her chronic illness. 

Our culture of pediatric fatphobia isn’t making kids healthier (or thinner, as Sole-Smith observes). It often stems less from true health concerns, and more from a place of body aesthetics and body policing on the part of parents. Kids, meanwhile, tend to see right through this. “Kids know what grown-ups don’t want to admit: that we’re mostly shrinking their bodies to make life easier. To make everyone around them more comfortable. To reassure ourselves that this isn’t our fault. And this leads us to treat kids in all body sizes in ways that can worsen their health,” Sole-Smith argues.

As I’ve written, such pediatric fatphobia can also result in children not being prescribed—or wanting to take—vital medication, such as birth control. In some cases, it even results in potentially life-saving medications being withheld on the grounds that they might lead to weight gain. In the conclusion of his mega-hit self-help book, 12 Rules for Life: An Antidote to Chaos, Jordan B. Peterson writes of his daughter Mikhaila’s diagnosis, at age six, with rheumatoid arthritis. While deeply concerned about his daughter’s illness, Peterson refused to follow her rheumatologist’s advice to give her the corticosteroid prednisone, a first-line treatment for such autoimmune conditions, to fight the inflammation. (He instead pushed for an experimental treatment that no other Canadian child had ever received at the time.) Peterson writes: “Predisone has many side effects, not the least of which is severe facial swelling. It wasn’t clear that this was better than the arthritis, not for a little girl.” Prednisone also leads, notoriously, to weight gain. The subtext of the discussion is that the pain and inflammation Peterson genuinely hated for his daughter was still less bad than the possibility of her, as a girl, having a swollen face—or, one strongly suspects, a fatter body.

This disturbing conclusion to a disturbing book has barely been noticed—so inured are we to the anti-fat biases that affect both fat and thin children, as Sole-Smith persuasively argues. After all, many a thin child will become fat during their lifetime. The message they receive that their body is only acceptable in its current, lean incarnation can lead to a lifetime of body dissatisfaction and, of course, eating problems.

Fat Talk argues that we should be in the business of eating disorder, rather than fatness, prevention. For, unlike fatness, eating disorders are an intrinsic source of suffering, and they can even be deadly in some cases. Eating disorders, along with subclinical forms of disordered eating, are also disturbingly widespread across the globe, according to recent research—defying the stereotype of thin white girls as the only ones regularly suffering from these illnesses. Eating disorders in fact affect every population (though girls and women are, to be sure, disproportionately affected). Moreover, as Sole-Smith notes, so-called atypical anorexia is actually more common than the so-called typical variant. Both types of anorexic patient may suffer from weakness and fatigue, as well as bone, muscle, gastrointestinal, cardiovascular, and blood pressure problems, which can become so severe that the (previously ambulatory) patient cannot walk or stand. The only difference between them is that those with atypical anorexia are not classified as underweight according to the BMI charts. That does not mean they are getting adequate nutrition—again, some people’s bodies hold onto fat determinedly—and, so, larger anorexic patients are often told to keep restricting their food intake and exercising intensely. We have a long way to go in addressing this form of a condition that has among the highest mortality rates of any mental illness.

The cover of Virginia Sole-Smith’s wise, compassionate intervention against fat-kid-phobia

But what about healthy eating? I hear you, and so does Sole-Smith. In a previous phase of life, Sole-Smith was very much a proponent of Ellyn Satter’s well-known “division of responsibility” framework, where parents decide what, where, and when children eat, and children decide how much to eat of those foods on offer. There are nuances here, both ones that feel at least diet culture-adjacent and ones that feel at least potentially resistant. On the one hand, children are to get only a small portion of dessert, served alongside the main meal, to allay its appeal and make it less something “special.” On the other hand, the paradigm also encourages parents to give kids unfettered access to desired foods like ice cream on a regular basis. 

But, as a recent Instagram post by Hayley DeRoche (of “sad beige toys for sad beige children” fame) brilliantly brought out, the motives here are often suspect, even if the advice is partly sound. Give your children regular access to certain foods so they won’t get obsessed with them—or get fat, is the quiet part that nevertheless may echo loudly in a child’s growing awareness of what their parent wants for them. And what they fear for, and about, their growing bodies.

What if we let go of that fear, and accepted that our children’s body types are largely out of our control, and there is nothing wrong with fatness? What if we viewed the family dinner table as at least as much a chance to teach children about body autonomy and self-trust, as ensuring they eat their broccoli? These are some of the questions Sole-Smith compassionately yet trenchantly asks us to wrestle with. As she puts it: “When we try to control both when kids eat and how much they eat, we’re telling our kids to trust us more than they trust their own hunger. When we make dessert conditional—something that must be earned by eating vegetables or through good behavior, something that can and is taken away, often arbitrarily—we give those foods too much power. And when we thread through all this our belief that a thin body is the goal, we reinforce our kids’ fear that their own body, their own hunger, is too much.” Instead, we can and should raise our children to understand that “thin bodies and fat bodies have equal value.” To do this, we have to understand the world anew ourselves—accepting that “humans have always come in a variety of sizes; that body diversity is both beautiful and necessary. You have to believe that being fat isn’t a bad thing. And that means you have to challenge a lot of what you thought you knew about health, beauty, and morality.” And, of course, eating.

Sure, like virtually every parent, I do want my three-year-old daughter to eat a wide range of foods if possible, in the interests of adequate nutrition, as well as pleasure and comfort and community. But, that being said, Sole-Smith’s meticulous research and interviews with pediatric feeding specialists, dieticians, and nutritionists make it clear that by far the most important factor in kids getting adequate nutrition is their getting enough to eat. And this can be compromised not only by food injustice and poverty, but also by parents who are too scared to put safe “beige” foods on the table, and restrict their children’s intake wittingly or unwittingly. If children get enough to eat then, according to experts like Katherine Zavodni, the nutritional piece of the puzzle tends to take care of itself. And the more flexible practice of “responsive feeding” can be particularly beneficial for families with neurodivergent children, as Naureen Hunani has argued. As Sole-Smith explains: “A responsive approach to family meals also means accepting kids for the eaters they are rather than working ceaselessly to mold them into the sophisticated, eclectic, “healthy” eaters we want them to be… Responsive feeding might mean adjusting the meal and snack schedule to accommodate the fact that your preschooler is always hangry at four thirty p.m., even though dinner is served at five p.m. It might mean getting up from the table to add some cheese sticks or strawberries when your child requests them—and thinking of that not as a failure that they aren’t eating what you’ve offered, but instead, as their contribution to the menu.”

For my own part, I’m leaning into the idea that some summer meals of just strawberries and ice cream are not going to hurt anyone. On the contrary, they might involve just the kind of letting go and emphasis on shared food joy that is ultimately deeply healthy and, for many of us, healing.