I don’t have any particular finesse in talking to children. I tend to speak to Bea and David like they’re adults, and while I try to be loving and compassionate, my default tone is matter-of-fact and direct. Another parent might have given more thought and preparation to debuting this sensitive topic. I decided to just wing it.
It was about nine o’clock at night. The kids and I were cuddling in my bed. I went for it.
“Oh, guess what?” I said lightly. “We’re going to go see someone who is going to help us eat more healthfully.”
I didn’t say “doctor.” I didn’t even say “nutritionist.” But you would have thought I just announced that they both had to get kidney transplants.
“What?” Bea cried as tears sprang to her eyes. “I don’t want to.”
“Me neither,” David chimed in, in a rare moment of agreement with his sister.
“What’s the big deal?” I asked.
“We’re just going because I’m fat,” Bea answered.
Wow, already this was going phenomenally poorly. Should I be frank, or should I protect her feelings and maintain my flimsy ruse? What was the right thing to do? What would a good parent do?
“No, that’s not it!” I insisted. “We are all going, because we all need help. Daddy eats too much at night, I want to stop drinking those stupid juices, Dave has to eat stuff other than pasta. This lady is going to teach us all how to be healthier. She’s like a nutritionist.”
David was bereft. “Two kids in my class went to nutritionists, and they hated it!” he complained. “They said it was like the most boring thing!” To David, something being “boring” is only slightly more acceptable than it being “extremely painful” or “potentially fatal.”
“See?” I said, directing my attention to Bea and stubbornly latching on to only half of David’s comment. “Lots of kids go to nutritionists! Two kids in Dave’s class have gone. Daddy and I went to one once before you were even born.” And, just to bolster the argument, I added: “Maddie went to one.” Maddie was a skinny girl in our neighborhood whose mom had sent her to a nutritionist when she was in preschool because she only ate cheese sticks. My hope was that the more skinny kids I could come up with who went to nutritionists, the less likely it was that Bea would feel this was some sort of sentence for her being overweight.
By now they were both crying, and I felt like I had lost control of the conversation. “Guys!” I said. “It’s going to be fine! We’re all going to go together. It’s like a New Year’s resolution.”
My central concern was for Bea’s feelings. Until we reached the safety of the doctor’s office, it was up to me to approach this topic in a positive way. Already, the kids were acting like going to this appointment was a punishment.
“Why are you crying, sweetie?” I asked Bea, caressing her cheek, ignoring David’s flopping around the bed in frustration.
“I want to be able to do it myself,” she whimpered.
“Do what yourself?”
“I know I need to lose weight, but I wish I could just do it myself,” she said.
“I know,” I said softly. “It’s not your fault.”
In that moment, I made the decision that I wasn’t going to withhold words such as overweight from our discussion. I knew that word could upset her or embarrass her. But the fact that she was overweight wasn’t news to her. I wanted to make sure she could see I was comfortable taking on the topic; euphemistic nomenclature smacked of unease.
I continued. “You have a health problem. You’re overweight. I wish we could fix it on our own, too, but we’ve tried, and it didn’t work. I don’t know how to do it. So we’re going to get someone to help us. And it’s not just for you. It’s for Daddy and David and me, too.”
“I know it’s just for me,” she said.
“It’s not,” I insisted.
“I’m embarrassed,” she whimpered.
“Look, the only reason anyone should feel embarrassed when they have an issue like this is if they don’t acknowledge it,” I replied. “It’s brave to admit you have a problem, and smart to realize that you need someone else’s help.”
Silence.
“Bea, this is a problem we can fix,” I told her firmly. “Lots of kids have much worse problems—diabetes or depression or cancer. Everyone has something they have to deal with, whether you realize it or not. This is your thing, and so we’re going to deal with it together.”
“I still don’t want to go,” Bea said sadly.
“Me neither!” David complained.
“Whatever, guys,” I said, drained, pulling them close to me. “It’s not a choice. We’re going.”
CHAPTER 5
I have to say that for a good minute there during the kids’ outburst in response to the idea of a family nutrition reboot, I almost gave up. I thought I would just tell Jeff we needed to figure out another approach. The kids are miserable, I’d say. Bea already feels singled out. This is bringing negative attention to the problem. It’s becoming too big a deal. Maybe, I thought, we should just go see the nutrition doctor in secret, and run the program on Bea surreptitiously. Maybe Jeff and I should just do the research and work we should have been doing all along about what she should eat and how much, and try feeding her that way before making a whole big dramatic issue out of it.
But I knew we had already tried our best on our own and had failed fairly spectacularly. I knew that in order to fight this disease, we needed the structure and expertise of an authority leading the way. It was the same reason I’d been successful at losing weight only when I did Weight Watchers—having guidelines to follow, going to the meetings, knowing someone else was going to be putting me on a scale and recording my weight, listening to a lecture, paying that weekly fee—those factors made all the difference for me. Even if Bea didn’t need that kind of supervision, I did. And I wanted Bea to have an active role in her own treatment.
The kids’ spirits lifted somewhat when they learned that for the first two appointments they’d get to leave school early. When the first meeting finally rolled around, I picked them up from school around lunchtime, and we met Jeff at the nutrition doctor’s office.
The mood was grim as we sat in the waiting room. Early dismissal notwithstanding, neither Bea nor David was happy to be there. I couldn’t wait for them to meet the nutrition doctor, so they could see she was cool.
She came out and greeted us, and I waited for the kids to be into her, but they were about as excited to see her as they were any other doctor, which is to say not at all. The first thing she did was weigh each of us. After I peeled off Bea’s jacket and sweater, she stepped on a digital scale. I pretended to be looking at something else so as to appear nonchalant about the number, but furtively caught sight of the display, which read 93. David was under 50, and it says much about my relative concern for his weight that I can’t remember the exact number, if I even bothered to look. I didn’t pay any attention to what Jeff’s weight was, consumed as I was with attending to the kids.
Next came the measurement of our height. Again trying to avoid the appearance of being obsessed with Bea’s stats, I stole a fleeting glance at the chart, and saw the doctor write a 6 as the last number for her height. Okay, so she’s ninety-three pounds and four foot six. I didn’t remember the exact numbers from her recent pediatrician appointment, but that seemed right.
We all sat down in the consultation room. David twirled around in a leather club chair until his head was pointing downward and his feet were in the air as we answered some basic questions about what we ate and how active we were. Then it was time to see whether any of us had a metabolism issue. This part was sort of interesting to me. Bea’s pediatrician had ruled out that explanation for her weight gain much earlier, but I’d always wondered whether I had a slow metabolism or a normal one, and exactly how many calories I burned in a day. A machine that resembled a laser printer with a plastic tube sticking out of it was going to tell me.
Each of us breathed into that t
ube for an interminable-seeming twenty minutes, then awaited the machine’s output.
To the extent that we may have been hoping for a medical explanation for our family’s weight struggles, we were disappointed. None of us had a metabolism problem. David’s resting metabolic rate was a little faster than average. The rest of us were just normal. Later, Jeff touchingly confessed to me that he felt let down by the experiment. He’d hoped that the machine would diagnose him as having a sluggish metabolism, which would explain why he had so much trouble managing his weight.
At that point, the doctor asked Bea and David, who was by now engrossed in a game on my phone, to go into the waiting room so she could talk to Jeff and me alone.
With the kids safely out of earshot, she opened Bea’s chart. “In case you were wondering,” she reassured us, “you’re doing the right thing by bringing her here.” She divulged that Bea’s BMI for age, or her body mass index plotted against that of other seven-year-olds, was in the 98th percentile. Children with a BMI for age in the 95th percentile or above are considered obese.
Obese. I found the label shocking. I almost couldn’t accept it. Overweight, I could see. I was prepared for that. But this word put our family in a whole different, more alarming category. To me, obesity conjured images of 200-pound kids, limping from orthopedic complications. Was that how the medical community saw Bea?
Bea’s percentile ranking was formidable, but she could hardly be considered an outlier. The statistics quantifying the extent of the childhood obesity epidemic are parroted constantly but merit repeating: at the time of this writing, one in three American children is overweight or obese. When I was a kid, 4 percent of kids ages six to eleven were obese. In 2008, 20 percent were. Chances are some of the kids you know—maybe even your own—fall into that category, whether you realize it or not.
It’s easy to look at chubby kids and assume they’ll grow out of their heaviness or that their size is merely an aesthetic disadvantage instead of a medical one. It feels hysterical to diagnose a child whose age is still in the single digits with a disease as dire as obesity. That may be part of why a solution to the problem is eluding us. We’re unwilling to accept the severity and permanence of the disease in children so young. Especially when it falls to us to help them.
I had not previously considered the possibility that Bea was in the obese category. But in a weird way, I was strengthened by the label. It gave me a diagnosis to cling to, to excuse the inevitable deprivation that was to come. No one looks askance at the parent of a diabetic kid when she steers her child away from sugar. It can be embarrassing to see a mother grab an Almond Joy out of her kid’s hand, but you can sympathize with her if you know that her son has a nut allergy. Knowing that Bea was obese officially gave her a disease that it was my responsibility to treat. What might have been construed as overzealous micromanagement could now be chalked up to good parenting. Or so I hoped and rationalized.
As we wrapped up the appointment, I purchased a copy of the doctor’s book. It had a recipe for brownies, which was one of the few desserts that had ever attracted David’s interest.
“Check it out, Dave, we can make these,” I said. There were also recipes for chicken Parmesan, chocolate chip cookies, and breakfast burritos. My not-so-subtle message: This is going to be fun, kids!
I flipped to the index of green-light values in the back of the book. The first thing I looked for was pizza. The kids regularly ate their school’s pizza lunch every Friday (while I enjoyed a day off from preparing lunch), and I wanted to see how much it was going to cost them. A yellow light and a green light, apparently—whatever that meant. We had to wait until the following week to find out how many “green lights” (two of which were exchangeable for a yellow light, four of which were exchangeable for a red light) we were allotted for each meal.
But I was excited to get started with a real plan for Bea and to get my own weight back down to the level I’d grown accustomed to. I felt a kind of adrenaline-fueled exhilaration. This was familiar territory for me: the first few days of a new diet, full of hope and anticipation, where the food shopping felt fun, and even words such as tablespoon in the recipes for the new diet foods sounded tasty. Best of all, I wasn’t doing it on my own—I had teammates!
We walked out of the office into the midday sunshine.
“Should we get lunch?” Jeff asked. The question chilled me. Well, yes, of course we should get lunch. But what would be an appropriate lunch for our situation? What was “lunch” going to mean from now on? We were about to spend a week in this weird limbo, knowing we were eating too much and not yet knowing how much less we should eat.
As we always do when we want to eat light, we decided to get Japanese food. We found ourselves at a table at a busy, dark, ramen restaurant. As Jeff and the kids looked at their menus, I paged through the food index of the book I’d just purchased, to look up the traffic-light values of various Japanese dishes.
“Edamame is free!” I exclaimed. “We can have as much of it as we want.”
“Cool!” Jeff chimed in, while the kids ignored us.
We ordered edamame. And soup, and shrimp tempura, and sushi, and chicken teriyaki. I added up the green lights, not knowing what the target was, but knowing we were undoubtedly exceeding it. But I was unprepared to justify a change in our usual ordering habits just yet.
It was strange that first week, holding the keys to the program in our hands but not actually knowing how much we were allowed to eat. It was like having a vial of pills for our disease but not knowing the dosage. Bea wouldn’t talk much about it, but David was oddly into it. One day at home, he spent half an hour making a pen-and-ink drawing of the cover of our new nutrition bible, inscribing it with the motivational phrase “Let’s eat healthy!”
At some point David and Bea asked me what their BMIs were, and together we located them on a chart in the book. Days later, upon opening the book to find a recipe, I noticed two slivers of yellow Post-it notes that David had carefully attached to the relevant pages. Dave is healthy weight, the first one read, written in David’s small, tidy handwriting and affixed to the boys’ BMI chart. The other, pasted alongside the girls’ chart in the same handwriting, read simply, “Bea is obese.”
So Bea knew she was not just overweight but obese. She also knew that this “nutritional regimen” she was on is what grown-ups commonly called a “diet.” I had the same attitude toward these words as I did toward telling Bea she was, indeed, “overweight.” Once it became clear that Bea’s problem wasn’t going to be addressed by changes barely discernible to her, such as extra activity and more fruits and vegetables, it didn’t make sense to shy away from frank terminology in discussing the issue.
This fear of calling a spade a spade reminded me of when Bea and David were in preschool and had to take a couple of standardized tests that are required of children in New York City seeking admission to selective public schools. The conventional wisdom was, For God’s sake, don’t let your child know he’s taking a test! Tell him he’s going to do “special work with a teacher,” or meeting with “a lady who is interested in finding out what four-year-olds know.” But not a test!
That’s what I don’t get. Since when is my four-year-old aware of what “test” means? And to the extent that he is, is the association necessarily negative? What “tests” has he really been exposed to at this point? A hearing test? A test of his reflexes? I hardly think the word is conjuring an image of sitting in a lecture hall with a blue test booklet in front of him, sweating over organic chemistry problems. So why can’t we just call it a test and present the word as a neutral thing—maybe even a good thing?
When my kids found out in kindergarten that they were getting “homework,” they were elated! Couldn’t wait. It was something big kids got to do. It was cool to them. Words that have negative connotations to us do not necessarily have those same associations for our children. I really didn’t understand why people seemed to think their kids were going to freak out
and blow their kindergarten assessments if they thought of it as a “test.”
Growing up, I remember being annoyed at the value judgment inherent in descriptive terms about someone’s physique. Why aren’t “fat” and “thin” as neutrally applied as “tall” and “short”? Why is what is socially considered to be “normal” such a narrow sliver of what is medically accepted to be normal? I should be able to describe people as “fat” if they are, indeed, fat, without that being considered an insult. Similarly, if I call people “thin,” they should be assumed to be as deviant from the norm as the people I just called “fat.” And individuals who are “normal”—which is a wider swath of people than most of society will acknowledge—are neither thin nor fat.
Meanwhile, shouldn’t “diet” connote what it literally means: the kind of food that a person normally eats every day? Like a vegetarian diet or a gluten-free diet. Why is it automatically assumed to refer to a weight-loss effort? I wanted to take the charge out of these words so that they weren’t so painful to hear.
Another example of how I felt our culture has fallen off the rails a bit with regard to these issues: I can’t even begin to zip up my mother’s size-8 dresses from the 1960s, but now if I go to the Gap, I’m sometimes a size small. If I’m a small, what are the loads of women who are way, way thinner than I am wearing? (The answer, apparently, can be found in the existence of inane new sizes including XXS and 00.) I assume that size numbering has evolved to protect women’s egos as we’ve gotten heavier as a population, but is that a good thing? We’re also served larger sodas and bigger portions of food than we used to be, because we like to eat more. Whole industries have changed to accommodate our new level of unhealthiness, instead of pushing to alleviate it.
The Heavy Page 5