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The Conversation You Need To Have With the Pediatrician

By Oona Hanson

I wish you didn’t have to have this conversation. I wish you could count on the doctor’s office to be a safe place for your child who has already been through so much. I wish all pediatricians had a better understanding of eating disorders, weight stigma, and medicine’s role in perpetuating food fears and anti-fat bias. I hope we’ll get there someday.

Until that day comes, however, it’s important to be prepared to speak up for your child. You’ve already done so much to support their healing. Now you can strengthen their recovery by advocating for appropriate care from their physician.

As you already know, eating disorders are incredibly sneaky and clever. They will seize upon a comment to justify harmful thoughts and behaviors. And if that comment comes from a medical professional, there is a heightened risk of fueling a set-back or even a relapse.

Because most pediatricians don’t receive sufficient training in eating disorders, they may not understand that weight does not indicate someone’s level of illness or where they are in recovery. So they may assume your child “looks healthy” and falsely believe all prior weight or eating concerns are in the past.

With relentless pressure on doctors to fight the so-called “childhood ob*sity epidemic,” they are often critical and fearful of higher weights, even when that weight is essential for recovery from a life-threatening illness. Weight stigma is harmful to all children, and for those with an eating disorder, it poses serious health risks.

So as your child recovers–especially if they were already in a larger body or have recovered into one–you’ll need to communicate with the doctor before your child’s next check-up. This communication might come in the form of an email or a message through an office portal. Even if you get confirmation of receipt, it’s a good idea to bring a hard copy of your request to the appointment.

So what do you actually write in such a letter? A lot depends on the context, including your relationship with the physician and your family’s needs. Having a template to work from can be incredibly helpful. In most cases, the simpler, the better. You might write something like this:

“Dear Dr. X. Please do not discuss weight, BMI, growth chart percentiles, nutrition, or exercise with my child. Speak to me privately if you have concerns.”

And if your child’s stage of treatment requires they not know their weight, you can add: “Until further notice, please do not allow my child to see or hear today’s weight.”

If you’d like to consider other approaches, there are other sample scripts available. Here are four:

“Dear Healthcare Provider” letter by Katja Rowell, MD and Anna M. Lutz, MPH, RD, CEDRD-S

“Don’t Talk About My Child’s Weight” cards from More-Love

“Do No Harm” from More-Love

“Dear Doctor” letter by a parent with an eating disorder history

Ideally, any such request would be added to your child’s chart, but it’s a good idea to be prepared to remind the doctor at each visit. And because healthcare professionals are people, too, they might forget. If anyone in the office starts to talk to your child about any off-limit subjects, it’s okay to speak up. You might say, “Excuse me. I’m going to have to stop you right there, as that topic can be harmful to my child’s health.” 

You may be thinking about the future, when your child won’t have you by their side at every doctor’s visit. You can help a young adult draft their own letter to use at medical appointments. Disclosing an eating disorder history and setting boundaries around potentially triggering topics are essential for taking care of their health.

Most adults can decline stepping on the scale altogether, unless truly medically necessary. But someone in recovery from an eating disorder may need to be weighed so the physician can monitor for potential weight loss; your adult child can request they not be told or shown the number. Working with a treatment provider on relapse prevention strategies will help your loved one develop the approach that is right for them.

As much as we might like to, we can’t bubble-wrap our kids and protect them from every potentially triggering comment or experience. But we can do our best to make their healthcare safe. Remember, the Hippocratic Oath begins, “First, do no harm.” Sometimes doctors just need help recognizing that their (well-intended) words can be harmful.

Perhaps most important, when we advocate for our kids, we’re modeling how to set boundaries, prioritize self-care, and ask for what you need even when it’s uncomfortable–all essential skills for supporting lasting recovery.

 

 

 

 

 

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3 Comments

  1. Susan Wheeler

    GREAT AND MUCH NEEDED way for parents to approach pedi’s..
    This should be mandatory reading for every pedi MD!
    Again, thank you, I am sending this along to many folks.
    Susan

  2. Sarah

    Very important and helpful, thank you. Yes absolutely pediatricians need (at the very least basic) training in eating disorders. We have had some extremely harmful comments made to my daughter, especially around how “healthy” exercise is, while she was very underweight and in the grip of exercise compulsions 🙁

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