Monday, December 29, 2008

Joan of Arcadia

We've been enjoying a new TV indulgence at our house, Joan of Arcadia.

This was a TV series that aired on CBS from 2003-2005. It was nominated for an Emmy for Best Dramatic Series and won the Humanitas Prize.

I didn't watch it when it was on originally; I only found it recently, on the SciFi channel. Alas, I find a lot of great series after they are canceled. Joan of Arcadia is one of them. But even though it was canceled after only 2 seasons, it's still worth watching.

It's about a teen-aged girl who suddenly starts getting visited by God. God appears to Joan in various ordinary-people guises and gives her various "homework" assignments, usually something that seems ridiculous or trivial at first, but which often turns out to have major effects on those around her. The storyline follows Joan as she fulfills (or doesn't fulfill) the assignment, and all the "ripples" that come from those assignments. It also follows the various members of her family as they face their own challenges and concerns too.

That 'visited-by-God' premise might be off-putting to some people, but it's really quite a good series. Sassy, moving, thought-provoking, laugh-out-loud funny---it really covers many bases all at once. And it's not saccharin-sweet like so many "religious" shows---it has an edge to it, and it's not afraid to ask hard questions or pose difficult dilemmas.

Now, you don't have to be religious to watch it. Even people who are not religious at all have found it thought-provoking and compelling at times. The writers made a point not to represent any religion specifically, but to explore spirituality in general. They avoided sanctimonious characters and simplistic solutions, and they included characters who struggle with spiritual questions without necessarily finding the answers.

I particularly liked that they included a character who doesn't believe in God/religion but who was portrayed intelligently and with respect for his views, too. He doesn't get converted or "fixed" either; he remains a skeptic, while also trying to respect his wife's changing spiritual beliefs.

I also love how Joan---being a sassy, smart-alecky teenager---gets to say a lot of the things people think about God and faith but don't actually dare to say out loud often. She pulls no punches in criticizing God, complaining and whining and accusing with gusto. She is so bitchy to God, it's really funny...and it's good to hear someone verbalize all the negatives people often think but feel guilty over even thinking. Person of faith or not, if you've ever had doubts about God, you'll probably hear them verbalized here, yet treated with respect. How refreshing.

A Few of My Favorite Things

There are so many other great things about this show, it's hard to know where to start in listing them all. I guess first, you'd have to acknowledge the really talented acting on the show. Amber Tamblyn is so amazing as Joan. She can turn from humor to pathos, insecurity to bitchiness on a dime, and she really carries the show. She is so genuine in the part. You really root for this character, even as she makes mistakes and gets off-track. She may be young, but this girl is a major talent.

Joe Mantegna and Mary Steenburgen are very believable as the parents. They ground the show, acting as sounding boards for the younger characters, yet also portraying depth and realistic complexity as a married couple struggling with their own dilemmas too. So often middle-aged parents are portrayed only minimally on TV; not so here. It's so refreshing to see the storyline focus on all the family, not just the younger segment of it.

Joan's friends are portrayed by some pretty amazing actors too, like Chris Marquette as "Adam" and Becky Wahlstrom as "Grace." Both brought me to tears several times with their performances, yet they both do comedy well too. Even many small recurring roles (like the science teacher, the gym teacher, and Joan's nerdy friends "Friedman" and "Glynis") have memorable acting in them. The talent pool on this show is deep.

I also love the gimmick of God appearing in different guises each time. There's Little Girl God, TV Anchor God, Cute Guy God, Lunch Lady God, Custodian God, Dog Walker God, School Mascot God, Mrs. Landingham God, Goth Kid God, etc. I love that. God even calls Joan on her cell phone at one point, showing up as---who else?---"God" on caller ID.

Another good point is the realistic character development on the show. Joan's family acts like a real family. They argue and complain about each other constantly, yet you also feel like they love each other deeply. They go through some very hard times, but they find a way to keep it together. This is one of the more realistic family relationships I've ever seen portrayed on a traditional TV series. Bravo.

Joan's teenage friends are fun too. The writers overdo the school cliques thing a bit, but it does make for good comedy at times, and it does serve to remind us of our own adolescent "outsider" moments. Joan's "geek" friends are very funny, definitely played for "geek factor" laughs, yet they are also real people. They are in turn awkward, smart, funny, vulnerable, obnoxious, insecure, egotistical, and nerdy....basically just like regular teenagers, but exaggerated a bit for TV purposes.

A Few Nit-Picks

Of course, the series isn't perfect. Despite loving it, even on first viewing I recognized a few clunkers here and there. There are things that are culturally insensitive, awkwardly written, or which seemed out of character.

And the second season, while it had some terrific moments, also had a couple of character missteps that really brought down the believability factor. There was definitely a bit of a second-season slump at points, yet I could see how some of it was because they were setting up conflict and story for the third season. Alas, they never got to do a third season, so we don't know if it would have paid off later on or not. But the second season was certainly a bit uneven in quality.

[I should also add a caution that sometimes the series deals with mature subject matter. At times there is frank talk about drugs, sex, homosexuality, death, and suicide, and there are a few tense scenes with guns and violence. These things may or may not bother you, but I think it's worth mentioning them so you can preview the series first, then decide whether it's appropriate for your particular child or not.]

So I don't want to over-inflate anyone's expectations.....the series had bumps along the way, and a couple of major missteps here and there. It's not perfect. And there may be some parents who feel that some of the subject matter is too mature even for teens.

But on the whole, it is SO head and shoulders above the usual stuff on network TV, it's not even in the same ballpark. At times, it is that good. Really.

Fat-Friendly Too!

One of the things that made points with me early on about Joan of Arcadia is that it was relatively fat-friendly, at least by Hollywood standards. Not every minute of every episode---there were a couple of fat jabs here and there, which were made all the more wince-worthy by the intelligent writing elsewhere---but for the most part, it was much more fat-friendly than most TV shows.

For example, the main characters actually eat on the show, even comfort food for emotional reasons, without it being made into a big neurotic crisis. It's wonderful to see a family actually eat normally on TV without it being a big deal.

Also, the main character, Joan, looks like a normal teen-aged girl. She's not fat by any means, but she's a bit pear-shaped, unlike most TV actresses today. Yet they don't try to hide her shape or tart her up for the sake of ratings, nor do they have her fixate on her body as a focus of her insecurity. They just let her be simple and cute and ordinary, like the girl next door. Refreshing.

One of the best and most noticeable ways in which this series is fat-friendly is the fact that you actually see fat people on the show. Not just as an occasional guest star, but fairly often, especially as the series goes on. Fat actors are seen all the background, as extras with a couple of lines, in small roles, and sometimes even with major lines as God.

It's always been one of my pet peeves that in a country in which so many people are supposedly "overweight" or "obese," you'd never know it by watching television. Fat people are mostly invisible on TV and in the movies, except for an occasional scapegoat for mockery by others or as literary shorthand for "evil" or "stupid/foolish" or "low self-esteem."

But not on Joan of Arcadia. Quite a few times, they had fat actors playing different versions of God (including Lindsay Hollister, the dancing fat lady in Get Smart). Some of the fat God actors were even recurring. And not just fat men, either, who tend to get far more work on TV than fat women.....they actually hired both fat women and fat men multiple times over the course of two seasons.

And the size of these actors usually had nothing to do with the plot line, nor did it get commented on. They were just fat. It was all just a part of achieving a wide variety of ordinary looks for God, from the typical good-looking Hollywood star to folks who looked like your very average-looking neighbor.....and everything in between.

Joan used a wider variety of ages, sizes, ethnicities, and "looks" than just about any show I've seen recently. It was one of my favorite things about the show. The people on it just looked so.....ordinary, so slice-of-life, so like the variety of people you see on the street every day. Sure, I could nit-pick and ask for even more diversity (which would have been even better), but really, it was far ahead of the usual Hollywood game. And I thought it really added to the look and feel of the show.

Truly, Joan of Arcadia is an exceptional show. I could just kill CBS for putting it on Friday nights (which guaranteed low ratings from its targeted audience, young people), and for canceling it after only 2 seasons. What a loss, but I guess that's what you get from Network TV. If only it had been developed through one of the cable channels! I would love to have seen where they would have gone with the show.
Alas, that's something we'll never know now. Still, what we do have is well worth checking out, even in truncated form.

Go Find It!

If you're interested, Joan of Arcadia
is available on now, both Season One and Season Two. Or if you aren't sure about whether you'd like it, you can check and see if your local library has it (or can get it through a lending program).

I got interested in the show this summer when I saw it on the Scifi channel, which unfortunately now seems to have dropped it. So then I checked it out of the public library so I could finish watching the whole thing. Now, because I think it's so good, I'm buying it on DVD.

I'm slowly watching it with my two older children, and we are using it as a springboard for discussion of the deeper issues brought up in the series. However, we also watch it simply because it makes us laugh out loud.....a lot. How often do you find such a combination on TV?

What a great series. Go check it out.

Thursday, December 25, 2008

The 12 Days of Gift Opening

I'm writing simply as a parent today. I want to talk about gift giving.

I want to write about helping our children be more grateful for their gifts, to be more present with each gift as they get it, about spreading out the joy of Christmas over a longer period. I want to talk about our family tradition of the 12 Days of Gift Opening.

What I see is that many kids get an awful lot of "stuff" all at once, under the tree. When I watch these gifts get opened, I notice that while they love the thrill of ripping through the paper and opening a bunch of stuff all at once, they don't always appreciate each present fully when they do this. They go off and play with one or two things intensely and leave a pile of "stuff" under the tree that gets neglected or ignored for some time.

I also noticed that when my eldest kids were very young, they'd want to stop after the first couple of gifts and just play with those gifts; they totally lost interest in opening the rest of their gifts because they had stuff they were already interested in. Little kids live in the moment; it's hard for them to open something really neat and then put it aside so they can open up the rest of the stuff for Grandma and Grandpa's benefit. Yet we routinely make them do just that.

When my big kids were very young, we started the tradition of letting them open ONE gift on Xmas Eve, and the rest on Xmas Day. Oh, this made them SO excited!! They loved it so much. They were almost more excited for the Xmas Eve gift than for the big pile on Xmas Day.

And I noticed that they really engaged so much more deeply with their Xmas Eve gift than with all their Xmas Day gifts. They really played with it, they really spent more time with it, and they really seemed to appreciate it more. Yes, the big Xmas Day present-fest was fun, but they really seemed to be more in the true spirit of Xmas during the Xmas Eve present-opening.

After a few years of making them open all their gifts at once so the Grandparents could see it all, we began to space out the gifts a bit more. We did open quite a few of them on Xmas Day (especially the ones from the Grandparents so they could watch), but we also watched the kids' attention span and called it quits when they were done emotionally. Then we would open one present per child every day after Xmas till all the presents were gone.

And you know what? It was amazing to watch! They loved doing presents that way, because the excitement of Xmas and of present-opening was spread out so much longer. Even if one child ran out of presents sooner than another child, they still got a thrill out of watching the other child finishing up their stash. It emphasized the surprise and the joy of giving and receiving so much more than the actual getting of some particular "thing." It became more about the spirit of Xmas and fun than the spirit of consumerism.

And I just saw them engage in and appreciate their presents more when they were spread out over time. They'd stop everything to really play without whatever the gift was, and there was a lot less whining about "less cool" presents like socks and whatnot. Even if you only got socks that day, someone else had something cool to look at or play with.

It reminded me of "The 12 Days of Xmas" song, and in time, we began deliberately pursuing spacing out presents over several days. Sometimes it was over 12 days, sometimes only over a few days; we don't follow any particular "rules" except going with the flow.

Now, as my older kids have gotten closer to teenage-hood, they'd rather do it all at once instead of spread it out more, but even so, I notice that they still have a better appreciation for their gifts when we talk them into spreading things out longer "for the little ones' sake."

I don't know how long this tradition will last; I only have one really little one left to emphasize "spreading things out for." But I'm hoping to talk my kids into continuing to extend the gift-opening season at least a little bit because it really seems to cut down on the hyper-consumerism of the season, the overemphasis on "stuff, stuff, stuff," and the underemphasis on gratitude for and engagement with what we do have.

Does anyone else do something like this at all?

Sunday, December 21, 2008

Greenish Wrapping Dilemmas

With all the weather going on lately, I stayed home, nice and warm, and worked on my Christmas giftwrapping. And that got me thinking about one of my annual debates, green giftwrapping.

Now, mind you, I'm no purist. I try to be "greenish" about some things, but I'm by no means "perfect" by the green crowd's standards. And that's okay by me; sometimes they get a little too politically correct, impractical, and inflexible for my tastes. Still, I don't like to be wasteful either.

And giftwrapping is nothing if not wasteful. All those trees, cut down, just so we can have 5 minutes of tearing off the paper? All the energy it takes to cut down the trees, transport them, make them into wrap, and then transport it all over the country? And then afterwards, all the paper that goes in the trash instead of into recycling?

But......I have little kids. They love to tear off wrapping paper. It's one of the biggest parts of the joy of opening their gifts. Heck, at certain ages, they like the tearing of the paper better than the gift itself. Then as they age, they love the brightly-colored papers under the tree, the ritual of wrapping and unwrapping, the garish over-the-topness of it all. Take that away from them, and they really miss it....and so do I.

So for a long time, we just went ahead and did wrapping paper. We did what we could to re-use as much as possible year to year, but little kids tearing off wrapping paper means there's not a lot of re-using, and I'm not going to deprive them of that ripping, tearing joy they love so much. As they get older I show them how to slow down and preserve things a bit more, but basically there's a lot of wrapping paper in the recycling bin each year.

We have considered some of the other "green" ideas for wrapping paper. My SIL and BIL are extremely "green" so they have wrapped with comics or newspaper for many years, or have used butcher paper with kid-made paintings and prints on it. My reaction has always been lukewarm to that. I mean, hey it's nice if you want to do that, but it's really not the same at all. It's not very attractive, it's not fun, and it's just a big PC downer, frankly. Doesn't feel like Xmas at all. At least not to us.

We have saved gift bags (the kind you get in Hallmark stores) and we often re-use those for big or awkwardly-shaped presents, but I'm not that fond of these kinds of bags. Too gaudy for me, not always recyclable, too easy for kids to peek in even with a gazillion pieces of tape on them. And just no "fun" factor for the kids.

Last year, I won some cloth gift bags at a birth conference, and I've been liking those. They look prettier than the foofy store paper ones, they use up scraps of fabric, they're really practical, and they hold up really well year to year. I like mine with drawstrings at the top, and I really like the ones with beautiful and/or soft, lovely fabrics. Again, good for big or awkwardly-shaped presents, and good for the adults....but not so good for the littles, who want the actual opening of the gift to be something special too. Opening a drawstring is just not that exciting, you know?

My favorite solution ever, though, is specialized gift boxes. A few years ago Mr. Well-Rounded invested in nesting, folding Xmas gift boxes. At first I thought these were the stupidest things ever, just something to take up my precious little closet space from year to year. But now, I have to admit.....these were a GREAT idea. We have re-used them many times over in the last five years or so. And once they get too tattered to re-use anymore, they can be recycled.

They are printed with terrific, cute patterns so they look festive and nice under the tree, like wrapping paper. You can put bows on them so they look like wrapped packages. And although not quite as fun as ripping open paper-wrapped gifts, even the littles really get a charge out of taking off all the tape and opening the box. Furthermore, if you get the nesting kind, they will fold flat and nest into each other so they don't take up much space during the rest of the year. Very important if you've got limited storage space!

So now what we do is a mix of all of these. Under my tree now I have some presents in re-usable cloth gift bags, I have some in traditional wrapping paper to satisfy that ripping frenzy need in the littles, and I have a lot of them in these re-usable Xmas boxes. That seems to be the compromise that best suits our family-----as green as we can manage without being too dogmatic about it, practical and pretty without being dull and boring.

Do you have any better solutions to the green wrapping dilemma? I'm sure many other parents struggle with this too and would love to have more ideas. What does your family do for wrapping presents for whatever holidays you celebrate?

Monday, December 15, 2008

Pregnancy After Weight Loss Surgery

I had already planned an entry on pregnancy after Weight Loss Surgery (WLS) to address the recent study purporting to show that WLS made pregnancy in fat women safer.

However, Sandy from Junkfood Science beat me to it. And really, there's no need to re-invent the wheel when someone else has already done it far more completely than I'd ever have time for. So if you want to read about the weaknesses of this study and how there really are still significant concerns about pregnancy after WLS, be sure and go read Sandy's entry.

But while Sandy has done the heavy lifting on this one, let me just add some comments.

First of all, let's not vilify people who have had this surgery. I am strongly against WLS but I also understand what drives many people to do it. Several friends of mine have done it, despite my strongly expressed concerns over the potential consequences. I empathize with their reasons, even while I disagree with how they are going about addressing their concerns.....but ultimately it is their body and they have the final say about what they do with it. I just pray now that the nutritional repercussions are not too severe because I truly love my friends and I want the best for them.

To be fair, let's also point out that many women have had seemingly successful pregnancies after WLS. Their babies seem to have been born healthy and fine, with no major obvious issues. For their sake, I am glad their babies seem to be fine, and I genuinely rejoice with them for their new little ones.

I have to be honest, though, and say that I fear what impact this might have on the baby long-term that we are not able to see now. Just because a baby is born with no obvious problems does not mean that it was not affected. The doctors seem far too content to say, 'Look, no obvious birth defects or problems at birth; see, pregnancy after WLS is perfectly safe!!' Actually, we know no such thing.

In fact, one of the important points this review missed was that there is an increased rate of small-for-gestational-age (SGA) and/or IUGR (intra-uterine growth retardation) babies in some of the research. I've seen studies where the abstract proudly announces that outcomes were more "normalized" among the women with WLS, that no bad outcomes resulted from the pregnancies after WLS in the study.

Yet, when you look closer, hidden in the full text is the finding, carefully shrugged off, that there was a higher rate of SGA and/or IUGR babies in the women who'd had WLS before pregnancy. And we know that these babies have higher rates of all kinds of health problems. Yet this issue gets hardly any press.

Another problem is whether or not the outcomes of pregnancies after WLS are being selectively reported. I have heard anecdotal reports of poor outcomes from women who are on WLS support boards, as well as from doulas and midwives who have worked with pregnancies after WLS. While many women have seemingly done well, there are also quite a few miscarriages happening, as well as some babies with birth defects.....yet few if any of these stories are being documented in the research that I've read.

That certainly suggests the possibility that poor outcomes of pregnancies after WLS are being under-reported. What kind of accountability is there for making sure that all outcomes of pregnancy after WLS are being recorded and reported? Is it simply a matter of poor tracking after WLS? Or is that women who have poor outcomes are not reporting them to their WLS surgeons? Or could it be that some WLS surgeons are selectively reporting to feature only the best outcomes?

One of my biggest concerns about this whole issue is that the people who are responsible for doing the research and reporting about it are the ones with the biggest economic interest in it. It's like asking the tobacco industry to be the sole group investigating and reporting on the effects of cigarettes. Or asking the pharmaceutical industry to sponser all the research about a certain drug and report these findings without any oversight or independent investigation to confirm or repudiate their findings.

Research on WLS is mostly done by WLS doctors. On the surface, this is logical, as they are the ones in the trenches every day, seeing patients, and the ones with the data in their files to pull from. But WLS is a profoundly profitable industry these days; greed (and prejudice about "saving" fat people from themselves) makes it easy for data to get distorted or selectively reported.

Frankly, in WLS research, far too much data conveniently gets "lost" to follow-up, and there is little or no accountability from outside, independent agencies. There needs to be far more independent oversight and investigation from people outside both the weight loss and the weight loss surgery industries.

Another thing that really bothers me about WLS (especially Gastric Bypass) is the aggressive marketing of it to childbearing-aged women, as if no fat woman on earth could possibly have a healthy pregnancy or baby without losing weight first. While it's true that there are risks associated with 'obesity' and pregnancy, it's also true that the MAJORITY of fat women have healthy babies just fine, and that prevention of complications in this group does not have to involve weight loss or dietary restriction.

It's not an either/or proposition....but you'd never know that from the marketing on some WLS websites. A lot of fat women are having WLS because they have been convinced that WLS may be their only way to have a pregnancy or a healthy baby, and that's simply not true.

Furthermore, aggressively marketing WLS to childbearing-aged women as the "best" way to ensure a healthy pregnancy and baby while we still know so little about the long-term effects of malabsorptive procedures on the baby seems horribly unethical to me. The long-term nutritional effects of WLS can be so devastating for the mother; how do we really KNOW it's going to affect a baby, both short-term and long-term?

Malabsorptive procedures bypass parts of the digestive system that absorb certain nutrients. At first, the woman's own body reserves are enough to sustain her, and the massive amounts of supplements taken after WLS help make up the difference. For some, that's enough.....but for many it is not. Most women of childbearing age face significant nutrient deficits after several years, once their own reserves are used up and they stop absorbing the supplements as well.

If a woman is not able to absorb enough iron, B12, calcium, vitamin D, folic acid, etc. after WLS to keep up her own levels long-term, how in the world is she going to be able to lay down sufficient quantities of this for a growing, developing baby? What are the possible long-term effects this could have on babies?

I realize that most women who have babies after WLS get pregnant within 1-3 years or so, while they still have some nutritional reserves. And this is probably what has saved the babies of these pregnancies so far....they are able to draw on the mother's nutritional reserves to absorb sufficient stores for their own development....but are they really receiving optimal amounts of these nutrients?

For example, after WLS, many women have so much trouble absorbing enough calcium and vitamin D that osteoporosis and/or rickets is a real risk later on. It takes years for most people to get to this kind of deficit, but it's a process of malabsorption that takes place gradually over time. So even if pregnancy takes place within a couple of years after WLS, are babies in these pregnancies truly absorbing enough during a pregnancy for their bones to be fully mineralized properly? Will they pay a price later on in life? Frankly, I have yet to see anyone properly examine that question in research but it certainly is one of my concerns.

Yes, vitamin supplements help compensate for the gut's decreased ability to absorb these nutrients, but many women become nutritionally compromised, even while taking supplements. If they can't support their own bodies' needs over time, even while on supplements, are they really able to fully support a baby's needs? What kind of long-term effects will there be from compromised access to B12, iron, vitamin D, calcium, vitamin A, etc.? I just don't think we know this yet.....and no one seems to be asking the question at all.

I wonder if what we've got here is akin to babies born during times of famine. Yes, even on a famine diet of significantly reduced calories and nutrients, many babies are born "okay" and seem like they are fine. It's a tribute to the remarkable adaptability of the fetus in utero that babies survive even under the least desirable of conditions, like famine. And yet, research clearly shows that babies born during times of famine are affected by that lack of nutrients; more develop diabetes, hypertension, obesity, and a host of other issues.

Of course, pregnancy after WLS is not exactly the same as pregnancy during a true famine. Women after WLS get more calories and probably more variety of foods than women during a famine. On the other hand, women in famine still have their full digestive and absorption capabilities, so they can at least make better use of the calories and nutrients they are getting. So, obviously, pregnancy during famine and pregnancy after WLS are not exactly the same thing, and it's difficult to draw too many broad conclusions.

Yet it's also clear that pregnancy during famine is not entirely a benign thing, and animal models clearly show that deprivation during pregnancy can have long-term consequences for offspring. Doesn't pregnancy after WLS have the potential for similar consequences? Seems like a logical concern, yet the WLS industry is completely shrugging these potential concerns off.

As far as I know, there are NO long-term studies of the offspring of WLS pregnancies. They can hardly manage to document decent percentages of WLS pregnancies for study as it is now (see Sandy's piece); there doesn't seem to be anything in place for long-term foll0w-up of the children of these WLS pregnancies years later.

So the question remains.....are we creating more long-term problems than we are solving? Will we face an epidemic of other health problems in these children 30, 40, or 50 years down the road? Is ANYONE even trying to investigate this? And who is overseeing the surgeons with their hands in the monetary goody jars?

I have great empathy for people considering WLS. Although I sincerely believe they are making a choice that often worsens health over the long run, I understand some of the reasons why many of them consider it. Although it's a choice I'd never make, it's their body, their choice.

However, I do not believe that a "safer pregnancy" or a "healthier baby" should be one of those reasons. The research on this topic is far too spotty in quality, too subject to selective reporting, too lacking in long-term follow-up, and too prone to bias because it's done by those with a vested economic interest in promoting it.

Friday, December 5, 2008

Finding a Size-Friendly Pediatrician

One topic that keeps getting requested in the comments is parenting as a fat person. That was on my to-do list anyhow, but the requests just moved up some of my plans for what to post and when. Believe me, this stuff is significantly on MY mind too.

I thought I'd start with the importance of finding a size-friendly pediatrician/family doctor.

Once you have that baby, then what? The pressure for limiting weight gain doesn't stop with pregnancy; once the baby is born, many docs measure that baby within an inch of its life and soon start getting concerned if your baby is larger than average or is gaining "too quickly." Soon the lectures and "suggestions" begin.

Obviously, all doctors are not created equal. Some pediatricians are truly wonderful and very supportive, regardless of size. We're not condemning all doctors by any means. But with all the new pressure on doctors about the "childhood obesity epidemic," many doctors are really ramping up the harassment factor if they even think your child might be larger than average.

Oftentimes, it goes back to the old assumption that if you are fat, you obviously overeat and/or eat the "wrong" foods, and therefore no doubt will be teaching that poor lifestyle to your child as well. So there may be extra lectures about "healthy" eating and exercise, extra measuring of the child, and extra monitoring for problems.

Any sign of the child being above the 85th percentile may be seen as having a fat (or an imminently fat) child, with pressure to keep that weight down. Weight loss and "fat camp" suggestions for older kids may even follow from some docs.

But often, the first signs of pressure come early, during breastfeeding.

Overfeeding and Breastfeeding Worries

Sometimes the "weight" pressure starts almost immediately. Doctors may be concerned that a fat parent will "overfeed" the baby, so sometimes there may be pressure not to nurse "too much"---to limit the baby to a certain number of minutes per breast, to space out feedings so as not to feed "too often," and to strictly avoid "comfort nursing" when the baby is upset or just tired.

This concern is a reflection of some doctors' lack of knowledge about breastfeeding. Overfeeding is more of a concern with bottle-feeding; babies do tend to consume more when feeding from bottles and don't self-regulate as well. The mechanism of sucking from a bottle is completely different than that of suckling from the breast; babies can't really control very easily what they get from a bottle, but they can from the breast.

Breastfeeding babies can self-regulate. When they have enough, they'll stop nursing and go to sleep, or they continue to suckle a little but it's non-nutritive suckling. They're not really getting much breastmilk (or calories) at all at that point. But to an outsider who doesn't understand breastfeeding very well (as many pediatricians don't), this may look like "overfeeding," and they may pressure the mother to limit nursing.

To experienced parents, this sounds like nonsense---as it totally does to me now---but I remember worrying about this a little with my first. Newborns just seem to nurse and nurse and nurse without stopping sometimes....I remember feeling a little worred I might overfeed my baby and make her fat. I remember thinking maybe I should nurse a little less often, or to detach her and not let her fall asleep nursing.

Now, understand that I was a new mom, and there was no information about pregnancy and parenting for women of size then. My first pregnancy and birth had been very traumatic, and as a result, I was not at all confident in my parenting at that point. I really began doubting myself and my every decision.

And alas, cultural conditioning kicked in in a major way at that point. All my long involvement in fat acceptance organizations seemed to have been for naught, and most of my fat acceptance went out the window. I was consumed by fear that I might make my child fat. I knew she had the genetics for it and there was nothing I could do about that, but I was truly scared that I might somehow make it worse. So I began obsessing a bit about how much, how often, etc. I "should" nurse.

A combination of a very interventive birth, delayed/infrequent nursing at first, plus lots of bottles from the hospital led to breastfeeding problems. It took several months, but in the end, we were lucky.... breastfeeding worked out fine. And once she was finally nursing well, I was loathe to stop her. And I knew frequent nursing was important for building up my supply. So I started ignoring those cautions not to nurse "too long" or "too frequently." Once I did that, breastfeeding went much easier, her growth was fine, and I relaxed a little bit more about how often/how long/how much.

But in the beginning, the stuff I was reading made me worry about whether her long nursings were "overfeeding" her. So there were some times when I would stop nursing before she really wanted to stop, or make her wait just a little longer between feedings...simply because I was afraid of overfeeding her.

I wonder how many other fat mothers have done the same.

What Does a Good Pediatrician Look Like?

I was fortunate....I lucked into a great pediatrician. I was impressed by her calmness, her rational approach to things, her respectful approach in talking to me, and her willingness to take into account my own views and concerns. And so far, she has not pressured me about my children's weight at all.

My first child was a butterball in her first year. Cheeks from here to forever, lots of cute dimply folds, definitely not a tiny delicate child by any means. Yet the doctor never expressed any concerns. She could see that the baby was developing and moving well, walking at 9 obviously butterball status was not keeping her from being active. She was extremely supportive of breastfeeding, didn't want me to rush solids, and never lectured me about food.
She did measure my kids and chart their growth carefully, but she never mentioned trying to get them down further on the growth charts. She was mostly looking at the overall trend of their growth curve, tracking it to see that it remained relatively steady.

Over the years she has been supportive of all of my kids, whatever their size and shape. She knows that kids go through some bulking up just before they do a growth spurt; she never said a word as my two elder kids went up a little on the growth charts just before they hit puberty. My third child is hitting the pre-puberty butterball stage now, so we'll see how supportive she stays at his next appointment....but so far she has always been supportive and positive.

She does ask questions about an active lifestyle (which I'm fine with, because I understand the importance of exercise, whatever your size) but she doesn't harp on it a lot...because she knows my kids get plenty of activity through soccer, swimming, yoga, etc. She knows we limit TV and computer time reasonably and that we make sure the kids get outdoor time.

So far, she's been a truly awesome pediatrician because she seems to get that kids come in all sizes and shapes and it's their habits that matter more than their percentile on a chart. She asks questions and offers opinions but gets that the parent makes the ultimate decisions about the child's care, and that includes the child's feeding and activities, etc.

We'll see how she is as my kids get older, and we'll see if she remains supportive if any of them develop into significantly large kids instead of borderline kids....but so far, I have to say I've been as lucky as can be.

Finding a Size-Friendly Pediatrician

But I hear stories online, and not all of them are so supportive. Some of them are downright scary. And so much begins with the kind of feedback the parent of size gets from the pediatrician or family doctor.

That's why it's so important to find a pediatrician that is truly size-friendly. You can start by asking open-ended questions about their philosophies. Don't ask them leading questions; ask open-ended questions and then let them talk. You'll get a better sense of their views and protocols if they don't know what answer you are looking for.

For example, you might point out to them that obviously they are dealing with a parent who is larger than average. Ask them what their concerns are about that for the child and how that might influence their care of your child. Then let them talk and see what they say. A pediatrician who seems worried or obsessed about weight size will betray that; one who is accepting and calm will get that across too.

If you feel you need to, follow up with specific what-ifs....what if my child measures above the 85th percentile in their grade school years? What if they measure above the 95th percentile? What are their recommendations for frequency of nursing, for starting solids, for juice and milk intake etc. if the child is larger than average? Do they ever recommend dieting? These are the sorts of questions that will help you discern their underlying attitudes about weight and size.


I think most doctors that work with young children have developed a modicum of sensitivity about weight issues. Most won't harass or harangue the child or parent who is larger than average. There may be some hints here and there, but most aren't over-the-top about their concerns and show some sensitivity in how they approach things. There are even some who are truly "on board" with HAES as a philsophy and support it enthusiastically in their practice.

On the other hand, there certainly are horror stories out there about pediatricians and family doctors, and you simply can't assume respectful treatment anymore. With the obesity hysteridemic (and its particular focus on children), more and more pressure will be placed on these doctors to weigh, measure, "educate," and admonish.

So ask questions, write letters, interview potential doctors.....and never EVER settle for less than fantastic, size-friendly care......for either yourself or your children.

What have YOUR experiences been with pediatricians? Have they been mostly positive or negative or a little of both? What hints do you have for other parents-to-be in dealing with this issue?