The weight of it: a pediatrician’s thoughts on how words last a lifetime

Start at the origin. Over two, up four. Down three, right six. Left five, up one. Keep connecting the dots. Everything will take shape.

I liked graphs. Plotting coordinates — whether it be for a parabola or ellipse — was always calming for me: numbers told you exactly where you needed to be.

But my numbers scared me. My 8-year-old feet would hesitantly step on the scale at the doctor’s office. I held my breath as I watched the nurse find the balance, always higher than the last visit. I was growing, sure, but the numbers just seemed so big. My stomach churned while I waited for my pediatrician to examine me. I was there for a cough, but yet I prayed they would ignore my weight, let me slide.

Throughout childhood, I was never clinically obese. Instead, I was just one of those kids that “had a little extra meat on them.” I was “solid” and would “fare fine if I missed a meal.” Falling in this ambiguous category for most of my young life is where I first developed an unhealthy relationship with my body, food, and exercise. By my own assessment, I was perpetually just a few pounds away from getting the “you need to lose weight” talk from my pediatrician, a conversation that fearfully enveloped every ounce of me.

I quickly got into the habit of fasting before doctor’s appointments, even when they were in the afternoon. In anticipation of the talk, I would sit in the waiting room, preparing possible responses about how I could exercise more and eat healthier. Maybe this time, I would promise to skip the cheesy garlic bread on meatball night from now on, even though it was my favorite. The doctor’s office started to feel like school — a place where I was being graded.

When I became a teenager, my size categorically remained the same. I encountered more doctors, new ones, and for the first time, I got the talk. They were quick to assume things about me. They postulated that I was sedentary and drinking a lot of soda, when in reality, neither were true. They approached my body with accusations instead of compassionate curiosity. It hurt. It still does.

While I had exhibited disordered eating behaviors nearly all of my life, I was not diagnosed with an eating disorder until medical school. After a period of extensive restricting and over-exercising that upended my life and culminated in a diagnosis of atypical anorexia, I found my way to eating disorder treatment.

Today, I am a pediatrician fiercely working toward eating disorder recovery.

While I have immensely benefitted from cognitive behavioral therapy, pharmacological intervention, and nutritional guidance, the thing that has helped me heal the most is something my favorite pediatrician said to me when I was ten years old.

I sat down in his office with my mom after my first double-digit age well-child check. Per routine, I watched him pull out the paper growth curve from my chart. I beat him to the punch, “Dr. Peterson, I know the graph will say I am overweight.” I stared down at my sneakers.

He kindly replied, “Valentine, you are a healthy and happy kid. It doesn’t matter where your point is on this piece of paper.”

And, of course, he knew my weight did matter, in the same way I know it does now. Yes, obesity is correlated with a variety of comorbidities, which is why we work with our patients to develop healthy lifestyles. But just like any other vital sign or diagnostic lab, weight and BMI mean nothing without context, without knowledge of the person behind that data point. My doctor knew my weight was “on the higher side,” but he also knew 10-year-old Valentine, who loved to help her mom chop vegetables for taco night and ride her purple bicycle. He knew that, more than anything, I needed a doctor to reinforce that my body was healthy as it was.

This cornerstone well-child check reminds me of how influential physicians can be in shaping healthy body image for their patients at any age. With this influence in mind, as a profession, we must be relentlessly intentional with our work every day. We must choose our words and questions with thoughtfulness, empathy, and humility. We must find a way to help our patients feel healthy, in all its unique forms. We must look beyond the numbers.

I was immeasurably lucky to have a doctor that saw my health as more than just my size and a series of measurements. I was, and am, more than a plotted point on a growth curve, more than a percentile. I was, and am, healthy at my size.

Valentine Esposito is a pediatric resident.

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