By the time they enter kindergarten, most American children believe that being "thin" makes them more valuable to society, writes journalist Virginia Sole-Smith. By middle school, Sole-Smith says, more than a quarter of kids in the U.S. will have been put on a diet.

Sole-Smith produces the newsletter and podcast Burnt Toast, where she explores fatphobia, diet culture, parenting and health. In her new book, Fat Talk: Parenting in the Age of Diet Culture, she argues that efforts to fight childhood obesity have caused kids to absorb an onslaught of body-shaming messages.

"The chronic experience of weight stigma ... is similar to the research we see on chronic experiences of racism or other forms of bias," Sole-Smith says. "This raises your stress level. This has you in a constant state of fight-or-flight, and stress hormones are elevated. That takes a toll on our bodies for sure."

Sole-Smith says parents can combat American diet culture by reclaiming — and normalizing — the word "fat." Instead of shushing a child in the grocery store who asks why a stranger is so fat, she advises parents to explain that bodies come in lots of shapes and sizes, some fat, some thin.

Sole-Smith, who herself identifies as "small fat," suggests using the word "fat" as a neutral descriptor, saying it helps "take all the power out of the word. We make it something that can't be weaponized against us, and that really is the first step towards starting to dismantle anti-fat bias."

Sole-Smith argues the issue of childhood obesity has become a "proxy," which obscures larger, systemic problems, including childhood hunger and poverty.

"We as a culture have really zeroed in on weight, because we think that's the piece that we should be able to control. But not only do we not have very much control over weight, it also won't fix anything else," she says. "All it really ends up doing is pathologizing kids' bodies and giving parents extra pressure and extra guilt and these sort of unrealistic standards we can't get to."

Interview highlights

On the harm of anti-fat bias

It becomes a really concrete barrier between fat people — fat kids and fat adults — and access to health care. ... So the fact that the first thing we're all asked to do at a doctor's office is to get on a scale, right there, you've immediately given the doctor this number to focus in on that doesn't tell your full story about your health, but that narrows the focus of the conversation down to weight. And if you're fat, that means that that's really all the doctor is going to focus on is weight loss, weight management. What are we doing to get your weight down?

What this does is it means that fat folks often receive subpar health care compared to thin people with the same conditions. They may be delayed on getting actual treatment because they're told they have to pursue weight loss before they're a candidate for medication or surgery or whatever would be the recommended course of action for a thin person.

It also means that folks then understandably delay going to the doctor. They're more likely to doctor shop. So that impacts your health, because you're not getting your regular preventative care appointments. You don't have doctors you have strong relationships with. By the time you finally do show up, you're probably less healthy because you haven't benefited from that preventive care. But this isn't a failing of fat people — this is a failing of the system.

On thin privilege

Thin privilege is a concept that is tricky to get our heads around, because if you have it, you don't really see how much you have it. I mean, it's a lot like white privilege in that way because you don't see how much it's benefiting you. But what we're talking about with thin privilege is the fact that if you are someone who can wear "straight" sizes [0 to 14], you can walk into The Gap or Target or whatever and find your size easily on the rack. ...

It means when you go to the doctor, your weight is not the first and often only thing that's talked about. It means you can sit on an airplane and not worry about buckling the seatbelt. You can go to a restaurant without worrying, Will they have booths that are too tight for you to get into while the chairs have arms that are too tight? Physical spaces are built for your body. And whatever your own personal struggles might be ... your body is not a target for the world in the way that someone in a bigger body is.

What's also sort of nuanced and tricky about thin privilege is the fact that you can be fat and still be benefiting from thin privilege relative to someone fatter than you. ... I identify as "small fat." I wear like a 16, 18, 20, and so I can order clothes — mostly only online, not so much in-person stores — but I can get clothes that fit my body pretty easily. I can take weight out of the conversation with a health care provider. I have certainly experienced medical weight stigma, but if I say "I don't want to get on the scale," they respect that decision. That's not available to someone who's in a bigger body than me.

So that's where it's sort of helpful to think about how am I able to move through the world in this body in a way that someone else isn't? And why are we OK with the fact that the world is not built to include all bodies?

On how thinness upholds white supremacy

The thin ideal is definitely a white ideal. When we trace the history of modern diet culture, we really trace it back in the United States to the end of slavery. And Sabrina Strings' book Fearing the Black Body is the iconic work on this that I would refer people to. But her research talks about how, as slavery ended, Black people gained rights, obviously, white supremacy is trying to maintain the power structure. So celebrating a thin white body as the ideal body is a way to "other" and demonize Black and brown bodies, bigger bodies, anyone who doesn't fit into that norm. So this is really about maintaining systems of white supremacy and patriarchy ... I think a lot of us are really working to divest from those ideas, but we haven't given ourselves permission to stop dieting or to accept our weight wherever it might fall.

On the widespread popularity of Ozempic as a weight-loss drug, and the message it sends

Ozempic as a diabetes medication, great, I want people to have access to the medication they need to treat their health conditions. And that's what I'm really arguing for in general here, is: Let's focus on the health conditions. Let's manage people's health and take weight out of the equation. And instead, Ozempic is a perfect example of how anti-fat bias drives us in the opposite direction. Because when they realized that weight loss was a side effect of this drug for some folks and that they could deliver what looked like really dramatic weight loss with minimal side effects, they immediately started marketing in that direction very aggressively.

[Ozempic] is not the only weight loss drug being marketed that way. There's also Wegovy, which the FDA just approved for use in ages 12 and up. ... And so what we're doing, again, is saying, "We're acknowledging the anti-fat bias is a problem. We're acknowledging that it's terrible to treat people in big bodies badly. But if we can just make everyone thin, that goes away." And again, the solution to racism is not to make everyone white. The solution to homophobia is not to make everyone straight. This is not how we as a culture want to be proceeding on this issue.

But there is so much money at stake here. These drugs are worth millions and millions of dollars. And the industry has lobbied hard over the years to create this market. A lot of the data we were talking about in terms of the rising rates of obesity, a lot of that has to do with how they've changed the measurements of BMI over the years to put more people into the overweight and obese groups to create larger markets for these drugs.

On why the BMI is a very flawed way to measure health

The BMI, the body mass index, was developed in the 19th century by a Belgian astronomer and statistician. It was never intended to be a measure of health. He developed this formula to measure what he called the average man, by which he meant Belgian white men in the 19th century. Which is not any of us today. ... It's not a relevant body measurement anymore. And the formula has changed very little since then.

It is still primarily a tool that's used for measuring population growth. It's useful to epidemiologists who are tracking population size across the country on a global level. But it does not tell us anything about anyone's individual health. It's only because the life insurance industry adopted it in the 1920s as a way of deciding how to price out insurance premiums that it got connected to health in the first place.

And so it's become this metric that doctors start and end every conversation about our health with, when it really doesn't tell us very much. It doesn't tell us percentage of body fat relative to percentage of muscle, which is why you'll hear people talk about pro athletes who have "obese BMIs," even though they're all muscle. With children, it doesn't take into account where they are in terms of puberty development. ... It really gets weaponized against folks and it gets used, like I said, to determine access to health care.

On using neutral language around food

I don't say "junk food." I don't say "bad." I don't say "garbage." I don't say, "Oh, you have to eat real food. You're having too many treats." I never put treats in opposition to anything else. They're just also part of the meal. ... You may want to enlist the help of a therapist or a dietitian who can help you really get to this more neutral place.

If you start to take a more relaxed approach and let these foods be part of your family's life, and make sure your kids have regular access to them, and you don't judge how many cookies they take, ... you let it play out. You will see that these become foods your kids can enjoy, but in a much less fraught way. And you'll find there are some that they actually don't even like that much. And they're leaving the bag in the pantry for weeks and not touching it or they're excited to see it for a few days and then the novelty wears off. It's a completely different way of engaging with food. I think that's one of the pieces of this that feels the most radical to a lot of folks because it's a level of permission we've never given ourselves.

Sam Briger and Susan Nyakundi produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the web.