Thursday mornings are my “Dear Prudence” time. One of my small pleasures in life is saving up all of Emily Yoffe’s advice columns for the week and reading them at one go on Thursday morning. It’s one of those little rituals that makes me a wee bit happier.
Sadly, this morning there was a bit of a snag. I know I’ve quibbled with her advice before, and I’m afraid I am again today.
My beef is with some advice she gave a mother whose daughter has a friend who likes to overeat. Apparently this woman was appalled by how much the little girl scarfed down while in her company, and the girl’s own mother is both unconcerned about her daughter’s eating and overweight herself. The writer wonders how best to handle the situation. (All of this was in a video segment, and I’m sorry I have to summarize rather than just quoting directly.)
Prudence recommended modeling healthy eating by inviting the girl for home-cooked meals, portioned appropriately. Sound enough counsel, I guess, though I doubt it will have any real impact in the girl’s life. But she capped her advice with a real howler. She recommended sending an anonymous letter to the child’s pediatrician, so an adult “with authority” might intervene on her behalf.
And that’s just ridiculous.
Would you like to know what I would do with an anonymous letter about a patient of mine telling me she overeats? Nada. El zilcho. (An anonymous letter reporting some kind of abuse would be a different story.) I am super curious to know what in heaven’s name Prudence thinks it would accomplish.
Let’s just say for rhetorical ease that I am the pediatrician in question. First of all, if I have any kind of meaningful role in this child’s life, then I am already aware that she is overweight. We record height and weight (and BMI, as a result) at every well check. Also, I have eyes. I know if my patients are overweight. An anonymous tip would tell me what that I don’t already know?
And even if an anonymous letter would somehow cause the scales to drop from my eyes about some random patient of mine, what would she suggest I do? I can think of no surer way to set off a depth charge under my relationship with a parent than to call her in for an appointment where I could engage in weight scolding based on an anonymous letter. In fact, I would find her embarrassment and resentment that some busybody was tattling on her perfectly understandable.
Lastly, I am baffled as to what this supposed authority I have is meant to be. The letter-writer makes clear that the chubby little girl’s mother is not interested in making any changes. While it is my job to discuss nutrition and wellness as part of health maintenance, and I would be remiss if I didn’t mention concerns about weight to the parents of an overweight child, quite a lot of those parents ignore my advice. Parents ignore my advice all the time, about diet and exercise and all manner of other topics. I am powerless to change that, and (excepting cases of actual neglect) have no choice but to accept it. I put these cases in my “I’m not a fishin’ wizard” file and move on. And that’s to say nothing of the dismal success rates of physician-based weight-loss interventions even for patients who are motivated.
So, sorry Prudie. But I have to disagree with your advice again. An anonymous letter to an overweight child’s pediatrician might make the writer feel better, but it won’t do a thing to help the little girl.