"Mommy, is pepperoni healthy?"
I thought I had at least a few more years until my kid ran headlong into diet culture
Welcome to Chief Complaint! For those of you who are new, this newsletter features intermittent musings about medicine, gender, parenting, and body liberation — all from your friendly neighborhood primary care doc. I’m so happy you’re here.
The other day, I was minding my own business, making a pizza for my family, happily placing Trader Joe’s vegan pepperoni on top, singing along to Frozen II, when my son says to me:
“Mommy, is pepperoni healthy?”
*** cue screeching breaks noise ***
What? I thought I had at least two more years until my darling, precious child ran headlong into diet culture. He is three.
But here we go, it had arrived. High stakes parenting moment.
I set the pepperoni down, but not before popping a slice into my mouth! Hope it wasn’t supposed to be cooked first? It’s made from, like, vital wheat gluten?
Me: Who told you the word “healthy,” lovebug?
Kid: Alex. He said lollipops are not healthy.
Me: Hmm… OK. What did Alex say “healthy” means?
Kid: Healthy means it’s a strawberry.
Me: Well, we are going to eat this pepperoni for dinner.
Kid: I like lollipops.
Me: So are lollipops healthy?
Kid: I got a lollipop from Mr. Mike when I got my hair cut. It was red.
Me: Lots of different foods can be healthy at different times. It just depends what your body needs.
Kid: Can I have a lollipop?
Like I said, my kid is three, so that was about the extent of the conversation. But it got me thinking — what is “healthy,” and how should I be talking about it with the kids in my life?
Since having a kid, I’ve been thrust into the Wild West of childhood nutrition, feeding philosophies, and all of the cultural baggage that comes with how to nourish our children. Food is so important, so of course we want to think deeply about how we feed our kids.
But I was totally unprepared for the multitude of ways that diet cultures shows up every damn step of the way.
First, there is breastfeeding vs. formula. Much has been written about this topic. I will save it for another day, except to say, there was a recurring conversation I had with physician moms when I was pregnant, when I talked with them about where I was going for prenatal care and delivery.
They’d say: “Oh, XXXX hospital is great, except…” Lowers voice. “Except it’s a baby-friendly hospital.”
What? I remembered learning about baby-friendly hospitals in residency. It’s basically a designation the hospital gets if they complete a checklist of things to make it safer for newborns.
“Yeah, it seems great,” these friends would say. “But it just ends up being that they have really, really mean lactation consultants. They’ll yell at you to breastfeed. They made me cry.”
Then, once your baby graduates to solids, there is baby-led weaning. OMG. So many feelings! I think I blocked this whole stage from my memory, because when a friend mentioned how this feeding philosophy was causing major drama between her and her in-laws, I really had to stop to think — wait, was this one of the many baby things I spent countless hours Googling in the night? I am so grateful it now feels like a distant memory.
Baby-led weaning is great in many ways, and we definitely used some of its principles in my house. I looooved watching my son squish huge chunks of avocado!
But the underlying message of the mania around this trend — which, I will note, doesn’t have much of a research base to back it up and yet has captured the hearts and minds of many of my otherwise rigorous pediatrician friends — is that if you give your six-month-old giant pieces of venison, the kid will forever have a peaceful and totally functional relationship with food. Ahem.
Also, I learned during this phase, you can pay somebody your life savings to come serve as a “feeding consultant” for your baby. They may or may not have any credentials, they advertise their services on Instagram, and they post lots of pictures of rainbow-colored fruit cut up in clever ways. Then they teach you to cut up your kid’s fruit in clever ways.
OK, we made it out of the baby-led weaning era, and on to toddlerdom. My kid seems to be enjoying a variety of foods, he (kinda) helps me cook, he says “grace” before we eat! (“It’s so nice / To sit down / And have lunch / With our friends / Enjoy!”)
And then bam, we’re talking about whether or not this vital wheat gluten pepperoni from Trader Joe’s is “healthy” or not. (Also, he asks: “Is seltzer healthy?”)
Here’s what I’ve come to believe. Amongst my peers, when we classify food as “healthy” or not, it has more to do with class reproduction than nutrition.
Feeding our kids “healthy” foods is about signaling class and status.
Here are some examples:
We looked at a local preschool (that charged me $70 to put my kid on a waiting list for two years) that had a “no-sugar policy.”
Now, what could a “no-sugar policy” possibly mean? There is sugar in almost every food I could send my son to school with. There’s sugar in bananas. There’s sugar in tomatoes. There’s sugar in BROCCOLI.
What the school meant, I think, was no “added” sugar. But even that is hard to define. When I add tomatoes to a salad, I’m adding sugar, but I doubt tomato salads were banned.
Ultimately, it was about keeping out foods from the school community that signaled non-adherence to cultural norms. Which in the case of this particular school, were largely White, highly educated, urban, left-leaning. (I also got serious sad beige toys vibes there.)
I was chatting with a parent at the playground the other day and talk turned to Halloween. She told me she had found “healthy” candy at Target to pass out to all the neighborhood kids. (It was this stuff.)
After I finished preventing myself from spitting out my latte ($20 for a 16 oz bag of a candy-resembling-substance where the #1 ingredient is “organic rice syrup”), I paused, and tried to give this nice parent the benefit of the doubt.
Why was she telling me this? Probably because, like me, she feels pulled in a million directions as a mom. She wants her kids to have fun on Halloween and she doesn’t want to be too uptight about letting them have treats, but also, she’s scared of *obesity* and *diabetes* and she’s terrified of any decision that might put her kids at risk for those things.
I empathize, I truly do. But trust me, those expensive rice-syrup candies have the same nutritional content as the old-school stuff. What they can do is show friends and neighbors that you have the resources to spend $20 on a bag of candy and that you’re the kind of parent who’s worrying about these issues. Again, class reproduction.
A few months ago, my family and I stayed with some friends in another state for a few nights, which of course gave us a front-seat view of another family’s food and nutrition anxiety. (I promise: I feel it too, despite being a physician who cares for children and an activist for size-inclusive medicine. Diet culture leaves none of us alone.)
I walk into the kitchen one morning while we’re there, and all the kids are eating popsicles at 8:30 am.
“Don’t worry,” my friend says, breathlessly. “They’re healthy popsicles.” She shows me the package. “100% juice. All natural.”
I don’t say anything, because I don’t want to be rude, and also, I feel a little bummed bursting her bubble. The kids enjoy their treats, and we move on with the day.
But… c’mon. These “all natural” popsicles cost an obscene amount of money at Whole Foods, and again, are a sign that the family can afford them and are a signal that they’re concerned about health. But nutritionally, they’re the same thing as the cheaper brands.
So when my darling, innocent child asks me, “Mommy, is this pepperoni healthy?” What should I say? That healthy vs. unhealthy conceptualization of foods is actually a way of signalizing class and status? That trends in nutrition research fluctuate and we actually understand very little about what it means to have a “healthy diet?”
Nope. I told him that the vegan pepperoni was healthy and we would be eating it for dinner.
I was invited to share some thoughts about weight-loss drugs with the American Family Physician blog, affiliated with the American Academy of Family Physicians. I’d be honored if you’d give it a read here.
Here’s an excerpt:
“What makes you feel like you want to use a medication for weight loss?” I asked her.
“I feel fat,” she told me.
And there we were. With the advent of widespread glucagon-like peptide 1 (GLP-1) receptor agonist use for weight loss, doctors have been thrust unwittingly into the middle of a massive, multibillion dollar weight loss industry—and we should proceed with caution.
…
I fear we are complicit in a deeply fatphobic culture that profits off of our patients’ body shame. Often, my patients’ requests for GLP-1 receptor agonists have very little to do with preventing disease and instead are a highly medicalized bandage on a complex social phenomenon: a patient who tells me, “I feel fat.”
And guys, it’s the final countdown to election day! Ahh! What are you doing to get out the vote in your communities?
I mean. The candy. Anything that lists “organic giggles” as their first ingredient is telling you straight up it’s a con!!
Well said! We need more MDs to think like you! 🙏❤️