In dozens of interviews with families I heard about doctors shaming low-income moms for buying dollar store ramen noodles instead of pricier fresh vegetables. I talked to teenagers who were gaining weight while dealing with depression or anxiety and whose doctors told them to cut carbs. Families described doctors who rushed conversations, grabbed bellies or made jokes about kids’ bodies.

What should the obesity guidelines say instead? Stop classifying kids and their health by body size altogether. This would involve a paradigm shift to weight-inclusive approaches, which see weight change as a possible symptom of, or a contributing factor toward, a larger health concern or struggle. These approaches focus providers on addressing that issue rather than managing weight loss. This means looking less at the number on the scale and talking more to families about their health priorities and challenges. Can they add healthy foods rather than restrict calories?

We cannot solve anti-fat bias by making fat kids thin. Our current approach only teaches them that trusted adults believe the bullies are right — that a fat body is just a problem to solve. That’s not where the conversation about anyone’s health should begin.