‘Oh the thinks you can think’ on pediatric obesity

Featured article in the Fall 2016 Issue of Nutrition Close-Up; written by Bev Benda, RDN, LDN, BCC

Years ago I saw the Broadway show, Seussical the Musical.1 It is based on two Dr. Seuss classics, Horton Hears a Who 2 about a sweet, gigantic elephant who befriends a dustsized boy from a microscopic town, and Horton Hatches the Egg,2 in which this same elephant guards his friend Mayzie’s egg while she parties. The musical transcends these story lines as it shares the message of accepting people despite size or looks. Several characters face criticism, isolation, loneliness, and low self-esteem because they are “different.” It comes full circle after showing how judgment hurts, and seeing beyond the surface creates true friendship and love.

As a Registered Dietitian, I couldn’t help but realize that the key refrain, “A person’s a person no matter how small,” could also have been, “A person’s a person no matter how big.”

In a world that seems horrified by the “epidemic of obesity,” many healthcare providers are quick to label people according to the Body Mass Index (BMI) as “normal,” “overweight” or “obese.” This tool has been given elevated status and a good medical billing code, so the scale greets patients quickly in the clinic. Never mind that sharing the BMI results may put parents and previously self-confident children in tears despite the medical oath of “do no harm.”

Health care providers routinely tell children they are “too fat” and many parents are told to “keep an eye on it” (whatever that means). Children are encouraged to “eat healthier,” as if they have control of the grocery cart, yet this advice has backfired according to the Academy of Pediatrics, who recently reported that this vague advice is confusing to families who are already eating balanced meals.3 For older children this can lead to weight stigma, skipping meals and eating disorders. Overall, BMI monitoring has been mostly ineffective in making a positive impact on weight, and it is a turnoff to parents who want nonjudgmental conversations about their children.4

If Theodor Seuss Geisel were alive today, what would he think of the way children are classified by weight as young as the age of 2? Would he join the fight against pediatric obesity or would he search for an alternative voice, such as that of the Cat in the Hat?

You’ve got a mind that is one of a kind, so why hide it away? It’s time to open the locks and think out-of-the-box and today is your day! Bounce on the brink of whatever you think, and oh, what could be better than that? And that is the fun of The Cat in the Hat!5

If we are to protect children and promote their health, perhaps we could be more like The Cat in the Hat. He is on the side of children. He does not target them, label them, or shake his head in disgust at them. To him, there is no such thing as an overweight or obese child. All children are simply precious and imaginative creatures like himself. Ask Horton and JoJo, who sing together, “I have wings and I can fly around the moon and far beyond the sky.”6 Using People First language is a good place to start, identifying people by name, not disease. One request the Cat in the Hat might make is: “Could we please stop writing ‘obese child’ in the medical chart? How about ‘delightful child who loves riding bike and reading books?’”

When we think out-of-the-box we can see that obesity isn’t the main problem. It is merely one of many symptoms of much bigger issues: lack of physical activity, excess use of technology (TV, computer, iPad, phone, etc.), high stress, poor nutrition, lack of sleep, poverty, lack of education, lack of motivation, etc. Consider that not all children who have poor lifestyle habits are overweight or obese. Many are slender, perhaps due to a fast metabolism, but nonetheless, they often still suffer from poor nutrition, lack of fitness, poor dental health, TV and computer obsessions, sleep disorders, emotional stress, or addictions.

If we are ever to make any progress in the area of “pediatric obesity” we must stop acting like General Genghis Khan Schmitz, the stern military general in Seussical who prided himself in being able to “scare children out of their wits.” He threatens that JoJo will have to “sweat and shiver, and eat raw liver” and he will not tolerate people who eat their bread “butter side down;” it must be eaten “butter side up!”7 General Schmitz is the epitome of the “one-size-fits-all” intervention and belief that “we have a program for you.” It’s Butter Side Up (canned program) because in healthcare these days, we just don’t have time for Butter Side Down (custom-made for you.)

Based on lack of progress in this area and evidence of harm (even increased bullying in schools toward children who are larger), it is obvious that we are putting our energy in the wrong places, and very possibly doing harm to children with our current practices. The Cat in the Hat is right: It’s time to open the locks and think out-of-the-box. And today is your day!5



Bev Benda, RDN, LDN, BCC, has dedicated the last 30 years to public health, health promotion and health care. Through her web site www.mycoachbev.com she provides onsite and virtual services that include coaching, motivational presentations, and consulting.


1. Ahrens, L., & Flaherty, S. (1999). Seussical. Internet: http://broadwaymusicalhome.com/shows/seussical.htm (accessed 20 May 2016).
2. Dr. Seuss. (2015). Dr. Seuss’s ultimate Horton collection. New York, NY: Random House.
3. Sim, LA, Lebow, J, Wang, Z, Koball, A, Hassan Murad, M. (2016, September). Brief primary care obesity interventions: A meta-analysis. Pediatrics (Online).
4. Frellick, M. (2016, September 13). Obesity interventions by pediatricians barely cut BMI. http://www.medscape.com/viewarticle/868716
5. Ahrens L, Flaherty SC. A day for The Cat in the Hat (lyrics). Internet: http://www.songlyrics. com/seussical-the-musical/a-day-for-the-cat-in-the-hat-lyrics/ (accessed 20 May 2016).
6. Ahrens L, Flaherty SC. Alone in the universe (lyrics). Internet: http://www.stlyrics.com/lyrics/seussical/aloneintheuniverse.htm (accessed 20 May 2016).
7. Ahrens L, Flaherty SC. The military (lyrics). Internet: http://www.songlyrics.com/seussicalthe-musical/the-military-lyrics/ (accessed 20 May 2016).


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