I really don’t want my children to be overweight. I know this because I see the consequences every day in my practice, consequences like high blood pressure, impending diabetes, or poor self-esteem.

At the same time, I really, really don’t want my children to have an eating disorder. I know this because I had one.

In college, I suffered from anorexia nervosa. I’m a little more than 5 feet 9 inches tall, and when I was in the midst of it, I weighed 112 lbs—and even then, I didn’t feel thin enough. It was a horrible way to live. It took me years to climb out of that hole; hands reached down to help me, but I had to do most of the hard climbing myself. Never, ever do I want one of my children to go through that.

Plan A, therefore, was that my children would always be at a healthy weight, with excellent eating and exercise habits. That way I would never have to intervene. I wouldn’t have to say anything to them that might start them wondering if their bodies were beautiful enough, anything that might make them start skipping meals or exercising out of desperation instead of fun. I liked Plan A.

But then Elsa didn’t lose her baby fat the way her older sister did. So much for Plan A.

I approached Plan B with true trepidation. And, as is usually the case with a Plan B, I made it up as I went along, adapting it to different situations and kids (Elsa wasn’t the only one who strayed into unhealthy territory). But there are two main principles that I have always tried to stick to.

First, I am incredibly consistent with everyone in the family when it comes to diet and exercise, no matter how much anybody weighs. There’s no junk food in the house, no soda and very limited sweets (“There’s no sugar in this house!” has been a common complaint over the years.) Everyone has to eat vegetables. Everyone has to exercise (including me and my husband). It has felt a little weird sometimes saying that the skinniest kid in the house can’t have another cookie, but I didn’t want the overweight kid to feel bad—and I didn’t want the skinny kid to learn bad habits. We have family rules about what and when people eat—and one of the great things about the consistency is that the kids enforce them with each other. I’ve watched Natasha remind Liam that he had chips at Nana’s house and so can’t have an Oreo—and watched Liam put the Oreo back in response.

Second, I have been really careful to never frame anything in terms of appearance. Instead, I’ve framed everything in terms of health. We limit sweets, junk food and fast foods because they aren’t healthy. We eat fruits and vegetables because they are healthy. We exercise to make us strong—and healthy. We want to be at a good weight not to be more beautiful or handsome, but because it’s healthy.

This has been hard sometimes; there were moments when I really struggled with the spin. And I’ve worried that the kids might be hearing it differently, that secretly they’ve been thinking: Mom thinks I’m fat, that’s why she’s saying these things. In preparation for writing this blog, I screwed up my courage and talked to my two older daughters about what they thought we’ve done wrong—or right—when it comes to our family health rules.

Elsa, 13, says she never felt bugged about her weight—and while there were times she resented getting yogurt for snack when her friends had chips, she understands why now. As for why she’s slimming down, she said, “I’m more mature now, so I’m making better choices,” (cracked me up, but I didn’t let on.) Michaela, 20, who communicates with me from college via Skype chat, wrote: I always took it as you being your crazy doctor self. I never took anything personally.

I know better than to pat myself on the back. There’s nothing more humbling than parenthood—and I’ve still got two younger ones to raise (or mess up). One of those younger ones is a thin and pretty 9-year-old girl, a fashionista who plays very close attention to the media, something her older sisters were less interested in.

The media, really, is where the real blame—and danger—lies. Sure, the attention on childhood obesity could have a backlash. But my guess is that the preteens with eating disorders are more affected by the skinny models, not to mention the skimpy, sexy clothing marketed directly at them.

So I’m working on a strategy to help me navigate media messages with Natasha—Plan C, I guess. I’ll get back to you on that one.

Claire McCarthy is a primary care physician and the medical director of Children’s Hospital Boston’s Martha Eliot Health Center.  She blogs at Thrive, the Children’s Hospital Boston blog.

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