Childhood Obesity: What Should Clinicians Do To Address Body Weight Shaming?

The American Academy of Pediatrics and The Obesity Society have published the policy statement “Stigma Experienced by Children and Adolescents with Obesity” and commentary which provides perspective on “Addressing Weight Stigma and Opening Doors for a Patient-Centered Approach to Childhood Obesity”.

With obesity being the chronic condition that American children face, it is essential that efforts to help children and adults achieve and maintain healthy weight address the stigma of weight. Unfortunately, weight-based victimization, teasing, and bullying by parents, family members, healthcare professionals, social media, and the general public can present challenges when addressing the issue. While some believe stigmatizing a child will motivate them to lose weight, children may experience indirect negative health outcomes from behaviors such as binge eating, social isolation, avoiding healthcare and decreasing physical activity that can result in a reduced quality of life. In the policy statement, Pont, et al., noted “Weight stigma poses numerous consequences for the psychological and physical health of children and adolescents, including adverse outcomes that may reinforce unhealthy behaviors that promote obesity and weight gain.” In the commentary, Kyle, et al., also recognized the negative impact of stigma on parents and families including reduced action as parents tend to be blamed for a child’s growth and weight. In response, blame may proliferate and families may avoid healthcare providers.

The policy statement provides the following recommendations to address weight stigma in clinical practice:

  1. Role Modeling: Professional behavior with colleagues, staff, and trainees should be supportive and nonbiased toward children and families. The complex etiology of obesity, including genetic and socioeconomic factors, environmental contributors, community assets, family and cultural traditions, and individual choices should be acknowledged.
  2. Language and Word Choice: Health practitioners should use appropriate, sensitive, and non-stigmatizing language when communicating about weight including objectively discussing weight rather than labeling a patient.
  3. Clinical Documentation: Obesity has real health consequences, so it is important to address the diagnosis in a balanced, sensitive, and supportive manner while helping children and families to understand the current and future health risks associated with excess weight.
  4. Behavior Change Counseling: Patient-centered approaches to behavior change should be used to determine goals and address barriers in achieving sustained health behavior change.
  5. Clinical Environment: Clinic spaces should be safe, welcoming, and non-stigmatizing for youth and their families.
  6. Behavioral Health Screening: Clinicians should assess for physical and emotional comorbidities and negative exposures.

The policy also provides four additional recommendations for advocating against bullying in schools, in youth-targeted media, by parents and by professionals. The authors conclude by stating, “Obesity is a challenging disease to treat. Many factors are at play, and many of these factors are difficult to effectively address during a short office encounter. The challenges healthcare professionals may face regarding obesity can affect interactions with patients and unintentionally communicate stigma, blame, or judgment when attempting to increase patient motivation for change. Unfortunately, evidence shows these approaches likely impair rather than improve health behaviors and weight outcomes.” It is noted that concerted efforts to reduce weight stigma can help empower patients to improve their weight-related health.

Find out more about addressing weight with your patients here.

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