“Fat Bias Starts Early and Takes a Serious Toll” (New York Times, Aug. 21, 2017)
“High School Senior Bullied for Her Weight Commits Suicide” (US Weekly, Dec. 2, 2016)
“Fat Shaming Can Lead to a Host of Health Problems” (CBS News, Jan. 31, 2017)
“Obesity, Bias and Stigma in the Doctor’s Office” (Huffington Post, Nov. 2, 2016)
Obesity is highlighted frequently in news media, but headlines increasingly are focusing on the societal stigma that many people face because of their weight. The phenomenon of weight stigma is real and has been documented by decades of research.
Unfortunately, this stigma extends to children and adolescents. Body weight has become one of the most common reasons that youths are teased, bullied and victimized. The harm these experiences cause for children’s health provides an important opportunity for pediatric health professionals to help address this problem.
The new AAP policy statement Stigma Experienced by Children and Adolescents With Obesityaddresses a timely but often neglected issue affecting the quality of life of children with obesity. The statement, from the AAP Section on Obesity and The Obesity Society, is available at https://doi.org/10.1542/peds.2017-3034 and will be published in the December issue of Pediatrics.
Weight stigma often is propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivate positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change.
Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youths who are vulnerable to weight-based bullying and victimization.
Health care professionals continue to seek effective strategies and resources to prevent and treat obesity; however, they also frequently exhibit weight bias and stigmatizing behaviors.
Raising awareness
Pediatricians and other health care providers caring for children can play an important role in reducing weight stigma, both in clinical settings and through advocacy efforts in the community.
Efforts to reduce weight stigma should include recognition and acknowledgement of the complex etiology of obesity, including genetic and socioeconomic factors; environmental contributors; community assets; family and cultural traditions; and individual choices. This recognition can help dispel common assumptions and stereotypes that place blame and judgment solely on individuals for having excess weight or difficulties achieving weight loss.
Pediatricians can encourage patients’ parents to ask their child’s teachers and school administrative staff if plans are in place to address potential weight-based victimization in their institutions. Parents also should be asked to consider potential weight stigma at home, of which friends and family members can be sources.
Words can heal or do harm, intentionally and unintentionally. Recent evidence shows adolescents with overweight and obesity prefer neutral words like “weight” and “body mass index,” whereas terms like “obese,” “extremely obese,” “fat” or “weight problem” induce feelings of sadness, embarrassment and shame when used by parents.
Furthermore, phrases such as “a child with obesity” rather than “an obese child” can help reduce potential stigmatizing language. Called people-first language, it is emerging as the preferred standard with obesity as well as other diseases and disabilities.
Through empathetic and empowering counseling techniques, such as motivational interviewing, health care professionals can engage the patient and/or parents in developing goals and addressing barriers for how they will achieve sustained health behavior change.
Recommendations
The policy statement offers the following recommendations to pediatricians and pediatric health care professionals:
Strategies to improve clinical practice
Role modeling. Demonstrate professional behavior that is supportive and nonbiased toward children and families with obesity.
Language and word choice. Use appropriate, sensitive and non-stigmatizing language when communicating about weight with youths, families and other members of the pediatric health care team.
Clinical documentation. Use neutral terms, such as “unhealthy weight” and “very unhealthy weight,” in clinical notes and when speaking with patients and family members.
Behavior change counseling. Use patient-centered, empathetic behavior change approaches, such as motivational interviewing, as a framework to support patients and families in making healthy changes.
Clinical environment. Create a safe, welcoming and non-stigmatizing clinic space for youths with obesity and their families, such as having chairs that can accommodate larger people and reading material supportive of healthy lifestyles.
Behavioral health screening. Assess patients for physical and emotional comorbidities and negative exposures associated with obesity, including bullying, low self-esteem, poor school performance, depression and anxiety.
Advocate against weight stigma in multiple settings
Schools. Work with schools to ensure antibullying policies include protections for students who are bullied about their weight.
Youth-targeted media. Advocate for the responsible and respectful portrayal of individuals with obesity in the media.
Provider training. Advocate for training to address weight stigma in medical school and residency curriculum and through continuing medical education programs for practicing physicians.
Parents. Empower families and patients to manage and address weight stigma in schools, in communities and in their homes. Because obesity rates are higher in communities that are socioeconomically challenged and in communities of color, additional stigma attributable to race, socioeconomics and gender could compound weight stigma experienced by some individuals, families and communities.
Dr. Pont, a lead author of the policy, is past chair of the AAP Section on Obesity Executive Committee. Dr. Puhl, also a lead author, is a fellow of The Obesity Society.
