Help obese kids avoid weight stigma, doctors advise

Shaming kids about their weight doesn’t encourage them to shed excess pounds, U.S. doctors warn.

In fact, it often has the opposite effect and contributes to behaviors like binge eating, inactivity, social isolation, and avoidance of routine medical checkups, the American Academy of Pediatrics and the Obesity Society advise in a joint policy statement.

“Keep it positive. We know that making change is tough, and patients will likely have trouble initially meeting some of their goals, but we can learn from these challenges and go from there,” said Dr. Stephen Pont, lead author of the statement and founding chair of the AAP Section on Obesity Executive Committee.

“Also, we know that children with obesity are more likely to suffer from low self-esteem, depression, and anxiety so we want to be extra mindful to focus on positive reinforcement and not negative reinforcement when encouraging behavior change,” Pont, of Dell Medical School at the University of Texas at Austin, said by email.

Keeping children from feeling stigmatized may also mean talking to them about what they see in the movies and on television, a separate study in the same issue of Pediatrics suggests. The authors of the study analyzed kids’ movies and found that most of the movies stigmatized weight.

Obesity is the most common chronic health problem among U.S. children, doctors note in the policy statement. One in three kids between the ages of 2 and 19 are overweight or obese.

Stigma and discrimination can add to their health problems and harm their quality of life, making them feel isolated, embarrassed and sad. Excess weight alone can be a predictor of victimization and bullying.

Physicians must take a lead role in educating children and families about how to help children achieve a healthy weight without making kids feel stigmatized for their size, doctors argue in the statement.

Kids who feel stigmatized often are victims of teasing, bullying, and harassment in school. Many children who see doctors about their weight report being bullied in the past year, and it’s not uncommon for kids to report this going on for more than five years.

“While there has been substantial attention to medical treatment and intervention for obesity in youth, the social and emotional impact of body weight – like stigma and bullying – often get neglected,” said Rebecca Puhl, a fellow at the Obesity Society and deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut in Hartford.

There are ways pediatricians can speak to parents and children about the weight that is supportive and encouraging instead of sounding unintentionally judgmental, Puhl said by email.

For starters, they can talk about “children with obesity” instead of “obese children” to emphasize that this is a medical condition. Using neutral terms like “weight” instead of negative terms like “fat” or “obese” can also help, Puhl said.

This goes for parents, too.

“Parents need to think carefully before having conversations about weight,” Puhl added. “As much as possible, parents should focus their comments on health and health behaviors, identifying ways that they and their children can practice healthier behaviors together as a family.”

For the study of how weight is treated in kids’ movies, researchers analyzed 31 films released from 2006 to 2010. Every film showed obesity-promoting behaviors, like characters with unhealthy foods, huge portions, sugary beverages and lots of screen time.

Most of the movies also stigmatized weight, with verbal insults about body size, for example.

These scenes may be hard to avoid, but parents can use them as teachable moments, said senior study author Dr. Eliana Perrin, who did the study at the University of North Carolina at Chapel Hill and is now director of the Center for Childhood Obesity Research at Duke University in Durham, North Carolina.

When parents do watch with kids, they might say something like, “We all laughed when so-and-so was made fun of, but I was thinking it really wasn’t funny for her, was it?” Perrin suggested.

“In our family, I’d like us to be friends with people and kind to people no matter what their size,” Perrin added. “Children with obesity are smart, fun, athletic and hard-working.”