Physicians urge education and positive language to end societal discrimination
For children who have overweight or obesity, stigma and discrimination can add to their health problems and harm their quality of life, making them feel isolated, embarrassed and sad. According to research, weight alone can be a predictor for victimization and bullying.
In a new jointly written policy statement, the American Academy of Pediatrics and The Obesity Society offer guidance for pediatricians and health care professionals to reduce weight stigmatization and discrimination, and to educate others about the negative consequences of such actions. The policy statement, "Stigma Experienced by Children and Adolescents with Obesity," will be published in the December 2017 issue of Pediatrics and published online Nov. 20.
"Treating obesity is complex and challenging," said Stephen J. Pont, MD, MPH, FAAP, a lead author of the policy and founding chair of the AAP Section on Obesity Executive Committee. "Sometimes we can forget the burden that weight stigma places on children and families struggling with obesity."
Weight stigma among youth is most often experienced as victimization, teasing, and bullying. In the school setting, weight-based bullying is among the most frequent forms of peer harassment reported by students. In fact, 71% of those seeking weight loss treatment say they have been bullied about their weight in the past year, and more than one third indicated that the bullying has gone on for more than five years.
"Youth face weight teasing and victimization at school from peers, but sometimes also at home from parents," said co-author Rebecca Puhl, PhD, deputy director for the Rudd Center for Food Policy & Obesity and fellow with The Obesity Society. "This issue needs to be on the radar for pediatric health professionals, who may be among the few allies who can offer support and help prevent youth from further harm from these experiences."
Weight stigma increases feelings of isolation and sadness, which can lead to avoiding activities, binge eating and additional weight gain.
"Words are powerful and can encourage or do harm, and so when working with families trying to make healthy changes, I remind myself: be nice, be patient," Dr. Pont said. "If we are aware and avoid words or actions that could be felt as stigmatizing by our patients, then they will be more successful."
Both AAP and The Obesity Society encourage health care professionals to model non-biased behaviors and language. For example, AAP recommends using "people first" language, such as "children with obesity" instead of "obese child." Empathetic and empowering counseling techniques are also encouraged, such as motivational interviewing, and addressing weight stigma and bullying in clinic visits.
Health care professionals can advocate for training and education about weight stigma in medical schools, residency programs, and continuing medical education programs. They can also empower families to be advocates to address weight stigma in the home environment and school setting.
"Treating children and teens who have obesity means more than just changing nutrition and physical activity habits. It's also about addressing the social and emotional impact that excess weight can have on their quality of life," Dr. Pont said. "Through these new recommendations, we hope to encourage more effective and empathetic approaches in how we address and care for children and families with obesity."