Yesterday, we began looking at the failed “solutions” to the growing global obesity epidemic. In the same way that shaming a smoker into stopping that nasty habit is likely not going to work, so too is the shaming of one who is overweight or obese not going to result in weight reduction. An important new policy statement from the American Academy of Pediatrics Section on Obesity makes clear that weight stigmatization results in discrimination… and worse:
Weight stigma refers to the societal devaluation of a person because he or she has overweight or obesity and often includes stereotypes that individuals with obesity are lazy, unmotivated, or lacking in willpower and discipline. These stereotypes manifest in different ways, leading to prejudice, social rejection, and overt unfair treatment and discrimination. For children and adolescents with overweight or obesity, weight stigma is primarily expressed as weight-based victimization, teasing, and bullying.
The authors explain that weight stigma can impact children as young as three years old:
Weight stigmatization is often 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 over time, which worsen obesity and create barriers to healthy behavior change. Experiences of weight stigma also dramatically impair quality of life, especially for youth. A landmark study by Schwimmer et al revealed that children and adolescents with severe obesity had quality-of-life scores that were worse than age-matched children who had cancer.
The policy statement addresses a common bias held by some pediatricians and other health providers that only makes things worse for patients seeking advice and treatment:
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 health care 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. In addition, the emotional distress experienced by patients who feel stigmatized can reduce the likelihood of returning for future health care visits.
The authors recommend the following practice-based strategies so that well-meaning pediatricians are not the ones inadvertantly doing the shaming and stigmatizing:
Role Modeling. It is important for pediatricians and pediatric health care professionals to demonstrate and model professional behavior with colleagues, staff, and trainees that is supportive and nonbiased toward children and families with obesity…
Language and Word Choice. It is important for pediatricians and pediatric health care professionals to use appropriate, sensitive, and nonstigmatizing language in communication about weight with youth, families, and other members of the pediatric health care team. Words can heal or harm, intentionally and unintentionally. Recent evidence shows that neutral words like “weight” and “body mass index” are preferred by adolescents with overweight and obesity, whereas terms like “obese,” “extremely obese,” “fat,” or “weight problem” induce feelings of sadness, embarrassment, and shame if parents use these words to describe their children’s body weight. Furthermore, using people-first language is one step to help reduce the use of potentially stigmatizing language, and it is now emerging as the preferred standard with obesity as well as other diseases and disabilities. People-first language places the individual first before the medical condition or disability and involves using phrases such as “a child with obesity” rather than an “obese child.”
Clinical Documentation. Obesity is a medical diagnosis with real health consequences, so it is important for children and families to understand the current and future health risks associated with the degree to which a patient weighs more than what is healthy…
Behavior Change Counseling. Beyond specific word choice, it is recommended that patient-centered, empathetic behavior change approaches, such as motivational interviewing, be used as a framework to support patients and families in making healthy changes...
Clinical Environment. Pediatricians should create a safe, welcoming, and nonstigmatizing clinic space for youth with obesity and their families…
Behavioral Health Screening. Addressing weight stigma in clinical practice also necessitates that pediatricians assess patients not only for physical but also emotional comorbidities and negative exposures associated with obesity, including bullying, low self-esteem, poor school performance, depression, and anxiety. These are often overlooked but can be signs a child is experiencing weight-based bullying.
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