obesity

Weight Stigmatization in Childhood Obesity

Childhood obesity represents a growing public health concern and a leading cause of morbidity among children. Multiple efforts have been implemented to curb obesity including educating parents to encourage dietary changes, physical activity, limiting screen time, and behavioral modification. However, relatively few strategies explore the social and psychological impact of the stigmatization of obesity in children, which represents a significant gap in our ability to provide care. It is important for pediatricians to model the approach to patients with unhealthy weight by realizing its stigma, using sensitive language, and engaging in motivational interview.

Weight stigmatization, which is defined as discrimination and stereotyping based on a person’s weight, has largely been cultivated and tolerated in our society. It is perceived as a way of motivating overweight children to lose weight. However, this approach generates negative psychological consequences on children as well as adults (Puhl et al. 2015). It is also ineffective at preventing further weight gain, social isolation, or eating disorders. Weight stigmatization creates a barrier for children to actively engage in healthy behaviors or to seek healthcare intervention. Multiple studies have shown that weight-based teasing correlates with an increased risk of worsening obesity (Haines et al. 2010).

Overweight children suffer from poor body image due to the weight teasing they encounter in their everyday lives. Weight stigmatization and victimization can arise not only from school friends but also from educators and parents. A study demonstrated that about 46% obese individuals experience greater weight victimization from members of their family than from others (Puhl et al. 2008).  This shows how weight stigmatization has become normalized in our society: family members are concerned with their loved ones’ health and have a misconception that pushing their children harder will make them want to lose weight. This also creates a long-lasting emotional effect on a child when the weight stigmatization comes from a parent or a family member. 

With childhood obesity remaining a public health crisis, pediatricians can display model behaviors with parents by educating families and society about the complexity of obesity (genetics, SES, environmental factors). This helps take away the assumption that the overweight individuals are to blame for their excess weight. Pediatricians can model sensitive communication, using more neutral terms for describing obesity such as “unhealthy weight” or saying “child with obesity” instead of “obese child”.  Engaging in motivational interviewing is also more effective for pediatricians to encourage behavioral changes. They can counsel parents to consider the effect of weight stigmatization on their children and ensure that they are actively addressing weight victimization at their children’s schools.  

Carine Halaby, M.D.

References:

AAP- Stigma Experienced by Children and Adolescents With Obesity. https://pediatrics.aappublications.org/content/140/6/e20173034#xref-ref-28-1

Haines J, Kleinman KP, Rifas-Shiman SL, Field AE, Austin SB. Examination of shared risk and protective factors for overweight and disordered eating among adolescents. Arch Pediatr Adolesc Med. 2010;164(4):336–343pmid:20368486

Puhl R, Suh Y. Health consequences of weight stigma: Implications for obesity prevention and treatment. Curr Obes Rep. 2015;4(2):182–190pmid:26627213

Puhl RM, Moss-Racusin CA, Schwartz MB, Brownell KD. Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health Educ Res. 2008;23(2):347–358pmid:17884836

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