Talking About Weight With Youth and Families

Rebecca M. Puhl, PhD


March 16, 2012

In This Article

The "Weight Conversation"

At a time when almost one third of youth are overweight or obese,[1] pediatric and family medicine clinicians have a crucial role to play in talking about weight-related health with parents and children. Although the medical community recognizes the importance of addressing the topic of weight with families, hesitancy and reluctance about the best way to approach these issues with patients can hinder these conversations.

Weight can be a sensitive issue, especially in the context of childhood obesity. Children and adolescents who are overweight or obese experience frequent weight-based teasing and bullying in the school setting (Puhl RM, Luedicke J, Heuer C. In the trenches: nature and extent of weight-based victimization experienced by overweight adolescents at school. In review with Journal of Research on Adolescence), and sometimes even at home from parents[2]; this has numerous consequences for their psychological, social, and academic functioning,[3,4] as well as their physical health.[5] These stigmatizing experiences leave children feeling deeply ashamed and vulnerable. It can be a struggle for healthcare providers to find the best way to communicate -- without contributing to blame, judgment, or shame -- the health risks associated with excess body weight and the importance of making improvements in lifestyle behaviors.

The "Tough Love" Approach

Some have argued that a "tough love" approach is needed -- the idea that plain speaking providers will jolt patients into losing weight. For example, the United Kingdom's Minister for Public Health went as far as recommending that all healthcare providers in that country call their obese patients "fat" to motivate them to lose weight, and that calling them "obese" provided insufficient motivation for patients to take responsibility for their health.[6] Recent antiobesity campaigns have taken a similar "wake-up call" approach and blamed parents for their child's obesity.[7]

We know from considerable research that a "tough love" approach can backfire, and can even worsen the problem. For example, when overweight or obese individuals are made to feel stigmatized, shamed, or blamed for their weight, they are more likely to engage in unhealthy eating behaviors (eg, binge eating), increase their calorie intake, drop out of weight-loss treatment, and avoid physical activity,[8,9] all of which can reinforce obesity and impair weight-loss efforts. In addition, confrontation and weight bias on the part of a clinician can result in avoidance of future healthcare utilization.[10] Research shows that parents feel blamed and dismissed by providers when they seek treatment for their child's excess weight.[11]


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