Talking About Weight With Youth and Families

Rebecca M. Puhl, PhD

Disclosures

March 16, 2012

In This Article

A Study of Weight Terminology Preferences

How can healthcare providers productively address and discuss weight with parents and youth? How should the conversation be initiated, and to what kind of language and terminology about weight are patients most likely to respond? Until recently, very little research had examined patient perceptions of weight-related language in the context of childhood obesity. To address this gap, we conducted a study[12]to quantitatively assess parents' preferences for terms that doctors use to describe a child's weight, and whether these different terms evoke positive or negative reactions or affect the parents' healthcare decisions. We surveyed a national sample of 445 parents and provided them with the following scenario:

"Imagine you have brought your child to the doctor for a routine check-up. The nurse has measured your child and found that he/she is significantly above his/her recommended weight. Your doctor will be in shortly to speak with you and your child. You have a good relationship with your doctor, who is committed to the health and well-being of you and your child. Doctors can use different terms to describe body weight. Please indicate how desirable or undesirable you would find each of the following terms if your doctor used it in referring to your child's weight."

Parents then rated the following 10 terms (presented in random order) on how desirable or undesirable each term would be if a doctor used it to refer to their child's weight:

  • extremely obese;

  • high body mass index (BMI);

  • weight problem;

  • unhealthy weight;

  • weight;

  • heavy;

  • obese;

  • overweight;

  • chubby; and

  • fat.

Parents also were asked the extent to which they believed each of the 10 terms to be stigmatizing, tending to blame the child for his or her weight, or motivating to the child to lose weight.

What Parents Prefer

Findings showed that parents consistently preferred providers to use neutral terms to describe their child's weight, such as weight, unhealthy weight, and high BMI. These terms were rated to be the least stigmatizing and blaming. Parents rated the most motivating terms to be unhealthy weight, weight problem, overweight, and weight. In contrast, the terms chubby, obese, extremely obese, and fat were rated by parents as the least desirable and motivating and the most stigmatizing and blaming. These findings remained consistent across sociodemographic factors (race, sex, age, income, and education), regardless of whether the parents were overweight or had a child who was overweight.

We also asked parents how they would react if a healthcare provider referred to their child's weight in a way that they felt was stigmatizing. Findings showed that:

  • 50% of parents would request the provider to use more sensitive language when discussing weight with their child;

  • 37% would feel upset and embarrassed;

  • 36% would put their child on a strict diet;

  • 35% would seek a new provider; and

  • 24% would avoid future medical appointments.

No significant differences were found between parents of children who were overweight compared with those whose children were not overweight.

These findings offer important practical suggestions for how clinicians can discuss weight with parents and children in ways that are perceived to be motivating. Of concern, however, these findings also suggest that a considerable percentage of parents may seek a new provider or avoid future medical appointments if they feel that their provider has discussed their child's weight in a stigmatizing way.

Healthcare providers need to consider carefully the way they talk with patients about weight. Using language that families find desirable and motivating and avoiding language that they perceive to be blaming or stigmatizing is key in efforts to initiate and engage in a positive and productive discussion about weight-related health with parents and youth.

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