Talking About Weight With Youth and Families

Rebecca M. Puhl, PhD


March 16, 2012

In This Article

Strategies for Weight and Health Conversations

The following strategies can be useful for healthcare providers as they enter discussions with patients about weight and health:

Acknowledge previous experiences. Recognize that families struggling with obesity may have heightened sensitivity to weight-based language because of previous experiences of the child (or parent) being teased or bullied.

Ask about preferred terminology. Rather than making assumptions about which specific terms to use when talking about weight with children and parents, it can be effective to ask parents and children about weight-based terminology that they would feel comfortable using in patient-provider discussions. For example, the conversation can start with a question that is presented in a supportive, nonjudgmental way, such as, "David, could we talk about your weight today?" or "David, why don't you tell me how you are feeling about your weight?" followed by "Sometimes people have preferences for how we talk about body weight. Are there particular ways that you would like me to refer to your (or your child's) weight during our discussion?" Initiating the conversation in this way communicates support of the patient and empowers the patient to play an active role in the conversation.

Avoid blame. Many parents feel that clinicians blame them for their child being overweight. When parents feel blamed, they are less equipped to help their children and more likely to be dissatisfied with the healthcare that their child is receiving. Communicate with parents that they are an important part of the solution to improve their child's health, and avoid using language that places blame on parents.

Use motivational interviewing. Use a motivational interviewing approach to enhance self-efficacy and confidence on the part of parents and youth in making meaningful improvements in their health behaviors. Sample motivational interviewing scripts can be found on the Yale Rudd Center for Food Policy & Obesity Website.

Encourage family participation. It is difficult for children to successfully improve their eating and exercise patterns if parents are not doing the same. Thus, an important goal is to encourage parents to make healthy lifestyle changes as a family, rather than imposing a certain health plan only on the child.

Set specific goals. Give parents examples of appropriate behavioral goals to set for their child and for the family (eg, eliminating intake of sugary drinks or increasing consumption of vegetables). Explain the importance of setting realistic goals and monitoring progress.

Don't focus on numbers. Emphasize to parents the importance of focusing on healthy behaviors in their child, rather than just how much their child weighs. It is difficult to lose weight, and focusing only on the number on the scale will probably lead to feelings of shame in the child and frustration for the parents. Providers need to communicate with parents the importance of providing ongoing reinforcement for improvements in their child's health behaviors.

Address bullying. If you are concerned that a child may be the target of teasing or bullying because of his or her weight, it is important to talk with the parents about proactive steps that can be taken to intervene and protect the child from additional victimization. Specific resources on what parents can do if their overweight child is the target of bullying also can be found on the Yale Rudd Center Website.

Address parental criticism. Parental frustration concerning a child's excess weight or lack of weight loss can sometimes translate into criticism and negative comments directed toward the child. If you are concerned that a child is the recipient of teasing, criticism, or negative comments about his or her weight from his or her parents, it is important to discuss with parents the harm that can result from these comments to their child's mental health and to the child's efforts to become healthier or lose weight. The Yale Rudd Center Website has information for parents about weight-based teasing and ways to combat this at home.

Empower, Support, and Motivate

The challenges in effectively preventing and treating childhood obesity are numerous. Patient/provider discussions about weight with parents and youth should not be among these obstacles. With careful and thoughtful consideration to language and communication about weight, healthcare providers can help empower, support, and motivate families to improve their health.


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