COMMENTARY

Weight Stigma in Kids: The Hurt May Not Go Away

Rebecca M. Puhl, PhD

Disclosures

November 20, 2017

Words Hurt

"I don't like exercising at school because I'm fat and often get hit by others. When we play dodgeball, I'm the target that gets hit."

"All through school, kids called me names, laughed at me, tripped me, and stuck pins in me to see if I would pop."

"My softball coach in high school constantly made fun of my weight in front of my teammates."

"My dad used to call me a cow as I was growing up. It still hurts."

These real-life examples illustrate the painful and frequent reality of stigma faced by many youth and adolescents who have obesity.

Weight-based bullying has been documented as one of the most common forms of victimization faced by youth.[1,2] These experiences have harmful consequences for health, ranging from increased psychological distress (eg, depression, anxiety, low self-esteem) to maladaptive eating behaviors (eg, binge eating, disordered eating) to avoidance of physical activity and increased weight gain.[3,4,5,6]

Recent longitudinal evidence found that weight-based teasing experienced in adolescence predicted maladaptive eating, obesity, and increased weight gain 15 years later in adulthood; thus, the harmful effects of weight-based teasing may be long-lasting.[7]

What Can We Do About Weight-Based Stigma?

The high prevalence of both obesity and weight-based stigma in youth has led to increasing calls for efforts to address this problem. A new policy statement from the American Academy of Pediatrics (AAP) specifically calls upon pediatric health professionals to increase their awareness of weight-based victimization in youth and to take steps to reduce weight bias in the healthcare setting and the broader community.

Garnering help from pediatricians to address weight stigma is particularly important for several reasons. Research studies show that youth are vulnerable to weight sigma not just from peers at school, but also at home from family members. As many as 37% of youth with obesity report being teased about their weight by their parents.[8] Adverse health consequences resulting from these experiences can be just as damaging as bullying from peers, especially for girls.[7]

Given that youth may be facing weight-based victimization both at school and at home, pediatric health providers may be one of the few allies who can intervene and provide support. Pediatricians can assess patients for signs of weight-based bullying, talk to parents about potential weight stigma at home, educate families about the harms of stigma, and encourage parents to engage with teachers at their child's school to implement plans to address weight-based bullying.

In addition, considerable evidence demonstrates that weight bias is commonly expressed by healthcare providers.[9,10] Stigmatizing encounters with providers can lead patients with obesity to be reluctant to discuss weight-related health issues, lower their trust in providers, avoid seeking healthcare, and have poorer treatment outcomes.[11,12,13]

Medical trainees report observing weight bias from their instructors and from other healthcare providers in their training, often in the form of derogatory remarks and "fat jokes" towards patients with obesity.[14] This reinforces a culture that accepts weight stigma in the clinical care training environment, and highlights the healthcare setting as an important target for stigma reduction efforts.

Thus, important steps can be taken by pediatricians and other healthcare providers to reduce weight bias, whether intentional or unintentional, by modeling and practicing respectful communication in patient-provider interactions and in their interactions with colleagues, staff, and trainees.

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