COMMENTARY

Weight Stigma in Kids: The Hurt May Not Go Away

Rebecca M. Puhl, PhD

Disclosures

November 20, 2017

AAP Policy Statement

The new AAP policy statement, released November 20, 2017, is entitled Stigma Experienced by Children and Adolescents with Obesity.[15] It addresses these issues head-on and makes specific recommendations for ways that pediatricians can help reduce weight bias in clinical practice and advocate against weight stigma in other settings. The Table below summarizes these recommendations:

Table. AAP Guideline: Key Messages

Improving Clinical Practice Advocating Against Weight Stigma
Model professional behavior with colleagues, staff, and trainees that is supportive and nonbiased toward youth with overweight and obesity. Work with schools to improve anti-bullying policies so that youth are better protected from weight-based bullying.
Use sensitive and nonstigmatizing language when communicating about weight-related health. This includes appropriate terminology used to describe patients' body weight[16] and using "people-first language" when talking about obesity. Help increase broader awareness of weight stigma by advocating for respectful, nonstigmatizing media portrayals of individuals with obesity. The media provides an important source of information about obesity. Often, though, individuals with obesity are depicted in stereotypical and stigmatizing ways in television, film, and social media; this promotes societal bias.
In clinical documentation and/or clinical notes, use patient-sensitive language and more neutral terminology about weight. Advocate for the inclusion of education and training about weight stigma in medical school curricula and continuing medical education programs.
Ensure that behavior change counseling uses empathic and patient-centered strategies (eg, motivational interviewing) to support children and families to make healthy changes. Support and empower parents in their efforts to address weight stigma at home, in the child's school, and in their broader community.
Create a safe, nonstigmatizing clinical office setting that is welcoming and accommodating to patients of diverse body sizes.  
When conducting behavioral health screening, assess patients for psychosocial consequences of obesity that can be potential signs of weight-based bullying, such as depression, anxiety, poor school performance, or low self-esteem.  

At the core of these recommendations is the fundamental principle of respect for children and families, regardless of their body weight or body size. In a culture where "fat shaming" is commonplace, these guidelines come at a much-needed time as youth continue to be bombarded by messages from the mass media that reinforce shame and blame for having a high body weight.

Pediatricians can help address the harmful impact of weight stigma and create a healthcare environment that emphasizes support, respect, and empowerment at the heart of health behavior change for youth and families affected by obesity.

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