New Guidelines Released on Pediatric Obesity and Stigma

Troy Brown, RN

November 20, 2017

The American Academy of Pediatrics and the Obesity Society have issued a joint policy statement on the stigma children and adolescents with obesity experience.

"Although numerous efforts are underway to help children and adults reach and maintain a healthy weight, many such efforts do not address the social consequences of obesity, specifically weight stigmatization and discrimination," the authors write.

Stephen J. Pont, MD, MPH, from the Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center of Central Texas, Ascension, Austin, and the Department of Pediatrics, Dell Medical School at the University of Texas at Austin, and colleagues present the policy statement in an article published online November 20 in Pediatrics.

"Treating children and teens who have obesity means more than just changing nutrition and physical activity habits. It's also about addressing the social and emotional impact that excess weight can have on their quality of life," Dr Pont said in a news release. "Through these new recommendations, we hope to encourage more effective and empathetic approaches in how we address and care for children and families with obesity."

Although some believe that stigma related to overweight or obesity can motivate patients to make positive changes, stigma fosters behaviors including binge eating, social isolation, avoidance of healthcare services, reduced physical activity, and additional weight gain over time. These can all exacerbate obesity and make healthy behavior changes harder.

"Youth face weight teasing and victimization at school from peers, but sometimes also at home from parents," coauthor Rebecca Puhl, PhD, deputy director for the Rudd Center for Food Policy and Obesity and Department of Human Development and Family Studies, University of Connecticut, Storrs, and fellow with The Obesity Society, said in the news release. "This issue needs to be on the radar for pediatric health professionals, who may be among the few allies who can offer support and help prevent youth from further harm from these experiences."

Pediatricians and pediatric healthcare professionals should model supportive and nonbiased behavior toward children and families with obesity, including recognition of the complex etiology of obesity. They should "use appropriate, sensitive, and nonstigmatizing language in communication about weight with youth, families, and other members of the pediatric health care team," the authors write. Examples include using "people-first" language such as "child with obesity" rather than "obese child."

In clinical notes and when communicating with patients and families, clinicians and healthcare professionals should use patient-sensitive language such as "unhealthy weight" or "very unhealthy weight" rather than "obese" or "morbidly obese."

Pediatricians should use "patient-centered, empathetic behavior change approaches" including motivational interviewing as a framework to help patients and families make healthy changes. "[C]reate a safe, welcoming, and nonstigmatizing clinic space for youth with obesity and their families," the authors write. This includes accommodating patients with various body sizes throughout the clinical environment.

Clinicians should assess patients for weight-based bullying by assessing for "physical but also emotional comorbidities and negative exposures associated with obesity, including bullying, low self-esteem, poor school performance, depression, and anxiety."

Pediatricians and pediatric healthcare professionals should also advocate against weight stigma by working with schools to ensure that antibullying policies address weight-based bullying; working to improve the portrayal of those with obesity in the media; advocating for the inclusion of training on weight stigma in medical schools, residency programs, and continuing medical education; and working "to empower families and patients to manage and address weight stigma in schools, communities, and their homes," the authors explain.

"By examining their own weight biases, modeling sensitive communication and behavior to children and families with obesity, and taking steps to address weight stigma with their staff, in their clinic environments, and in the broader communities, pediatric health care professionals can make important shifts in the culture of care for children with obesity. With these concerted efforts to reduce weight stigma, interventions can more effectively help and empower patients to improve their weight-related health," the authors conclude.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 20, 2017. Abstract

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