Kids and Weight: What Not to Say

Their intentions may be good but, far too often, the way people talk, think and act about obesity can fuel weight stigma. And while it’s a stigma that society often tolerates under the guise that shame can motivate people toward positive change, it may do more harm than good. Research shows that weight stigma may actually trigger binge eating, social isolation, and avoiding important health care services.

One third of U.S. children are overweight—about half to the degree of being considered obese—and too often bear the brunt of this stigma. Aiming to counter that, the American Academy of Pediatrics published a policy statement to help pediatricians fight this stigma. From that, UR Medicine pediatrician Dr. Stephen Cook, one of the statement’s authors, shares advice for adults who regularly interact with children.

• Know that it’s complicated. There’s no one cause for obesity, nor is it just a matter of personal choice or a lack of willpower. Many factors, including genetics, socioeconomics and environment, contribute to the disease in addition to individual choices about diet. Pediatricians—and all adults—should be aware of these complex factors when interacting with children or families with obesity.
• Do as I do. Adults should model non-biased, supportive behavior. Understanding the complexity of obesity, and recognizing it in social settings, can help dispel common assumptions and stereotypes, which tend to place all the blame on the individual. Adults should also help educate their children, who are often receiving stereotype-filled messages elsewhere. For example, one recent analysis of children’s movies found that 70 percent included weight-stigmatizing content, virtually all of which targeted characters with obesity.
• Choose words wisely. Use appropriate, non-stigmatizing language. Phrases like “unhealthy weight” and “body mass index” are preferred by adolescents who are overweight, whereas terms like “obese,” “fat,” or “weight problem” induce feelings of sadness, embarrassment, and shame. Also, use people-first language whenever possible such as “child with obesity,” rather than “obese child.”
• Speak up. Advocate for changes. Ask your schools if their anti-bullying policies include protections for students who are bullied about their weight. Weight-based bullying is the most common form of school bullying, with one study finding that 71 percent of adolescents seeking weight loss treatment had been bullied about their weight in the past year.

Stephen Cook, M.D., M.P.H., is an associate professor of Pediatrics at the University of Rochester Medical Center and the Center for Community Health. He cares for patients of the general pediatric practice at UR Medicine’s Golisano Children’s Hospital.