'Fat' label on a child can predict later obesity

Katherine K. Dahlsgaard wrote this for the "Healthy Kids" blog. She is lead psychologist at the Anxiety Behaviors Clinic at Children's Hospital of Philadelphia.

Parents, it turns out that you probably shouldn't use the f-word around your children.

No, not that f-word.

The other one.

Fat.

In a research letter published recently in JAMA Pediatrics, researchers found that 10-year-old girls who were told they were "too fat" by family members, friends, or teachers had a greater chance of obesity when they were measured again at age 19 than those who had not been weight-labeled.

You might be thinking "Well, of course girls who were overweight at age 10 were more likely to be obese at age 19." The study authors thought of that, too, and statistically controlled for the girls' initial Body Mass Index. Regardless of what a girl weighed at age 10, being labeled as "too fat" (and 58 percent or 1,188 of them were) still predicted a greater chance of obesity in early adulthood.

Risk for obesity at 19 was slightly higher if the girls had been told they were "too fat" by family members rather than by friends or teachers.

The study authors note that their results are in line with research showing that stigmatization of overweight children has negative consequences for their emotional and physical well-being.

Moreover, research with adults has already indicated that weight-based discrimination is associated with weight gain rather than weight loss, possibly because being made to feel bad about your weight might lead to overeating as a coping behavior.

The researchers conclude that interventions aimed at stigmatizing or shaming the overweight aren't likely to work to improve health, and instead recommend nonstigmatizing approaches.

What would that look like?

Lead author Jeffrey Hunger states, "I think a nonstigmatizing approach to improving health is one that focuses on that - health. We have a laser focus on weight, which is an imprecise indicator of actual health. There's no need to say the f-word at all if you want to improve your child's health.

"You can encourage healthy eating and physical activity without ever commenting on his or her weight."

So what's a parent to do if a child comes home in tears, complaining that a classmate, teacher, or coach called her "too fat"? I recommend that you:

Practice assertiveness skills with your child with role-playing (first she plays the bully and you answer back, then you play the bully and she answers back). This way she'll be prepared to answer back if teased again.

Ask her how she feels about her body. She may very well like the way she looks. But, if she is distressed about her size, don't give advice, just listen and empathize ("I can hear that you are sad today").

Emphasize a healthy lifestyle for all family members so that one child does not feel stigmatized.

Getting enough sleep, staying active and exercising regularly, and eating nutritious foods are things that everyone should do.