Over the last decade, there's been a major push for a healthier lifestyle among youth and great strides have been made towards education and prevention in weight management. However, weight stigma is an area in pediatrics that is not often talked about, and I believe it directly relates to why we continue to see rising numbers in childhood obesity.
A recent American Academy of Pediatrics policy statement about stigma experienced by kids and teens with obesity explains that "as early as preschool, young children attribute negative characteristics and stereotypes to peers with larger body size."
It goes on to say that by the time a child has reach elementary school, negative weight based stereotypes have become "common". I found to be heart breaking as I see this every day working with kids. By the time I see patients at our clinic, this weight stigma has usually manifested in some form such as low self-esteem, emotional eating, resistance to participation in gym class or sports teams, and other behaviors affecting quality of life.
The statement also highlighted research that found the way a healthcare professional in pediatrics addressed body weight with patients could lead to stigma and health care avoidance. As healthcare providers, it is our responsibility to evaluate and treat a condition such as a high body mass index without making patients feel stigmatized during the process. Currently, there isn't enough literature to evaluate the most effective ways for health care professionals to address patients and their families about obesity.
In my work, I approach this issue by focusing on a child's health rather than weight. The focus should be on lifestyle habits and making changes as a family to help support the child. The emphasis is on small steps that can help achieve a healthier BMI. Small goals are set in our visits to help empower the child and family to take steps towards developing a healthier lifestyle. The focus on small sustainable goals will lead to a life long journey of health, reinforcing that the end goal is not a matter of size or a number on the scale.
Another area that requires attention is the various aspects of a child's life that is affected by weight stigma. A child who has been subjected to weight-based teasing and bullying is more at risk for depression, anxiety, substance use, low self-esteem, and poor body image. A child suffering from poor body image may then be uncomfortable exercising or eating in front of others. This sets up the child for unhealthy eating and a lack of interest in increasing physical activity. A shocking 85 percent of high school students report witnessing weight-based teasing towards peers during school gym class. We urge our young people to be active, but it is clear that many of them face barriers to achieve this.
As a professional in pediatric obesity treatment, I feel a great sense of urgency to continue the work of education and advocacy for our children with a higher BMI. My colleague Elizabeth Coover, a pediatric dietician, put it perfectly "We still have so much work ahead of us to reduce weight bias in the media, but also within ourselves. It's important for our profession to work to educate others about the negative effects of weight bias and to promote positive language and images."
My hope would be that as this statement is read by pediatric health care providers, conversations will be started and work will continue around ways to eliminate this bias. Perhaps what is needed is an increase in education for pediatric health care providers around weight management and treatment. Also being a parent, this another reminder about how we need to talk to our kids about the damaging impact of weight-based teasing and bullying.