American Academy of Pediatrics releases policy statement on weight stigmatization

Lucy Cai

A new policy statement released by the American Academy of Pediatrics addresses an often neglected issue surrounding body weight — weight stigmatization.

Weight stigmatization, which involves negative attitudes and stereotypes toward people due to their weight, can have adverse consequences for children and adolescents.

“This policy statement is about increasing awareness that stigma poses a legitimate barrier (to) weight-related and emotional health,” said Rebecca Puhl, the deputy director for the Rudd Center for Food Policy & Obesity at the University of Connecticut and one of the lead authors of the policy statement. “The goal is to shift the culture of care from one that at times can be judgmental and blaming to one that is supportive and empowering to families and children.”

Weight stigma is often tolerated in society because people can see guilt and blame as a catalyst to change, said Stephen Pont, a Dell Medical School assistant professor and one of the statement’s lead authors.

“Sometimes folks have this idea that guilt and blame can motivate change, but for most people, guilt and blame can paralyze you — it doesn’t motivate you to engage in more physical activity (or) wash your vegetables and have a great salad,” Pont said.

Stigmatization of people for their weight can have negative physical health implications. For example, those who experience weight stigma may resort to unhealthy behaviors that lead to further weight gain, Pont said.

“(Weight stigma) can prevent people from coming back to physicians to continue healthy changes,” he said. “It motivates people to be less active and go to comfort foods. (Weight stigma) doesn’t motivate people to take up healthy behaviors.”

In children, weight stigma commonly stems from peer bullying and can be harmful to mental health, Puhl said.

“(Our team’s research) found that of the children seeking weight loss treatments, at least 70 to 90 percent of them report being bullied for their weight by their peers,” Puhl said. “These experiences really put children at risk for psychological distress and social isolation.”

Pont added that children who are overweight or have obesity often experience greater rates of poor self-esteem, depression and anxiety than their peers.

For example, one study referenced by the policy statement assessed quality-of-life scores for children with various medical conditions and found surprising results.

“Children with obesity actually reported lower experienced quality-of-life (scores) than children with cancer,” Pont said.

To combat weight stigma in the clinic, the authors of the policy statement recommend that pediatricians be cognizant of the way that they approach and discuss weight-related issues with their patients.

“Patient-provider discussions about weight have to be empowering and supportive,” Puhl said. “That involves different things, (including) patient-centered counseling approaches such as motivational interviewing.”

Sensitive communication also includes carefully choosing words used to discuss weight. The authors of the policy statement recommend that pediatricians use more neutral words such as “very unhealthy weight” instead of “fat” and employ people-first language, such as “child with obesity” instead of “obese child.”

Pediatricians can also ensure that their clinic physically accommodates patients of all body sizes.

While it’s easy to miss these details, being mindful can often facilitate a more welcoming atmosphere, said Wendelin Slusser, the associate vice provost of the Healthy Campus Initiative at the UCLA School of Public Health and a co-author of the policy statement.

Accommodations include having chairs with armrests that permit patients of all body sizes to sit, Slusser said.

“(Clinicians also) aren’t aware that toilets have to be reinforced,” Slusser said. “Another thing is gowns — some don’t fit different body types. Some scales may not go up to the weight of different patients. Tables also have to be strong enough to hold patients of different sizes, especially in pediatrics.”

Although there is a long road ahead to reducing weight stigma, the policy statement is an important first step, Slusser said. The statement indicates that the American Academy of Pediatrics, the country’s largest group of pediatricians, is viewing weight stigma as a serious problem.

“People are trying hard to make this different,” Slusser said. “(The policy statement) actually went through all the committees and the executive committees and was considered a priority to write as a policy.”