These days, being a kid, tween or teen is hard enough, without adding a physical issue to the mix. Weight stigma is tough for adults — so imagine the burden it can add to a young person. Experts know that weight stigma can contribute to feelings of shame, humiliation, and social isolation. It leads to bullying and raises the risk that the child or teen with obesity will likely become an adult with obesity, with all the co-morbid physical conditions that often accompany the disease.
A new joint policy statement from The American Academy of Pediatrics (AAP) and The Obesity Society (TOS) recommends a heightened awareness and specific recommendations regarding the prevalence of weight stigma, and the harmful impact it can have on youth and their families.
It’s important to treat the physical aspects of obesity in the young, but it is equally important to understand the kind of hazards that weight stigma creates. Weight stigma causes a person to feel devalued. Terms like lazy, unmotivated, and lacking willpower and discipline are often assigned by society to individuals diagnosed with obesity. Imagine if those labels begin to be identified by children or teens and then follow them through life.
We know that seriously overweight youth and those diagnosed as obese are victimized, teased and bullied by their peers (and sometimes by adults). It’s incorrectly assumed that shaming individuals will result in motivation to lose weight. Quite the opposite usually happens, with food disorders and self-harm as the outcome, which can result in worsening obesity.
Kids and teens with obesity have been shown to have quality-of-life scores worse than age-matched kids who had cancer. Research shows that parents, other family members, teachers, health care professionals and society at large often contribute to the burden of weight stigma of the young.
When we treat obesity we seem to focus mostly on the physical aspects and there is often a serious omission with regards to the emotional components and especially to identifying and handling weight stigma.
The school is the most common place for weight bullying. According to The Obesity Society position statement, nearly 71 percent of students who seek weight loss treatment say they were bullied about their weight in the last year, and more than one third say the bullying has gone on for more than five years. There’s evidence that kids who are overweight or who have obesity may have academic performance rated "lower" than their actual test scores and schoolwork products. These kids may refuse to participate in physical education or sports for fear of more bullying, and their feelings may result in emotional binge-type eating. Both of those behavior patterns can just make the disease even worse.
Mothers and fathers may tease or bully or simply be verbally insensitive to their kids who struggle with weight issues. In the media, lean kids are often portrayed as kind, popular, attractive, while larger characters are seen as aggressive, unpopular, evil, or unhealthy. In the healthcare setting professionals can make patients feel like they are lazy, non-compliant, dishonest (about true eating or exercise practices), less intelligent.
When polled, patients shared that they felt words like fat, obese and extremely obese were very stigmatizing, while just discussing weight or unhealthy weight was preferable and less upsetting for them.
In a Perspective paper published in Obesity, treatment of obesity will only be complete and likely successful if stigma and bullying are addressed in the treatment plan. That means that schools, families and the public health sector have to take on this strong recommendation as well. These kids, because of weight stigma, can disengage from school, academically and socially.
Self-harm behaviors and suicide rates are higher among kids who are teased or bullied about their weight.
Recommendations from the American Academy of Pediatrics include:
Supportive, unbiased role modeling from adults and professionals involved in the care of this population. Refrain from even suggestions of blame.
Make careful word and language choice when speaking about weight with young patients and with their family. Use of terms like weight, body mass index (BMI) and health should be the focus of discussions.
Obesity should be treated as a medical condition that requires a multi-focal treatment plan, involving the patient and the family. Use of problem lists with solutions can help to target the condition and its many aspects.
Healthcare settings should have appropriate sized furniture, gowns, toilets and other regularly used items that need to be sized for a larger patient. This will reduce feelings of humiliation.
Motivational interviewing is a technique that allows the patient, in this case a young person, to help identify the problems and solutions from their perspective. It’s a non-judgmental form of interaction between patient and healthcare provider.
Screenings for obesity should not just include the physical elements like weight, BMI, lab tests, other physical screenings, but also emotional comorbidity screenings that assess bullying, school performance, depression, anxiety, and low self-esteem.
Pediatricians, in particular, should be advocates in multiple settings. They can interface with school professionals to create and monitor anti-bullying campaigns. They can interface with the media for more honest, respectful and responsible portrayals of youth of all sizes. Pediatricians can also advocate for sensitivity training in medical schools since current rates of childhood and teen obesity suggest that these are the patients likely to be seen by newly graduating physicians. Pediatricians can help to empower parents and families to manage and address weight stigma. This is especially crucial in the lower socioeconomic stratospheres of society.