Preventing Childhood Obesity

Obesity: Reducing Weight Bias, Stigma and Discrimination

By: Nancy Trout, MD, MPH

The American Academy of Pediatrics (AAP) recently released the Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity, describing the condition for the first time as a common, complex, and chronic disease with multiple potential associated health complications. The significance of this is far reaching for children and their families, as obesity currently affects over 14 million children and adolescents in the United States. The policy guidelines also emphasize the existence of risk factor inequities and how they contribute to racial and ethnic disparities for children and adolescents with obesity.

Read the Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity.

People with obesity face a pervasive and durable form of social stigma that continues to be perpetuated and accepted by society. Obesity as a condition has long been viewed as a consequence of a person’s poor choices to eat too much and move too little. Entertainment and cultural norms often portray people with obesity in dehumanizing and belittling ways, using unflattering images or portraying them eating unhealthy or large quantities of food. The reality is that it is a complex, multi-factorial disease with genetic, epigenetic, physiologic, environmental, and socioeconomic contributors. Children who have obesity should not be stigmatized. Their body habitus is neither their fault nor their choice.

 Obesity Bias, Stigma, Discrimination

Weight bias, stigma and discrimination occur along a continuum. Weight bias encompasses both conscious and unconscious beliefs and attitudes about people with obesity. Weight stigma includes social devaluation of individuals and can also be directed at parents and caregivers. Stigma towards parents often leads to feelings of isolation, blame and fear for the health of their child or suspicion of neglect. Weight discrimination includes overt weight-based prejudice and unjust treatment in schools, in health care offices, in workplaces and in society. Pediatricians and other health care providers have been, and continue to be, a source of weight bias.

The AAP recognizes that children and adolescents with obesity frequently experience weight-based victimization, including teasing and bullying, by adults, peers, teachers, and even family members. This weight shaming can lead to poor self-esteem, anxiety and depression, school avoidance, poor academic performance, and social isolation, which combine to worsen a child’s health trajectory.

Intervention Strategies

The AAP guidelines stress the importance of healthcare providers communicating support and alliance with children, adolescents, and families as they evaluate and treat patients. Discussing weight and obesity with families can elicit strong and emotional responses, and acknowledging the experiences that patients have while focusing on their health will help establish a foundation for treatment. Some of the strategies recommended by the Joint International Consensus Statement for ending the stigma and supported by the AAP include:

  • Increasing personal awareness through taking an Implicit Association Test (IAT) on the topic of weight
  • Recognizing the complexity of obesity as a chronic disease rather than personal choice
  • Placing a greater focus on health instead of weight
  • Using person first language: a patient with obesity instead of an obese patient
  • Using non-stigmatizing images in patient education and other literature
  • Treating individuals with obesity with dignity and respect

Ending obesity bias, stigma, and discrimination begins with awareness and acknowledgment, of both our individual beliefs and of obesity as a complex chronic disease of energy dysregulation. Creating a culture of inclusion and belonging must be expanded to include acceptance of people at all weights without judgment or discrimination. 

Nancy Trout, MD, MPH, is a primary care pediatrician and co-director of Start Childhood Off Right, which is a childhood obesity prevention initiative of Connecticut Children’s Office for Community Child Health.

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