Latino Parents Perceptions of Weight

Terminology Used in Pediatric Weight Counseling

Shanna Doucette Knierim, MSN, CPNP; Alanna Kulchak Rahm, PhD;
Matthew Haemer, MD, MPH; Silvia Raghunath, MBA; Carmen Martin, MPH;
Alyssa Yang, BS; Christina Clarke, MS; Simon J. Hambidge, PhD, MD
From Ambulatory Care Services, Denver Health, Denver, Colo (Ms Knierim, Ms Raghunath, and Dr Hambidge); Department of Pediatrics,
University of Colorado School of Medicine, Aurora, Colo (Ms Knierim, Dr Haemer, Ms Yang, and Dr Hambidge); Geisinger Health System,
Danville, Pa (Dr Rahm); Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo (Dr Rahm, Ms Martin, and Ms Clarke); and
The Colorado School of Public Health, Aurora, Colo (Dr Hambidge)
Dr Hambidge has received royalties unrelated to this study from Elsevier for editing a general pediatric textbook. The other authors declare that
they have no conflict of interest.
Presented during a platform session at the Pediatric Academic Societies annual meeting, Washington, DC, on May 6, 2013.
Address correspondence to Shanna Doucette Knierim, MSN, CPNP, Ambulatory Care Services, Denver Health, 777 Bannock St, Mail Code
1914, Denver, CO 80204 (e-mail: shanna.knierim@dhha.org).
Received for publication June 4, 2014; accepted November 14, 2014.

ABSTRACT
OBJECTIVE: To identify which English and Spanish terms

weight problem, and overweight, finding them motivating,

confusing, or insulting. Parents found fat gordo and
obese obeso consistently offensive. Most participants found
growth charts and the term BMI confusing. Parents consistently reported that providers could enhance motivation and
avoid offending families by linking a childs weight to health
risks, particularly diabetes.
CONCLUSIONS: Demasiado peso para su salud (too much
weight for his/her health) was motivating to many Spanishspeaking Latino parents. Among English-speaking Latino
parents, no single English term emerged as motivating, wellunderstood, and inoffensive. Linking a childs excess weight
with increased health risks was motivating and valuable to
many parents regardless of language spoken.

Latino parents consider motivating, as well as culturally and

linguistically appropriate, for provider use during weight counseling of overweight and obese Latino youth.
METHODS: Latino parent perceptions of common Spanish and
English terms for overweight were discussed with 54 parents in
6 focus groups (3 English, 3 Spanish). Atlas.ti software was
used for qualitative analysis. An initial codebook was used to
code passages for English and Spanish terminology separately.
Subsequent changes to the coded passages and creation of new
codes were made by team consensus.
RESULTS: Demasiado peso para su salud (too much weight
for his/her health) was the only phrase for excess weight that
was consistently identified as motivating and inoffensive by
Spanish-speaking parents. Sobrepeso (overweight), a
commonly used term among health care providers, was motivating to some parents but offensive to others. Englishspeaking parents had mixed reactions to unhealthy weight,

KEYWORDS: Latina/latino; obesity; overweight children;

parental perceptions; weight counseling
ACADEMIC PEDIATRICS 2015;15:210217

WHATS NEW

have shown providers should avoid derogatory terms and

colloquial terms during weight counseling, but no
consensus exists for which terms to use.1014 A recent
survey of 400 parents reported the terms weight,
unhealthy weight, and weight problem to be the most
desirable and motivating terms for use in pediatric
weight counseling.3 However, the study included only
English-speaking parents with Internet access and did not
distinguish Latino from non-Latino parents. Although
prevalence of childhood obesity continues to be higher
among Latino and non-Latino black youth than among
non-Latino white youth,1519 national ambulatory data
have uncovered a notable disparity in the delivery of
preventive counseling20,21 and obesity counseling, with
non-Latino children 1.94 times more likely to receive
obesity counseling than Latino children22 and English
speakers up to 1.6 times more likely to receive diet and
physical activity counseling than Spanish speakers.23,24
Providers lack of self-efficacy in counseling, including

Latino parents identified demasiado peso para su

salud (too much weight for his/her health) as a motivating, inoffensive phrase for use during pediatric
weight counseling. Focus groups of Latino parents
identified no single English term that was motivating
and inoffensive.

HEALTH CARE PROFESSIONALS have a responsibility

to routinely determine a childs body mass index (BMI)
percentile and associated weight status and communicate
the screening results to the parents, according to the Institute of Medicine Committee on Prevention of Obesity in
Children and Youth.1,2 This challenges medical providers
and health educators to provide effective weight
counseling to families with overweight children while
using motivating,3,4 inoffensive,1,3 and culturally
appropriate terminology.59 Previous studies of adults
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Copyright 2015 by Academic Pediatric Association

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ACADEMIC PEDIATRICS

WEIGHT TERMINOLOGY

uncertainty in what terms are appropriate to describe

elevated BMI status, has previously been reported as an
important determinant of whether and how effectively providers discuss child weight status.25 Given the known
impact that culture has on perceptions of weight,2632
understanding the cultural perceptions of excess weight
and common weight terminology is critical. However, to
our knowledge, no previous research has assessed
Latinos perceptions of English and Spanish terms for
excess weight, resulting in a gap in provider knowledge
about how to counsel Latino families with overweight
youth in an effective, culturally and linguistically
appropriate manner.
This study examined Latino parents perceptions of
terms for excess weight. We hypothesized that English
terms for excess weight, even those deemed motivating
in previous literature, may be offensive or not well understood by English-speaking Latino parents; that common
terms and tools used in pediatric weight counseling may
not be preferred or understood by Spanish-speaking Latino
parents; and that cultural perceptions of weight status and
terms affect Latino parents receptiveness and response to
providers weight counseling efforts.

METHODS
STUDY SETTING AND POPULATION
Denver Health33 (DH) is Colorados largest safety net
health care system; most DH patients (98%) are below
200% of the federal poverty level. Of DH empaneled pediatric patients ages 2 to 18 years, 70% are Latino, over 50%
of whom are Spanish speaking.15 The majority of the
Latino families are of Mexican descent, most commonly
from the state of Chihuahua. While a recent national data
report shows 17% of youth are obese,16 18% of DHs pediatric patients are obese, amounting to over 9000 empaneled
pediatric patients with obesity.15 Of DHs Latino pediatric
patients, 20% are obese,15 compared to 15.5% statewide in
Colorado34 and 22% nationally.16 Colorado has been identified as 1 of 3 states to not show an improvement in early
childhood obesity.35
LATINO PARENT FOCUS GROUPS
Latino parents (one from each household) were recruited
via phone from a database of DH pediatric primary care
patients to participate in parent focus groups conducted
during a 6-week period in JuneJuly 2012. Inclusion
criteria for the study were: self-identified Latino (via medical record and confirmed during recruitment call), 18 to 80
years old, and the parent or grandparent/primary caregiver
of a 2- to 18-year-old primary care patient at DH (index
child). Parents were allowed to self-select into their
preferred-language focus group. Reminder letters (sent 1
week before) and reminder phone calls (1 to 2 days before)
encouraged attendance.
For the focus groups with Spanish-speaking parents,
158 families were contacted (320 total calls), 66 adults
were recruited (42% recruitment), and 31 adults attended
(47% attendance). For English-speaking focus groups,

211

410 families were contacted (675 total calls), 57 were

recruited (14% recruitment), and 23 adults attended (40%
attendance). The final 54 parents (31 Spanish speakers
and 23 English speakers) were assigned to 1 of 6 focus
groups according to the index childs age and weight
status and the parents language preference. Three separate
focus groups were held for each language, with 7 to 13
parents per group. The groups were arranged as follows:
1 English (FG1) and 1 Spanish group (FG2) for parents
of index children aged 2 to 18 years who were not overweight or obese; 1 English (FG3) and 1 Spanish group
(FG4) for parents of index children 2 to 6 years old who
were overweight or obese; 1 English group for parents
of index children 7 to 18 years old who were overweight
or obese (FG5), and 1 Spanish group for parents of index
children 2 to 18 year olds who were overweight or obese
(FG6) (ages 2 to 18 were combined in this group to accommodate scheduling constraints). Overweight was defined
as a BMI at or above the 85th percentile and lower than
the 95th percentile, while obesity was defined as a BMI
at or above the 95th percentile for children of the same
age and sex, using Centers for Disease Control and Prevention childhood growth curves.19,36 Parents were given a
$35 grocery gift card for participation. Lunch and bus
tokens for transportation were also provided.
Focus groups were led by bilingual facilitators (CM, SR)
who have extensive experience in focus group methodology. A structured focus group guide modeled from previous parent surveys about weight terminology3 and
created by team consensus prompted parents to brainstorm
terms and phrases for excess weight in children. Participants were then presented with a list of preselected common English or Spanish terms for overweight. These
terms were derived from terms identified in the pediatric
obesity literature and from focus groups with bilingual
health care personnel. Using the parent-generated list and
the preselected terms, parents were asked a series of questions about their perceptions of these terms for overweight,
including: Which of these terms have you heard your
childs doctor use?; What terms do you wish that your
childs doctor would use if the doctor wanted to discuss
that your childs weight was too high and was unhealthy?;
What terms make you want to help your child lose
weight?; Which of these terms would make you feel
proud of your childs weight?; and What terms would
offend you if a doctor used it to describe the weight of
your child?
Audiotapes of the parent focus groups were transcribed
in either English or Spanish. Spanish transcripts were
translated into English while preserving the Spanish terms
or phrases to describe overweight to enable coding based
on the parents original Spanish terms. Both the English
translation and the original Spanish passages were reviewed by bilingual study team members during coding.
It should be noted that while the focus groups were conducted in either English or Spanish and presented with
the language-concordant preselected term list, each group
commented on words from both languages. Parent focus
group participants also completed a demographic

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KNIERIM ET AL

questionnaire that queried past experiences with weightrelated bullying for the parent and child.
TERMS FOR OVERWEIGHT PRESENTED TO LATINO PARENT
FOCUS GROUPS
The following 10 previously studied English terms were
chosen to be tested with our English-speaking Latino parents: weight, unhealthy weight, high BMI, weight
problem, overweight, heavy, chubby, obese,
extremely obese, fat.3,1214
To our knowledge, there is no list of Spanish terms for
overweight that has been previously published or studied.
In order to generate a list of commonly used Spanish terms
to describe excess weight in children, we conducted 2 targeted focus groups with 12 Spanish-speaking health care
personnel led by experienced bilingual facilitators (SR,
CM) and the study team nurse practitioner (SK). Participants were provided lunch; no other incentives were provided. Ten participating DH pediatric providers included
4 pediatricians, 2 family medicine doctors, 2 physician
assistants, 1 nurse practitioner, and 1 registered dietitian.
Together, they averaged 10 years of clinical experience,
estimated 25% to 95% of families in their practices were
Latino (mean 70%), and estimated that Latino families or
patients chose to speak Spanish with them 10% to 94% of
the time (median 70%). Two topical experts also participated: a weight management and nutrition specialist/pediatrician, and a bilingual (first language Spanish) community
health outreach director specializing in pediatric weight
management programs. The primary languages of participants were Spanish (n 2), Spanish and English (n 2)
and English (n 8). These health care personnel focus
groups generated a list of Spanish terms for overweight
commonly used in weight counseling. These terms were
subsequently presented for comment to the Spanishspeaking parent focus groups: peso (weight), demasiado
peso para su salud (too much weight for his/her health),

ndice de masa corporal alta (high body mass index),
est
a engordando (getting fatter), sobrepeso (overweight), muy gordito (very chubby), gordito (chubby),
obeso (obese), muy gordo (very fat), and gordo (fat).
All study participants provided informed consent. The
study was approved by the Colorado Multiple Institution
Review Board.
DATA ANALYSIS
Parent focus group transcripts were entered into Atlas.ti
software for qualitative analysis of themes. Passages for
English and Spanish terminology or phrases were coded
and analyzed separately. The initial codebook was created
by researchers CM and AKR (our lead qualitative investigator) from episodic summaries of each focus group37 and
reviewed by the study team. All focus group transcripts
were then coded by a single coder (AKR) and reviewed
in team meetings for consensus. Changes were made
and new codes created as determined by the team. A second coder experienced in qualitative analysis (CM)
confirmed all codes after the initial coding and final coded
passages were summarized and reviewed with the study

ACADEMIC PEDIATRICS

team. Chi-square or Fishers exact tests were used to

compare sociodemographic characteristics between English- and Spanish-speaking parents.

RESULTS
All parent participants identified themselves as Hispanic
or Latino, and almost all were mothers (Table 1). Six participants were grandparents of the index child (2 in the English group, 4 in the Spanish group); the rest were parents.
Spanish-speaking parents were more likely than Englishspeaking participants to be born in Mexico (94% vs 13%,
P < .001), married (71% vs 30%, P .01), and have less
than a 9th grade education (48% vs 4%, P < .001).
English-speaking participants were more likely than
Spanish-speaking participants to report an annual income
less than $10,000 (36% vs 48%, P .05), to report being
teased, treated unfairly, or discriminated against because
of weight (57% vs 16% P .002), and to report that their
children felt teased, treated unfairly, or discriminated
against because of weight (44% vs 16% P .03).
Our analysis of parent responses yielded 3 main themes
that were prevalent throughout the focus groups, regardless
of parent language: 1) few phrases are suitable for use in
pediatric weight counseling with Latino families as a result
of parent perceptions and understanding of weight counseling terminology and tools; 2) linking a childs excess
weight to health issues may motivate Latino parents; and
3) concern for excess weight in children is affected by cultural perceptions of weight and weight terminology.
FEW PHRASES ARE SUITABLE FOR USE IN PEDIATRIC
WEIGHT COUNSELING WITH LATINO FAMILIES
Latino parents identified few words or phrases that were
perceived as motivating, inoffensive, and desirable for providers use during pediatric weight counseling. Many
Spanish and English terms were confusing or offensive
to focus group participants. Among Spanish-speaking
Latino parents, demasiado peso para su salud (too
much weight for his/her health) was the only phrase for
excess weight that was consistently identified as motivating, inoffensive, appropriate, and desirable for use by
providers in pediatric weight counseling. Parents in 2
Spanish focus groups volunteered additional evidence
that demasiado peso para su salud may be the most motivating Spanish weight counseling phrase (Table 2, quotes
13). Many parents also reported sobrepeso (overweight) to be a motivating term (Table 2, quote 4) and identified it as the most commonly used term by their childrens
providers. However, other parents reported sobrepeso to
be offensive (Table 2, quote 5). Motivating properties of
other Spanish phrases were discussed, such as subido de
peso (gaining weight) or demasiado peso para su estatura (too much weight for his/her height). However, demasiado peso para su salud (too much weight for his/her
health) was the phrase most frequently characterized as
motivating and desirable for doctors to use, and it was
the only term that was then further qualified as motivating
during parent discussion. Among English-speaking Latino

ACADEMIC PEDIATRICS

WEIGHT TERMINOLOGY

213

Table 1. Sociodemographic Characteristics of Latino Parents

Characteristic
Gender
Male
Female
Age
2132 y
3350 y
5170 y
Refused/missing
Primary language at home
Spanish
English
Country of birth
United States
Mexico
Other (Guatemala)
Education
Less than 9th grade
Some high school
High school graduate
Some college
Annual household income
<$10,000
$10,000$30,000
>$30,001
Refused/missing
Marital status
Married
Separated or divorced
Single
Widowed
No. of children per family
12
34
510
Total no. of children of focus group participants
Ages of all children
01
25
611
1218
>19
Missing

English Language,
n (%) (n 23)

Spanish Language,
n (%) (n 31)

Total,
n (%) (n 54)

2 (9)
21 (91)

1 (3)
30 (97)

3 (6)
51 (94)

7 (30)
13 (57)
2 (9)
1 (4)

9 (29)
18 (58)
4 (13)
.

16 (30)
31 (67)
6 (11)
1 (2)

3 (13)
20 (87)

30 (97)
1 (3)

33 (61)
21 (39)

20 (87)
3 (13)

1 (3)
29 (94)
1 (3)

21 (39)
32 (60)
1 (2)

1 (4)
10 (44)
11 (48)
1 (4)

15 (48)
4 (13)
10 (32)
2 (6)

16 (30)
14 (26)
21 (39)
3 (6)

11 (48)
7 (30)
5 (22)
.

11 (36)
12 (39)
2 (6)
6 (19)

22 (41)
18 (33)
7 (13)
5 (11)

7 (30)
5 (22)
11 (48)
.

22 (71)
3 (10)
5 (16)
1 (3)

29 (54)
8 (15)
16 (30)
1 (2)

9 (39)
8 (35)
6 (26)
79

10 (32)
18 (58)
3 (10)
106

19 (35)
26 (48)
9 (17)
185

2 (3)
19 (24)
28 (35)
20 (25)
10 (13)

4 (13)
23 (22)
37 (35)
20 (19)
19 (18)
3 (3)

6 (3)
42 (23)
65 (35)
40 (22)
29 (16)
3 (2)

P
.57

0.77

<.001*
<.001

<.001

.05

.01

.15*

.59

*P values were calculated by Fishers exact test, except for primary language and number of children, for which the chi-square test was
used.

parents, no English term emerged as motivating, well understood, and inoffensive. Parents had mixed reactions to
the terms unhealthy weight, and weight problem
(identified in previous work as motivating terms3) and
overweight; these terms were motivating to some parents, confusing to others, and insulting to still others
(Table 2, quotes 613). Parents also were confused by
the term unhealthy weight because it could apply to children who were either overweight or underweight (Table 2,
quote 6). No English terms or phrases from either the previously studied 10 English terms3 or from parent brainstorming met the criteria of motivating, well understood,
and inoffensive. The English phrase too much weight
for his/her health (the direct translation of the wellreceived Spanish phrase demasiado peso para su salud)
did not arise during focus group discussion.

Across both language groups, parents were insulted by

the terms obeso and its English equivalent, obese, as
well as gordo and its English equivalent, fat. There
also was agreement that any term can be insulting; how
the word is said by the provider can determine how offensive it appears: Yo sea, no me molesta, lo que me dijo, sino
como me lo dijo. Eso es lo que a veces si te molesta (I
mean, it doesnt bother me, what they said, but how they
say it to me. Thats what can indeed bother you sometimes).
Limited parent understanding of weight counseling tools
and terminology was evident during both English and
Spanish focus groups. Most parents could not verbally
define BMI (body mass index) and found it confusing;
one parent suggested BMI meant blood pressure. When
asked if they understood the phrase
ndice de masa

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KNIERIM ET AL

ACADEMIC PEDIATRICS

Table 2. Parents Perceptions of Terms

Theme 1. Few Phrases Are Suitable for Use in Pediatric Weight Counseling With Latino Families
Spanish-Language Comments
Demasiado peso para su salud (Too much weight for his/her health)

les te

rminos Uds. desean que el doctor utilice cuando les habla acerca del peso de su nin
~o? (What terms do you
1
Moderator: Cua
want the doctor to use when he talks to you about your childs weight?)
Participant: Demasiado peso para su salud.(Too much weight for his health.)

s adecuada, demasiado peso para su salud? (You think thats the best one, too much weight
Moderator: Ud. cree que es la ma
for his health?)
Multiple Participants: S
. (Yes.)

la salud del nin
~o en medio. (Well. the
2
Bueno. la frase que s
me motiva es demasiado peso para su salud. Esto es porque ya esta
phrase that motivates me is too much weight for his health. That does it for me because the health of my child is in the balance.)

les de estos te

rminos Ud. escucha que Ud. dice, Oh, necesito cambiar la nutricio

n, necesito no darle grasa?
3
Moderator: Cua
(Which of these terms do you hear that you say, Oh, I need to change their nutrition, I need to not give them fatty food?)
Participant: Su hijo tiene demasiado peso para su salud, eso afecta a m
, as
sea poquito, mucho, es cuando me preocupa.
(Your child has too much weight for his health. That affects me, whether its a little or a lot, thats when I get worried.)
Sobrepeso (overweight)
~os pierdan peso, cua

l de esas palabras si el doctor utiliza. les puede motivar a hacer algo? (So your
4
Moderator: [Para] que [los] nin
kids lose weight, which of these words could the doctor use. to motivate you to do something?)
Participant A: Sobrepeso. (Overweight.)
Participant B: Sobrepeso. (Overweight.)

les de estos te

rminos que tenemos aqu
en las dos listas a Uds. las ofende? (Which of these words that we have
5
Moderator: Cua
here in the two lists offends you?)
Participant: Sobrepeso. (Overweight.)
English-Language Comments
Unhealthy weight
6
I dont like [unhealthy weight] just because my son, hes a little, itty bitty thing and according to doctors hes unhealthy because now
hes too small and he doesnt eat as much. And my daughter, shes unhealthy weight because shes a little bit more chunky. So I
dont like it. Its kind of confusing when I hear the word.
7
If she said its an unhealthy weight. What can I do to change it and make a healthier environment?. I think unhealthy weight would
be the best for me.
Weight problem
8
You never know, OK, is it over or is it in-between or is it average, you know what I mean?
9
Its motivating to me, I want to get the problem solved before it gets too late.
10 But a weight problem. I took it offensive. it hurt me.
Overweight
11 [If] my doctor told me my son or daughter was overweight, I would change their life and my life to eat healthier.
12 When [doctors] say your child is a little overweight, [parents] just say, oh OK. Thats it. They dont want to talk or discuss anymore about
it because thats questioning what you are feeding them or if youre a good parent or not.
Overweight/obese
13 A lot of people dont know what obese or overweight means, its just oh, theyre just thinking Im fat or ugly.
Theme 2. Linking a Childs Excess Weight to Health Issues May Motivate Latino Parents
English-Language Comments
14 It could cause health issues. Put that in there somewhere in your conversation.
15 [Doctors] need to let them know, this is what the risks are with your son or daughter being overweight.
Spanish-Language Comments

s que nada porque lesen el caso de mi hija pueda darle el diabetis. (Well more than anything becausein my daughters
16 Pues ma
case, she can get diabetes.)

un poquito pasada de peso, tiene que cuidar su salud, tiene que
17 La pediatra nunca me ha hecho sentir mal, siempre me ha dicho esta
hacer ejercicio, pero nunca lo ha hecho con una manera de ofenderme o de hacer sentir mal a mi hija.. Simplemente le ha dicho
que tiene que cuidar su salud, su peso. (The pediatrician has never made me feel bad, shes always said shes a little overweight,
you have to watch her health, you have to exercise, but shes never said it in a way that offends me or that makes me feel bad about
my daughter.. Shes simply said to take care of your health, your weight.)

corporal alta (high body mass index), multiple Spanish

speakers responded, Pues, yo no le entiendo muy bien
(Well, I dont understand it very well). Similarly, many parents reported receiving, but not understanding, growth
charts when used for weight counseling of their child:
Then [doctors] show you on the graph and its going up
and up, so Im like, well, is she getting this way or shes
getting this way? So theyre saying shes too tall for her
age or something? and They give [growth charts] to
you at your physicals. I got one at my daughters and I
did not understand it.

LINKING A CHILDS EXCESS WEIGHT TO HEALTH ISSUES

MAY MOTIVATE LATINO PARENTS
The importance of linking a childs excess weight to
health risks, particularly diabetes, was emphasized by
English- and Spanish-speaking participants during 5 of
the 6 focus groups (Table 2, quotes 1417). By emphasizing the link to health risks, parents explained that providers can motivate families to make healthier diet and
exercise choices without offending them. High blood pressure, heart disease, and bad heart and lung also appeared
to help English-speaking parents understand the health

ACADEMIC PEDIATRICS

risks associated with excess weight in children.

Conversely, when the childs weight was not related to
the childs health, parents often viewed the weight counseling discussion as a criticism of the childs appearance
or their own parenting: This could affect her life, her
whole life. See and I didnt understand that because I
was a young mother and I didnt understand what obese
meant.. I just understood that it was offensive and youre
saying that my childs fat.
CONCERN FOR EXCESS WEIGHT IN CHILDREN IS AFFECTED
CULTURAL PERCEPTIONS OF WEIGHT
Many focus group participants expressed strong aversion to having an underweight child and preference for a
heavier child. While parents discussed their personal preference for large babies and the social stigma associated
with thin babies, it was evident that pride in a childs excess
weight extended beyond infancy: You want your kids to
be the strongest. You want them to be the biggest so they
can dominate, and Entre los otros Latinos, los Hispanos,
si esta un ni~
no as
grande, gordo, as
, dices, Mira que lleno
de vida esta (With other Latinos, the Hispanics, if a child
is big, fat, you say, Look how full of life he is).
Many parents did not think excess weight in their children was concerning for a variety of reasons, including
family genetics and a childs young age. Examples include:
It wasnt that she was overweight, it was just that she was
bigger, taller like her dad, and Why are you telling my
daughter she has a fat roll at 7? One participant even
stated that she had never seen an obese child. However,
other parents did express deep concern for their childs
weight status: You know your kids are overweight, its
really scary and its like you have your hands tied just
watching them getting heavier and heavier, you know,
because I have the older kids that are heavier and one is
just so extremely huge that Im justevery day I worry
about him.
Cultural connotations of weight-based terminology were
prevalent in the focus groups. Some words or phrases themselves engendered pride or affection rather than stigma.
Parents reported the following terms could make them
feel proud about their childs weight, not concerned: above
average, big, chubby, pudgy, tan gordo/gorda (so
fat), gordito/a (chubby), and est
a muy grande (he/she
is very big). Multiple participants discussed the common
use of weight-based nicknames in Latino families. For
instance: My family has always had a gorda [fatty].
[and] a flaca [skinny]. I have aunties that I call gorda,
flaca. Parents reported that gordis (little fatty), gordito (chubby), and panz

on (big belly) are often used as
terms of endearment or nicknames for children.

BY

DISCUSSION
This study was the first, to our knowledge, to capture
Latino parents perceptions of weight terminology in English and Spanish. Among Spanish-speaking Latino parents, the phrase demasiado peso para su salud (too
much weight for his/her health) was seen as motivating

WEIGHT TERMINOLOGY

215

and appropriate for providers use during youth weight

counseling. Some parents also reported sobrepeso to be
a motivating term during direct questioning from the preselected list, while other parents had mixed reactions to the
term, reporting it to be offensive. Demasiado peso para
su salud (too much weight for his/her health) may be
perceived more favorably by parents because it was further
qualified as motivating during parent discussions, and it
automatically links excess weight to health, an association
reported to be valuable by many parents.
There was no English term or phrase that was viewed as
motivating, well understood, and inoffensive by our
English-speaking Latino participants. However, parent
focus groups did elucidate the following: 1) while previous
literature identified unhealthy weight, and weight problem as the terms most motivating to lose weight,3 many
English-speaking Latino parents were confused or offended by these terms which do not distinguish between
overweight and underweight issues; 2) by avoiding terms
that produce a sense of pride (ie, above average,
chubby, tan gordo/gorda [so fat], and est
a muy
grande [he/she is very big]) or terms that may be common
familial nicknames (gordito [chubby]), providers may
have more success engaging families in effective weight
counseling discussions; and 3) linking a childs excess
weight to health risks was important to both English- and
Spanish-speaking Latino caregivers. Linking excess
weight to health problems, particularly diabetes, appeared
to help parents understand a provider was concerned about
the childs health and not just critical of the childs appearance or the adults parenting. Without this link, parents
gave many examples of being offended, becoming defensive, or refusing to return to that provider. Providers may
avoid offending families and enhance family motivation
by either using specific phrases that link the childs weight
to increased health risks (demasiado peso para su salud
[too much weight for his/her health]) or deliberately
creating a context of excess weight negatively affecting
health within which other terms for overweight may be
used. In this manner, a providers tone and the context
may impact reception of weight counseling more than specific words used.
Although the term BMI and the use of growth charts
were not well understood by parent focus group participants, it should be noted that alternative methods to
communicate BMI and weight status to low-literacy and
minority populations, including using color-coded growth
charts, have been demonstrated to be effective.38 However,
these low-literacy tools were not in use at the time of the
focus groups.
This study is limited by the small sample size, which was
a result of the focus group methodology. Additionally, our
sample of participants was limited almost exclusively to
low-income families of Mexican origin, so other diverse
Latino populations may not only produce different perceptions of terms but also result in altogether different weight
terminology. Although we examined over 10 terms in each
language and participants brainstormed for additional
terms, our lists were not exhaustive; additional terms in

216

KNIERIM ET AL

both languages may warrant examination. We are also

limited in our ability to characterize the context or tone
used by providers when the studied terms were presented.
Finally, attendance rates ranging from 40% to 47% may
limit the generalizability, while the low recruitment rate
of English-speaking Latino parents suggests caution in interpreting those results.
To assess whether these findings, particularly the favorable perception of demasiado peso para su salud, can be
generalized to a broader population, we surveyed over 500
Latino parents of pediatric patients and will report these results separately. We will assess how the English translation
of demasiado peso para su saludtoo much weight for
his/her healthwas received by English-speaking Latino
parents, assess weight-related behavioral intentions of
caregivers, and explore weight-loss assumptions among
Spanish-speaking and English-speaking groups.

CONCLUSIONS
Provider weight counseling with Latino families can be
improved by linking a childs weight to health, understanding Latino families cultural perceptions of weight status
and weight terminology, and exploring more effective
ways to communicate about growth charts and BMI terminology. In talking with Spanish-speaking Latino parents
with overweight children, providers may want to explore
the use of the phrase demasiado peso para su salud
(too much weight for his/her health) to motivate families
to make healthy changes, but more research needs to be
done to verify the generalizability of these focus group results and to further investigate motivating, inoffensive English terms to use with Latino families.
ACKNOWLEDGMENTS
Funded by the Kaiser Permanente Colorado Community Benefits
Program and in-kind support of Denver Health (co-PIs, Dr Hambidge
and Ms Knierim).

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