I weigh my words (pun intended) every time I address the topic of a childs

obesity in the exam room. Yes, I know, you probably want to tell me that I
shouldnt use that word obese and I promise that I dont. But in the
childs electronic medical record, thats the official coding if the childs body
mass index is at or above the 95th percentile for age and gender. And medical
providers, just like parents, may find themselves walking a difficult line as
they try to discuss this fraught subject without increasing the distress that
many children are already feeling.

Guilt and blame dont motivate change, they just make people feel bad, and
when people feel bad, they dont tend to be motivated toward healthy
behavior, said Dr. Stephen J. Pont, an assistant professor at the University of
Texas Dell Medical School.

Dr. Pont is one of the lead authors of a new policy statement issued jointly by
the American Academy of Pediatrics and the Obesity Society titled Stigma
Experienced by Children and Adolescents With Obesity. The statement,
published online Monday in the journal Pediatrics, advises pediatricians
to use neutral words like weight and body mass index rather than terms
like obese and fat. The authors also suggest we use language that puts the
person before the condition, as in, a child with excess weight rather than an
overweight or obese child.

More broadly, the authors advise that medical practices need to look carefully
at their procedures and their attitudes to make sure they arent building in
biases against overweight children, and beyond that, they want us out there
advocating against this kind of stigma in society. And they put this advice in
the context of an extensive research literature on how very common it is for
children to be teased and bullied because of their weight, and how very
counterproductive that is.

For all the attention paid to weight and its health effects in medical settings,
the social and emotional side is often neglected, said Rebecca Puhl, a clinical
psychologist who is a professor in the department of human development and
family studies at the University of Connecticut, and the other lead author on
the policy statement. Weight is now one of the most frequent reasons kids
are teased or bullied, she said. In addition to the well-documented effects on
childrens mental health and self esteem, she said, research has shown very
harmful effects on childrens eating behavior, and increased risk that they will
stay sedentary and gain weight.

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RECENT COMMENTS
Buzz
23 minutes ago
Weight is now one of the most frequent reasons kids are teased or bullied...
????!?now? Someone revoke this persons PhD.
Suzanne
32 minutes ago
I would have benefited from more interest in why I isolated myself from others. The
physician is looking at the physical manifestation of...
Cathy
32 minutes ago
I have 3 children and all are relatively active and none are obese or even close. I let
them have snacks etc but one thing I have totally...

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In a study published earlier this year in the journal Preventive Medicine, Dr.
Puhl and her colleagues looked at the longitudinal effects of teenagers being
teased about their weight. The study involved over 1,800 people who had
been followed for 15 years and are now in their mid 30s.

Weight-based teasing in adolescence predicted obesity, and also eating food

to cope with emotions, Dr. Puhl said. These teasing experiences have long-
lasting implications for health and for health behavior. For women
especially, these adolescent experiences of teasing by peers or family
members were associated with binge eating, poor body image, obesity, and a
 higher B.M.I. 15 years later, she said; for men there were some of the same
associations, including obesity as adults, if they had been teased by their
peers as adolescents.

Research shows that two-thirds of adolescents in weight-loss camps report

being bullied or teased about their weight, over 90 percent of the time by
their peers, Dr. Puhl said. A third report that they are also teased by family
members. Pediatric health professionals may be one of the few allies to offer
support and try to prevent harm.

My colleague Dr. Mary Jo Messito, the director of the pediatric obesity

program at Bellevue Hospital, said, the worst thing to do is go into the room
with an 11-year-old girl and say, your child is obese, the child will start to cry.
She recently saw a boy whose mother kept bringing up, You dont want to be
like uncle so and so, he had to have this operation, he almost died the kid
is now terrified.

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Katherine Bauer, an epidemiologist who is an assistant professor in the

department of nutritional sciences at the University of Michigan School of
Public Health in Ann Arbor, cited what she called the prevalent belief that
people dont know theyre heavy, and if we just inform them they will
magically be motivated for behavior change. In fact, she said, weight stigma
does exactly the opposite; criticizing and inducing shame only make people
feel terrible about themselves, not motivated or capable of making changes.

We are all, including our children, living in a culture that is profoundly

critical of excess weight and at the same time constantly offering
opportunities and advertisements for overindulgence. Its important to focus
on positive reinforcement and not jump to negative, Dr. Pont said. What this
 means, for parents and for health providers, is to make sure we see the child,
not just the number on the scale. Recognize that a child is far more than
what their weight is, praise them for all the positives, so when we get to some
of the more challenging topics, they can still maintain their self-esteem, Dr.
Pont said.

And that time in the exam room has to include talking about nutrition and
exercise, but the focus should be on health or health behavior rather than
looking thin, fitting into certain pants, Dr. Puhl said. So its absolutely
reasonable to talk about eating patterns, about family meal times, about what
foods kids choose at home and at school, about screen time and exercise. Of
course, excess screen time or too much junk food are problems even if youre
thin.

The most effective way for parents to help a child is to make healthy changes
for the whole family, regardless of shape or size, Dr. Pont said. Try making
small changes slowly, like adding one new green vegetable into the family
diet, not keeping sugary drinks in the home or walking to school instead of
driving.

And yes, to bring up the big turkey in the room, Thanksgiving is upon us; here
come the relatives. If you have a child for whom this is a sensitive subject, try
to make sure that no one spoils that childs day. When it comes to a childs
weight or eating habits, the Thanksgiving table is not an appropriate place to
be commenting, Dr. Puhl said.

Public discussions at the table that are teasing or negative are not helpful,
Dr. Messito said, and some people will overeat in response to feeling stressed.

114COMMENTS
And all the experts recognize that one essential message to children is that
however important healthy changes in their diet may be, they can still enjoy
special days and special treats and special meals. Enjoy the holiday; make
the changes not on a holiday, Dr. Pont said.

Food is our way of connecting with people, especially around Thanksgiving,

our way of bringing people together and showing thankfulness, said Dr.
Bauer. Lets have a shaming-free Thanksgiving where we just enjoy
ourselves.