Wednesday, August 08, 2012

What parents feel about doctor's using terms that may stigmatize overweight kids?

In light of the importance of provider-patient dialogue and trust in managing obesity, this interesting article reviews the need to avoid terminology that either stigmatizes or discourages overweight individuals from addressing their weight problem. In addition, the authors discuss using terms that parents and patients might find motivational and could help providers manage the growing number of overweight children.

Methods. This study surveyed adults who were part of an international pool of survey participants in 2010. The respondents included 445 parents who had a child between 2 and 18 years old. Almost 60% of the respondents were women, 71% were white and 13% black, and 44% had at least 1 overweight child. More than 50% of the respondents were either overweight or obese on the basis of their reported height and weight, from which body mass index (BMI) was calculated. Just over one fourth (26%) of respondents had been teased or discriminated against because of their own weight, and 43% of the respondents had at least 1 child who was teased or discriminated against because of his or her weight.
During the survey, the investigators presented 10 terms in random order and asked the respondents to score them on a 1- to 5- point scale with respect to the term's desirability for clinicians to use when referring to their child's weight. The 10 terms were:
  • Extremely obese;
  • High BMI;
  • Weight problem;
  • Unhealthy weight;
  • Weight;
  • Heavy;
  • Obese;
  • Overweight;
  • Chubby; and
  • Fat.
The respondents rated, on the same scale, the degree to which each of the terms was stigmatizing as well as the degree to which they thought each term would motivate a child to lose weight. Finally, the participants were asked to respond to a question about how they would react if their child's healthcare provider referred to their child's weight in a way that made the child feel stigmatized. Options for that question included "speaking with doctor, avoiding future appointments, encouraging the child to lose weight," and other options.
Findings. With respect to the desirability of terms, the term "weight" was considered desirable by the greatest number of respondents. Second in rank was "unhealthy weight," followed by "high BMI." Those 3 terms were ranked very closely together by the respondents. The next 2 preferred terms were "weight problem" and "overweight." Five terms were considered undesirable: heavy, chubby, obese, and extremely obese., The term "fat" was the least desirable of the 10 terms.
When the parent was asked how stigmatizing the term for the child's weight would be, the order of responses was almost identical, with "fat" being the least desirable and "high BMI" being the least stigmatizing. The least desirable terms were also felt to be the least encouraging with respect to weight loss, whereas "unhealthy weight" or "weight problem" were the words that would be most encouraging to actually lose weight. Most (68%) parents reported that they would react to the use of a stigmatizing term by encouraging the child to lose weight, and 50% reported that they would discuss more encouraging terms with the provider. However, 35% of the parents reported that they would search for a new provider, and 24% would avoid future medical appointments. The investigators concluded that the terms "weight" and "unhealthy weight" were the terms preferred by parents for providers to use when referring to a child's weight problem and that the terms "fat," "extremely obese," and "obese" were the least desirable. They were also viewed as the most stigmatizing words.


I wonder how many providers felt that we were actually improving the situation when we began to use more objective terms such as "overweight" and "obese" as defined by Centers for Disease Control and Prevention's BMI percentiles? It certainly makes sense that the term "unhealthy weight" would be preferred, focusing on the goal of improving health and not stigmatizing an individual. This seems to be something that both patients and providers can get behind and support. Therefore, it might be worth making the term "unhealthy weight" part of our daily lexicon as one more weapon in the ongoing fight against childhood obesity.
Commentary: In India, most parents call an overweight child as being 'healthy'. Hence the term 'unhealthy weight' is not only less stigmatizing, but also confronts this issue head on! I would suggest that given the increasing problems related to obesity in adults (cardiac hospitals are the one of the fastest growing healthcare segment in India) it is imperative for Pediatricians to identify this problem in children, avoid stigmatizing the children/ parents, & encourage 'lifestyle changes' that focus not only on the child but the entire family to help the child lose weight.

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