Obese youth are often stigmatized by society, and this stigmatization can have drastic, and long lasting consequences ranging from decreased self esteem to increased suicidal ideation. And for those youth who remain obese into adulthood, they also face worse employment, educational opportunities and even stigmatization by healthcare professionals.

Knowing that obese youth face this sort of discrimination, and the toll this can take on parents, you have to wonder what effect Pediatricians can have. Given that parents put a lot of trust in pediatricians, and often pediatricians form the first port of call for parents concerned about their child’s weight, the words they use and the policies they promote can make a lot of difference to those concerned about their weight.

The Rudd Center for Food Policy and Obesity is a world leader in obesity stigma research

This led to a study being conducted Dr Rebecca Puhl and colleagues at the Rudd Center for Food Policy and Obesity at Yale University, where they asked parents what terms they would like pediatricians to use when talking about a child with a higher than ideal weight, and also what action they would take if their doctor used stigmatizing language. As I’ll talk about later, the article caused a bit of a firestorm online.

What did they do?

They used an online questionnaire to try and recruit a diverse sample of parents across the US. This was done by using banner ads, key words, search links, email and online invitations and was done by Survey Sampling International. They have an ongoing sample they can draw from, and invited parents to participate in the study. Of those who chose to participate, 84% (521) completed the survey. Via an online survey, they asked parents to report their BMI, and their child’s BMI. They then had to rank how desirable the following 10 terms were in describing a child who is above their recommended weight: extremely obese, high BMI, weight problems, unhealthy weight, weight, heavy, obese, overweight, chubby and fat. Finally, participants were asked what they would do if their doctor referred to their child’s weight in a way that made them feel stigmatized – would they continue seeing that doctor, help their child lose weight or avoid future appointments? The researchers then analyzed these data, and identified predictors of respondents’ answer preference.

What did they find?

Parental responses for the top three terms for describing a child who is above their ideal weight were “weight,” “unhealthy weight” and “high BMI.” The three least popular were “obese,” “extremely obese” and “fat.” The ranking of terms by how stigmatizing it would be for a child followed the same order as well. Finally, when parents were asked how they would react if the doctor used a stigmatizing term, approximately 68.6% of parents said they would encourage their child to lose weight, although 50.6% said they would talk to the doctor about using different language in the future. Surprisingly, this did not differ if the respondent had an obese child or not; 66.2% of parents of non-overweight or obese youth said they would encourage their (hypothetical) child to lose weight compared to 71.6% of parents of at least one overweight or obese child. Finally, they found that parents who had themselves experienced weight-based stigma were more likely to find the words stigmatizing, and also considered some terms to blame the child for the weight more than other parents who had not experienced weight based stigma.

And what now?

Perhaps the most striking finding from this is that many parents admitted that they would take drastic measures if stigmatizing language were used: 35.8% of parents said they would put their child on a strict diet. Contrary to the popular view among commentators on news sites, calling a “spade a spade” can potentially have damaging and far reaching consequences (links to media sites here, here and here). Words can be incredibly damaging – the current study looked at the effect of those words on parents, and completely ignored the effect of those words on the child in question (a possible area for future study). Pediatricians can dictate child relationships with healthcare professionals through the life course, and establishing a good rapport at a young age could promote healthy behaviours.

Puhl RM, Peterson JL, & Luedicke J (2011). Parental Perceptions of Weight Terminology That Providers Use With Youth. Pediatrics PMID: 21949145