Key Pediatric Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

January 10, 2018

In This Article

Pediatric Obesity Stigma

American Academy of Pediatrics and the Obesity Society

Role Modeling

It is important for pediatricians and pediatric health care professionals to demonstrate and model professional behavior with colleagues, staff, and trainees that is supportive and nonbiased toward children and families with obesity. These efforts should include the recognition and acknowledgment of the complex etiology of obesity, including genetic and socioeconomic factors, environmental contributors, community assets, family and cultural traditions, and individual choices. This recognition can help dispel common assumptions and stereotypes that place blame and judgment solely on individuals for having excess weight or difficulties achieving weight loss.

Language and Word Choice

It is important for pediatricians and pediatric health care professionals to use appropriate, sensitive, and nonstigmatizing language in communication about weight with youth, families, and other members of the pediatric health care team. Words can heal or harm, intentionally and unintentionally. Recent evidence shows that neutral words like "weight" and "body mass index" are preferred by adolescents with overweight and obesity, whereas terms like "obese," "extremely obese," "fat," or "weight problem" induce feelings of sadness, embarrassment, and shame if parents use these words to describe their children's body weight. Furthermore, using people-first language is one step to help reduce the use of potentially stigmatizing language, and it is now emerging as the preferred standard with obesity as well as other diseases and disabilities. People-first language places the individual first before the medical condition or disability and involves using phrases such as "a child with obesity" rather than an "obese child."

Clinical Documentation

Obesity is a medical diagnosis with real health consequences, so it is important for children and families to understand the current and future health risks associated with the degree to which a patient weighs more than what is healthy. However, this should be addressed with a balanced and empathetic approach, so that the information is conveyed and understood in a sensitive and supportive manner. Using more neutral terms, such as "unhealthy weight" and "very unhealthy weight," both in clinical notes and when speaking to patients and family members, can assist in these efforts. Electronic health records and medical coding nomenclature could consider using the terms "unhealthy weight" and "very unhealthy weight" instead of "obesity" and "morbid obesity" in problem lists to further support the use of patient-sensitive language during clinical encounters.

Behavior Change Counseling

Beyond specific word choice, it is recommended that patient-centered, empathetic behavior change approaches, such as motivational interviewing, be used as a framework to support patients and families in making healthy changes. Through motivational interviewing, health care professionals collaboratively engage the patient and/or parents in determining their goals and addressing barriers to how they will achieve sustained health behavior change.

Clinical Environment

Pediatricians should create a safe, welcoming, and nonstigmatizing clinic space for youth with obesity and their families. This requires creating a supportive practice setting that accommodates patients of diverse body sizes, from the clinic entrance to the examination room.

Behavioral Health Screening

Addressing weight stigma in clinical practice also necessitates that pediatricians assess patients not only for physical but also for emotional comorbidities and negative exposures associated with obesity, including bullying, low self-esteem, poor school performance, depression, and anxiety. These are often overlooked but can be signs that a child is experiencing weight-based bullying.

Parents

It is important for pediatricians and pediatric health care professionals to work to empower families and patients to manage and address weight stigma in schools, communities, and their homes. Pediatricians can encourage parents of patients to actively inquire with their children's teachers and school administrative staff to ensure that plans are in place to address weight-based victimization in their institutions. Parents should also be asked to consider potential weight stigma at home, of which friends and family members can be sources. Finally, because the rates of obesity are higher in communities that are socioeconomically challenged and in communities of color, additional stigma attributable to race, socioeconomics, and sex could further compound the weight stigma experienced by some individuals, families, and communities.

References

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