Originally posted at the Obesity Action Coalition, so a little different than my usual posts. But do check them out.
I was talking with one of my public health students, the mother of an
eight-year-old, when she told me that she was worried about taking her
little girl to the doctor. She was embarrassed because she knew the
doctor was going to tell her that her child was “overweight.” How awful,
I thought, that advice about a child’s weight could be so uncomfortable
that a parent, even a student of public health, would rather just avoid
Is this real? Are doctors stigmatizing children affected by obesity
and their parents? If they are, how are they making their judgments, and
communicating them to patients?
What exactly do we mean by stigma? It’s not easy to define. Stigma is
the judgment of some aspect of a person’s physical appearance, health
or behavior. This includes a person’s weight. Stigmatization happens
when people are treated badly, blamed for their characteristic, or have
assumptions made about their behaviors. For example, many people with
obesity are judged for their size, with other people thinking that they
are lazy or lack control.
Although we are used to seeing stigmatizing ideas and pictures on TV
and in press, we don’t expect it at the doctor’s office. The unfortunate
truth is that, although some doctors are careful to avoid bias,
healthcare providers regularly pass judgment on children affected by
obesity and their families.
Few doctors are stigmatizing children and families on purpose.
Whenever a doctor sees a child for a regular visit, he or she has a long
list of information and advice they want to share with the child’s
parents. They want to see that the child is growing well, learning well,
creating healthy friendships, and getting the right vaccines, among
many other things. All of this is shared before the parents even get to
ask their own questions; it can be too much to squeeze into just a few
visits a year.
In the midst of all these discussions, doctors use growth charts to
tell parents that their child is affected by excess weight or obesity.
Many parents are surprised – children with obesity don’t look like
adults would expect. Children are naturally very thin, and can look thin
even if they are heavier than they should be.
This takes time to explain, and time is very limited in most doctor visits. The conversation can be difficult for parents and children. Many
patients feel like their doctor is judging them because of their
weight. They are often right to feel this way, as studies have shown
that a majority of medical students and doctors have negative beliefs
about their patients with obesity. It’s easy to see how these beliefs
can affect how they talk with their patients, even if they don’t intend
to be hurtful.
While most doctors agree that we should not pass judgment on
children, some do believe it is beneficial to put pressure on parents
for the child’s weight-loss, something that has been called “stigma
lite.” Yet we know that stigma in any form just doesn’t work. In fact,
it usually backfires, making families less motivated to make healthy
Most doctors who are trying to provide advice about obesity are not
knowingly stigmatizing the child or the parent. But, without a careful
approach to the subject, it is easy to see how parents may feel that
way. Doctors often give advice that seems easy, but is hard for many
families. When faced with the difficulties of daily life, it can be hard
to imagine how to help a child “just” be more active.
About the Author:
Asheley Skinner, PhD, is an Associate Professor of Pediatrics at the
University of North Carolina at Chapel Hill. She has written many
papers about the childhood obesity, including health outcomes and
obesity stigma. She is committed to developing ways to improve obesity
without causing unintended harm.