Youth Weight Bias and Discrimination in Healthcare Settings, April 2010

Youth Weight Bias and Discrimination in Healthcare Settings, April 2010

OVERVIEW OF POSITION

The Obesity Society (TOS) strongly opposes any form of weight bias or discrimination, and is committed to increasing public awareness about weight bias and its negative consequences for those affected.

RECOMMENDATIONS 

Actions coming from the White House Obesity Initiative call for all pediatricians to assess children’s BMI and to provide information to parents to help their child achieve a healthy weight through nutrition and physical activity (7). Recommending that pediatricians help monitor their patients more actively and support their patients in their weight management efforts should help normalize conversations about weight. Pediatricians will need to become more comfortable initiating and maintaining dialogues about the role of health and weight. Providers should assess their own biases to ensure they are providing the best quality care to their patients. 

To address the issues of youth weight bias in the healthcare system, the Obesity Society’s Anti-Weight Discrimination Task recommends the following:

  • Include language about weight bias in healthcare organizations’ patient rights policies, and require weight bias training for all healthcare professionals (8). 
  • Encourage healthcare providers to seek out training on motivational interviewing to enhance their competence and comfort in facilitating proactive conversations about weight. Understanding family challenges and directing parents to the best available resources to address their specific needs should be a part of this discussion. 
  • Provide resources to pediatricians to enhance their efforts to support parents in making family changes. This might include a list of offerings within the healthcare system or community-based resources such as YMCAs or other entities that offer children’s health/lifestyle programs. Programs targeting parents should also be made available. 
  • Encourage pediatricians to have regular conversations about weight-related behaviors with ALL their patients (not just overweight youth). This normalizes the conversation and frames it in the context of health as opposed to weight.

BACKGROUND AND STATEMENT OF THE PROBLEM

The obesity rates among children have reached an alarming level. Close to 20 percent of U.S. children from ages six to 17 years of age are obese (1). When overweight status is also considered, approximately 33% of U.S. children in the U.S. are classified as overweight or obese (2). In spite of the prevalence of obesity within this age group—and increased attention being given to this issue through the creation of initiatives such as First Lady Michelle Obama’s Let’s Move Campaign—weight bias among youth is still occurring. Research suggests that approximately 60 percent of obese girls and boys report being victimized by other children (3), and have increased odds of being bullied regardless of their gender, race, family socioeconomic status, school demographic profile, social skills or academic achievement (4). Weight bias in youth can have devastating effects, both physically and emotionally. Response to such treatment by some children includes resorting to unhealthy habits such as binge eating or purging in order to lose weight. Others avoid participating in physical games or sports due to embarrassment or fear of being ridiculed. This leads to a more sedentary lifestyle that contributes to poor health and additional weight gain. Many obese youth suffer from low self-esteem, poor school performance, and social isolation. (5)

Weight bias directed towards children comes not only from members of their peer group and other youth, but may also come from adults, including healthcare providers. Doctors have the same bias against individuals who are obese as other members of the general public. They tend to believe their obese patients lack will power, are lazy and unwilling to put in the hard work to gain control over their weight (6).

Patients are not immune to this bias. Children, particularly adolescents, who are trying to develop their sense of self, are even more vulnerable to negative messages and attitudes from providers.

Obese children are sometimes blamed for their weight status and may be less likely to receive equal treatment than normal weight children. Negative attitudes and unfair treatment by providers can jeopardize the healthcare of individuals who may be reluctant to come back for follow-up care or seek out preventive care.

It is not only children who may be the targets of weight bias, but their parents as well. These caregivers often feel frustrated and confused. They may be the targets of blame from society for not “attending to” their children’s health while simultaneously not knowing where to find resources and programs to help address their child’s weight.

Healthcare providers are a key resource that parents rely upon for their healthcare information. Their role provides an optimal opportunity to be cheerleaders and trusted resources for information on how to alter a child’s obesity trajectory. A child’s primary healthcare provider is ideally situated to consistently raise the issue with parents and children and help inform families about the role of the environment and lifestyle in the obesity epidemic. In addition, they can offer, in a supportive and nonjudgmental way, strategies and tools for behavior changes.

Unfortunately, many healthcare providers do not take advantage of this opportunity to promote healthy, weight-related behaviors. They may fear angering parents, may not be able to suggest approaches for addressing weight in any sustainable way, or may be frustrated at the lack of available community programs designed to address this issue in a comprehensive manner.


References

  1. Federal Interagency Forum on Child and Family Statistics. (2009). America’s Children: Key National Indicators of Well Being, 2009. Washington, DC: Federal Interagency Forum on Child and Family Statistics.)
  2. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008 JAMA. 2010;303(3):242-249.
  3. Rudd Center for Food Policy & Obesity http://www.yaleruddcenter.org/what_we_do.aspx?id=207
  4. Lumeng JC, Forrest P, Appugliese DP, Kaciroti N, Corwyn RF, Bradley RH. Weight Status as a Predictor of Being Bullied in Third Through Sixth Grades. Pediatrics. (doi:10.1542/peds.2009-0774)
  5. Ibid
  6. Rudd Center for Food Policy & Obesity (2008). Weight Bias: The Need for Public Policy
  7. American Academy of Pediatrics http://www.aap.org/obesity/whitehouse/index.html
  8. Rudd Center for Food Policy & Obesity (2008). Weight Bias: The Need for Public Policy