With youth obesity on the rise – an estimated 1 in 5 youths are impacted by obesity, according to the CDC – conversations about healthy weight are becoming more commonplace not only in the pediatrician’s office, but at home, too. But the language we use around this sensitive topic is important, as youths are acutely aware that words have a direct impact on their mental health.
Sixteen-year-old Avery DiCocco of Northbrook, IL, knows how vulnerable teenagers feel.
“I think it definitely matters the way that parents and doctors address weight,” she says.”You never know who may be insecure, and using negative words could go a lot further than they think with impacting self-esteem.”
A new study published in Pediatrics brings light to the words that parents (and providers) use when speaking to youths (ages 10 to 17) about their weight.
Researchers from the UConn Rudd Center for Food Policy & Health in Hartford, CT, led an online survey of youths and their parents. Those who took part were asked about 27 terms related to body weight. Parents were asked to comment on their use of these words, while youths commented on the emotional response. The researchers said 1,936 parents and 2,032 adolescents were surveyed between September and December 2021.
Although results skewed toward the use of more positive words, such as “healthy weight,” over terms like “obese,” “fat” or “large,” there was variation across ethnicity, sexual orientation, and weight status. For example, it was noted in the study, funded by WW International, that preference for the word “curvy” was higher among Hispanic/Latino youths, sexual minority youths, and those with a BMI in the 95th percentile, compared with their white, heterosexual, and lower-weight peers.
In 1997, the American Academy of Pediatrics came out with a policy statement on weight stigma and the need for doctors to use more neutral language and less stigmatizing terms in practice when discussing weight among youths.
But one of the reasons this new study is important, says Gregory Germain, MD, associate chief of pediatrics at Yale New Haven Children’s Hospital, is that this study focuses on parents who interact with their kids much more often than a pediatrician who sees them a few times a year.
“Parental motivation, discussion, interaction on a consistent basis – that dialogue is so critical in kids with obesity,” says Germain, who stresses that all adults, coaches, and educators should consider this study as well.
“When we think about those detrimental impacts on mental health when more stigmatizing language is used, just us being more mindful in how we are talking to youth can make such a profound impact,” says Rebecca Kamody, PhD, a clinical psychologist at Yale in New Haven, CT, with a research and clinical focus on eating and weight disorders.
“In essence, this is a low-hanging fruit intervention,” she says.
Kamody recommends we take a lesson from “cultural humility” in psychology to understand how to approach this with kids, calling for “the humbleness as parents or providers in asking someone what they want used to make it the safest place for a discussion with our youth.”
One Piece of the Puzzle
Germain and Kamody agree that language in discussing this topic is important but that we need to recognize that this topic in general is extremely tricky.
For one, “there are these very real metabolic complications of having high weight at a young age,” says Kamody, who stresses the need for balance to make real change.
“Finding a fine line between discussing obesity and not kicking your kid into disordered eating is important,” he says.
The researchers also recognize the limits of an online study, where self-reporting parents may not want to admit using negative weight terminology, but certainly believe it’s a start in identifying some of the undesirable patterns that may be occurring when it comes to weight.
“The overarching message is a positive one, that with our preteens and teenage kids, we need to watch our language, to create a non-judgmental and safe environment to discuss weight and any issue involved with taking care of themselves,” says Germain.
Pediatrics: “Patient and Family Perspectives on Terms for Obesity.”
Gregory Germain, MD, associate chief of pediatrics, Yale New Haven Children’s Hospital.
Rebecca Kamody, PhD, clinical psychologist, Yale.