STEAMBOAT SPRINGS, COLO. – In discussing a child’s weight problem with the parents, it’s best for physicians to refrain from using the terms "fat," "extremely obese," and even "obese."
"Parents find those terms undesirable. They’re stigmatizing, blaming, nonmotivating, and condescending," Dr. Paul R. Stricker said at a meeting on practical pediatrics sponsored by the American Academy of Pediatrics.
And that’s not just his personal opinion, either. He cited a recent groundbreaking study in which investigators at Yale University in New Haven, Conn., conducted a national online survey of the parents of 455 children aged 2-18 years. The purpose was to examine parental perceptions of language related to weight in order to improve the quality of physician-parent discussions about their child’s obesity. The underlying idea is that the likelihood of successful long-term weight loss is enhanced if the parents are committed to the proposed lifestyle modifications.
On a 5-point rating scale, most parents ranked "weight" and "unhealthy weight" as terms they preferred physicians to use in describing their child’s extra pounds. Moreover, the parents indicated they found the terms "unhealthy weight," "overweight," and "weight problem" to be the most motivating to lose weight, noted Dr. Stricker, a youth sports medicine specialist at the Scripps Clinic in San Diego.
On the other hand, parents perceived the terms "chubby," "fat," "obese," and "extremely obese" quite negatively, rating them as the least motivating to encourage weight loss (Pediatrics 2011;128:e786-93).
These data cast doubt on the wisdom of the British public health minister's 2010 declaration that U.K. health providers should call their obese patients "fat" to motivate them to lose weight.
As a pediatric sports medicine specialist, Dr. Stricker’s goal is to help overweight kids have a positive sports and exercise experience. He wants it to be "something they’ll want to pass along to their own children." He combines his exercise guidance with dietary instruction in weight loss, with an emphasis placed on eating multiple small meals to keep the metabolic rate revved so more calories are burned.
But lifestyle interventions don’t always work, and Dr. Stricker highlighted a recent German study that’s eye-opening as to why.
The prospective study included 111 overweight and obese 7- to 15-year-olds and their parents. The youths were referred to a 1-year-long best-practice lifestyle intervention program.
Treatment success was defined as at least a 5% weight reduction at follow-up 1 year after completing the year-long intervention. The investigators found – consistent with their study hypothesis – that psychosocial familial characteristics were significantly predictive of long-term success or failure. This was true even after the researchers controlled for familial obesity in order to cancel out the impact of genetic factors.
The strongest predictor of long-term failure for the lifestyle intervention was maternal depression. Maternal attachment insecurity and family adversity also predicted long-term treatment failure (Pediatrics 2011;128: e779-85).
These findings point to the need for further research aimed at developing lifestyle interventions for pediatric weight loss that are tailored to a family’s psychosocial dynamics, Dr. Stricker observed.
He reported having no financial conflicts.