Dear Pediatric Provider,
How telling your patient that they are overweight causes harm
In a culture where excess weight and fat are viewed as moral failures and unattractive, this message will immediately be interpreted as…
“I am not good”
“Something is wrong with me”
“And it is my fault”
We are no longer in a world where being told that you are overweight won’t be internalized, (were we ever?). Our children are constantly inundated with weight, body, exercise, and health messages. Their media is rich with images of what is physically acceptable and what is not. Weight loss messages from physicians, although well-meaning, can be the straw that breaks the camel's back.
Too many patients have taken the doctor's words to heart, and worked on weight loss, only to show up in my office months or years later with serious eating disorders. This often leads to costly, and traumatic hospitalizations, treatment stints, and years of struggle to try to recover.
This is only bound to get worse with the new APA guidelines on Obesity prevention.
What we propose you do instead
Take a closer look at your patient’s growth charts.
Have their percentiles always trended higher?
Do their genetics imply that they will be denser, heavier, larger?
Are they tracking along their same curves?
If so, we encourage you refrain from weight-centric discussions and instead focus on actual markers of health as you would with any smaller child, such as blood pressure, blood sugar, cholesterol, etc. Then, if there are any health markers out of normal limits, address those. We also encourage you to focus on changes that might be within the control of the child and family such as sleep hygiene and patterns of eating.
If the child has in fact significantly deviated from their curve, unexpectedly crossing over two or more percentage lines in either direction, connect with the parents first. Share your concerns and get permission prior to speaking with the child.
Even then, rather than focusing on the child’s weight, ask how they are doing emotionally, socially, physically. How do they spend their time, etc. What might be the cause of this deviation? Do they need additional resources? This might be a good time for a referral to an ED or HAES-informed dietitian or even therapist depending on the findings.
We acknowledge that providers only want to do what is best for their patients. We also recognize how busy doctors are and limited by the time restraints imposed by insurance companies. Sometimes, with the fear of what might come with higher weights, we jump to conclusions, and place the focus in the wrong place. We’d like to think that this is unintentional bias but need to remind you, that after seeing one more child hospitalized for an eating disorder, that it causes harm.
For additional Weight Neutral Resources check out the Health At Every Size® Health Sheets
“What to say Healthcare”—a free CE resource for providers on this very topic