Could We Talk About Your Weight Today?

Monica Richter, MD, FAAP
WCAAP Key Contact – Obesity

“Could we talk about your weight today?” This question is one of the recommended approaches to discussing obesity and overweight with your patients. So I am asking you: Could we talk about talking about weight? A recent policy statement by the AAP, “Stigma Experienced by Children and Adolescents With Obesity,” suggests starting by recognizing the complex etiology of obesity and then paying attention to language. Instead of obesity and morbid obesity, more neutral terms such as “unhealthy weight” and “very unhealthy weight” are recommended.

The policy statement emphasizes becoming aware of the stigma experienced by children and adolescents with obesity. Weight stigma is harmful to both the emotional and physical health of our patients. It can lead to unhealthy eating behaviors, decreased exercise and physical activity, social isolation and poor academic outcomes, emotional and psychological effects, and worsening obesity.

There are many obvious barriers to discussing obesity in our office such as time constraints, the complex etiology and absence of an easy fix and the slow onset. The fact that 1 in 3 children and adults have weight problems means that it is becoming normalized and many families are surprised to hear that they have a weight problem. So discussing obesity is difficult, and our fear of causing emotional distress in patients who feel stigmatized makes it even more difficult.

Fortunately, there are tools to help us talk about weight. To become more aware of your own attitudes and assumptions about body weight, you can utilize the University of Connecticut’s Rudd Center resources. To help you talk about obesity “Change Talk: Childhood Obesity” is a free resource (available online or in your smartphone’s app store) for providers to learn and practice motivational interviewing skills. Using interactive avatars, you can participate in three different clinical encounters. The first is with 10-year-old Ethan and his mother. Ethan’s BMI is at the 95th percentile and this is a sensitive topic for him and his mother. The second clinical encounter found on “Change Talk” is with Samantha. She has been breastfeeding her infant, but now she’s going back to work and thinking of introducing formula. The last encounter is with 4-year-old Maya who returns with her dad, Adrian, for a follow-up for pneumonia. Maya’s BMI has been sharply increasing and Adrian has trouble refusing her requests for unhealthy snacks.

Take some time to download the free app and have some fun. I suggest trying different pathways to see how easy it is to upset the family. You get valuable feedback on your performance at each step with a performance dashboard at the conclusion.

AAP Policy Statement Infographic