How to (delicately) talk to a child who's overweight

As a kid who started struggling with his weight around age seven, Nancy Leslie’s* youngest son, Cameron, got picked on by classmates all the time. “He even quit sailing lessons because he got teased about his weight,” says the North Bay, Ont., mother of three. And when Cameron was bullied about his weight at school, teachers and school authorities wouldn’t step in. “Their attitude was, well, he’s a fat kid, he’s going to get picked on. Kids are cruel,” says Leslie.

A new policy statement from the American Academy of Pediatrics is aimed at raising awareness about the kind of stigma kids like Cameron face every day. According to lead author Stephen Pont, an Austin, Texas, paediatrician and the founding director of the AAP section on obesity, the guilt and shame kids feel when they’re singled out due to their size is harmful in multiple ways. “Research is now showing that weight stigma can result in things like social isolation, binge eating, not going to see the doctor, and decreasing physical activity, creating a negative feedback cycle that results in increased weight gain,” he explains.

The emotional and psychological fall-out is even worse: Pont and his co-authors cite research showing that weight-based teasing and bullying is linked with an increased risk of problems ranging from anxiety to substance abuse. It’s also associated with a two-fold jump in the odds of thinking about or attempting suicide.

More than 5,000 educators who responded to a survey by the US National Education Association declared weight-based bullying was more of a problem than bullying involving sexist remarks, or bullying because of sexual orientation or disability. And a recent multinational study (including Canada, Austria and Iceland) found weight was the most common reason youth are bullied.

And it’s not just other children who are guilty of shaming kids who struggle with their weight, intentionally or otherwise. “Unfortunately, healthcare providers are some of the worst exhibitors of weight stigma,” notes Pont. According to the AAP paper, health professionals “often view patients with obesity as being lazy, lacking self-control, and being less intelligent.”

Even teachers and parents contribute to the shaming. For example, according to data from one large-scale US study of preschoolers and kindergarteners, teachers rate the academic performance of students with obesity worse than their test performance suggests. Another study found that 37 percent of adolescents attending weight-loss camp had been teased or bullied about their weight by a parent, while a survey of women with obesity found that 53 percent had experienced weight stigma from their mothers, and 44 percent had from their fathers.

Much of this may be inadvertent. “When it comes to talking about weight with children, too often well-intentioned parents may end up communicating critical, judgemental, or shame-inducing messages,” says Rebecca Puhl, one of the authors of the AAP paper and deputy director of the Rudd Centre for Food Policy and Obesity at the University of Connecticut. For example, Leslie recalls a family member who wouldn’t have dreamed of calling Cameron fat telling him to don a shirt before going outdoors, presumably to prevent others from teasing him.

The AAP devised some recommendations for paediatricians speaking to kids with larger body sizes, but many of the messages are relevant for parents, too. Here are some things to keep in mind when talking to kids with obesity—or any child, for that matter.

Consider the big picture. From income and ethnic background to a culture that encourages unhealthy choices at every turn, there are a lot of factors outside of a child’s control that can contribute to obesity. So don’t get bogged down in blaming your child, or yourself, for his weight.

Watch your language. “When conversations focus on how much a child weighs, or their body size, it can easily become distressing to children,” says Puhl. “Parents should focus their comments on a child’s health or health behaviours, rather than the number on the scale.” And offer positive guidance—instead of telling kids not to eat certain foods, offer praise when they choose healthy ones. Check out the free app ChangeTalk: Childhood Obesity for more suggestions. And think about how you talk about your own body: Your kids are listening and learning when you complain you feel fat, or that you hate your chunky thighs.

Set a good example. “Modelling healthy behaviours at home, and creating a home environment that makes it easy for everyone to engage in healthy eating and physical activity is a positive way to improve health for the whole family,” Puhl says. “Everyone—regardless of their body size or weight—benefits from healthy behaviours.” Start by making small, sustainable changes, like cooking one more meal from scratch together per week, or playing outside with your kids after dinner.

Monitor media. From the fat jokes in Kung Fu Panda to Puss in Boots urging another character to diet in Shrek The Third, a lot of kids’ entertainment—including 70 percent of movies—contain at least one instance of weight stigma. If a book or show exhibits weight stigma, you can switch to another, or at least talk about why such behaviour is hurtful.

Watch for warning signs. “If parents see their child is experiencing emotional distress related to their weight, or is being bullied about their weight, it’s important to take this seriously,” Puhl stresses. "This can mean problem-solving with their child to identify ways to avoid future bullying incidents, but also talking to school teachers or administrators if the situation continues, and talking to their child’s paediatrician if they are concerned these experiences are affecting their child’s emotional well-being or physical health."

*Names have been changed.

Read more: How your kid can help stop bullying One way parents can fight childhood obesity