Parents to pediatricians: Don’t tell me my kid’s ‘fat’

What’s the best way to be told that your child is overweight or obese?

Not at all, of course. But if that bad news must be delivered, a national survey published in the journal Pediatrics this week finds that parents will feel blamed and respond badly to words like “fat,” “obese” and “extremely obese,” and would feel more motivated if a physician said their child has an “unhealthy weight,” a “weight problem,” or a “high BMI” (Body Mass Index).

Surprising? Hardly. But it does fly in the face of some pretty authoritative advice given just last year in Britain, where Public Health Minister Anne Milton recommended that National Health Service doctors call their overweight patients “fat” as a means of motivating them to lose weight. (She actually preferred “fat” to “obese,” opining that calling patients “fat” would encourage more “personal responsibility.”)

(Maybe being called “fat” with a British accent is less stinging.)

It turns out, the words that physicians and healthcare providers use to warn parents that their children are carrying too much weight really do matter: The survey suggests that parents who hear terms they feel are stigmatizing or convey blame may be more motivated to avoid the doctor who uttered those terms than they are to help junior eat and exercise his way to a healthy weight.

Sixty-eight percent of the respondents--all of them parents with at least one child between the ages of 2 and 18 living at home--said that if they perceived their child to be stigmatized by his or her physician because of weight, they would react by encouraging their child to lose weight. More troubling: 37% said they would feel upset and embarrassed, 36% said they would put their child on a strict diet (a strategy that researchers have demonstrated is almost always counterproductive), 35% would seek a new healthcare provider, and 24% would avoid future medical appointments.

Pediatricians’ efforts to play a positive role in their patients’ health “may be undermined if they use stigmatizing language that can hinder important discussions about children’s health,” the authors wrote. “The use of weight-based terminology that patients find desirable and motivating, and avoidance of language that patients perceive to be stigmatizing and blaming, is an important first step,” they added.

One obstacle many physicians must face in choosing their words carefully is their own prejudice. Many studies have documented physicians’ poor view of overweight and obese patients: A 2003 study found that more than 50% found them to be awkward, unattractive, ugly and noncompliant, and 1 in 3 considered them weak-willed, sloppy and lazy.

Make no mistake about it: Numerous studies find that parents of overweight kids are woefully poor judges of their children’s problem--especially if they themselves are also overweight. So a physician’s objective reporting of a child’s weight status is important.

But that sobering shower of cold, hard facts needs to come with a dose of compassion--and diplomacy--if a physician’s advice is to lead to positive behavior change. In short, words matter.