The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Parents don't want childrens' doctors to use the words 'fat' or 'obese'

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Live well

Friday, Sep 30, 2011

When discussing excess weight with children, researchers found that parents prefer that doctors use the terms "weight" and "unhealthy weight" rather than "fat," "obese," and "extremely obese." Parents perceive the latter terms are stigmatizing, blaming, and the least likely way to motivate children to lose weight.1

Weight stigmatization, or bias, is common in health care settings.2 And while parents report that the physician's office is the best place to seek treatment for their child's weight, some parents also report feeling blamed by providers for their children's excess weight.3 Thus, researchers set out to determine which weight-based terms were preferred by parents versus those that evoke negative reactions and consequences like demotivation, unhealthy eating behaviors, and avoidance of physical activity.

Almost 450 American parents with children aged 2 to 18 years completed an online survey to assess their perceptions of 10 common terms to describe excess body weight in youth including "extremely obese," "high BMI," "weight problem," "unhealthy weight," "weight," "heavy," "obese," "overweight," "chubby," and "fat." Parents were asked to use a 5-point rating scale to indicate how much they perceived each term to be desirable, stigmatizing, blaming or motivating to lose weight.

Results showed that more than 60% of parents said referring to a child as "extremely obese" or "fat" would be considered the most stigmatizing. On the other hand, terms like "weight," "unhealthy weight," or "high BMI" were found most frequently to be the least stigmatizing. Results also showed that parents may react to weight stigmatization by their providers in harmful ways. Thirty-six percent of parents reported they would put their child on a strict diet (which is not indicated for children); 35% of parents said they would seek a new doctor; and 24% of parents said they would avoid future medical appointments in response to weight stigmatization by a health care provider.   

Thus, it is important that not only health care providers, but also others who are developing or delivering obesity programs targeting youth, ensure that terminology and messages communicated are nonstigmatizing, respectful, and motivating. The prevention and treatment of childhood obesity is challenging enough; discussions about weight with parents and children should not be among these obstacles.

1Puhl, R. M., Peterson, J. L., & Luedicke, J. (2011). Parental perceptions of weight terminology that providers use with youth. Pediatrics, 128(4), e786-e793. DOI: 10.1542/peds.2010-3841.

2Schwartz, M.B., Chambliss, H.O., Brownell, K.D. (2003). Weight bias among health professionals specializing in obesity. Obes Res, 11(9), 1033-1039.

3Eneli, I.U., Kalogiros, I.D., McDonald, K.A. (2007). Parental preferences on addressing weight-related issues in children. Clin Pediatr (Phila), 46(7), 612-618.