Weight Stigma by Association Among Parents of Children With Obesity: A Randomized Trial

An emotionally loaded subject - parents experiences when CHC-nurses introduce a conversation related to their child being overweight

BACKGROUND

Children with a raised BMI are a major public health challenge in the world that can cause serious consequences for children's physical and mental health. Child health care nurses' responsibility is to promote health and prevent ill-health in children, but because being overweight is stigmatized CHC-nurses find it difficult to talk to the parents about concerns over the children's weight, in fear of losing their trust.

AIM

The purpose of this study was to describe parents' experiences of when CHC-nurses introduce a conversation related to their child being overweight.

METHOD

This study was conducted via semi-structured interviews with nine parents and the data was analyzed using qualitative content analysis.

RESULTS

The result showed that being overweight in childhood is a sensitive topic, and this is presented as four categories A hard time coping, A desire to protect the Children, Changes of Parental Perspective and Trust - a mediating factor. This is a sensitive topic for the parents, who have a hard time accepting the situation and place the blame on themselves, and the nurse's approach and relationship with the parents is of great importance for the outcome of the conversation.

CONCLUSIONS

Parents seem to have another perspective on health and weight than the healthcare providers, and both parents and CHC-nurses might benefit from an increased understanding of one another's view. Parents need to gain knowledge about how healthcare providers assess children's growth, and the CHC-nurses need to be aware about how to be responsive to the parents and allow them time to process the information. The focus should be on healthy lifestyle choices regardless of weight.

Parents' experiences of their children's obesity management at the children's hospital on Reunion Island

AIM

Parents' perspectives on their child's obesity (BMI >IOTF-30) management are essential to ensure positive outcomes. This study explored parents' experiences in managing their children's obesity and investigated the sociocultural and environmental factors influencing such management on Reunion Island, a French overseas department in the Indian Ocean.

METHODS

This qualitative study used a general inductive analysis approach. Semi-structured telephone interviews were conducted from France, between January and April 2019, with nine parents of children treated in the Childhood Obesity Unit of the Children's Hospital on Reunion Island. The interviews were analysed by using thematic analysis until data saturation.

RESULTS

Four main themes emerged reflecting the stages of parents' experiences during treatment: a life history with feelings of justification and guilt, acceptance, involvement and activism. Cultural food traditions were a barrier to implementing healthier habits. Support and advice from the healthcare services alleviated feelings of isolation and motivated parents to be more proactive in their children's obesity management. Parents' involvement motivated their children and improved their relationships.

CONCLUSIONS

Parent's involvement is essential in managing children's obesity. To maximise treatment outcomes, tailored interventions that address parents' unique family dynamics and sociocultural perspectives are key.

Understanding Differences in Medical Student Perceptions of Treatment Adherence Based on Weight Status in Pediatric Care

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.

The Effect of Parent-Targeted Obesity Messaging on Parental Weight Talk Intention: A Randomized Controlled Experiment

It is unknown if parent-targeted health messages about childhood obesity affect parental weight communication with children (e.g., encouraging a child to diet). This randomized, controlled, online experiment assessed the effects of exposure to different message frames on parental intentions to 1) engage in weight communication with their child and, 2) follow the health advice in the message. A diverse sample of U.S. parents (N = 452) were randomly assigned to one of three conditions: 1) a mock news article emphasizing childhood obesity (weight-framed message) with health behavior advice for parents; 2) an article with identical health behavior advice for parents, but framed within the context of improving children's school performance (school-framed message); and 3) a no-treatment control group. Following message exposure, parents completed online surveys assessing their intention to engage in weight communication and the recommended health behaviors. Hierarchical linear regression was used to assess the relationship between experimental condition and the outcome variables. Parents in the weight-frame condition were significantly more likely to report intention to engage in weight communication with their child than parents in the control group, while there was no difference between the school-frame condition and the control group. Parents in both message conditions were equally likely to report intention to adopt the health advice, but parental weight-based self-stigma moderated the relationships. Parent-targeted health advice that features childhood obesity may encourage parents to engage in weight communication with their children. Our findings can inform the development of health messages targeting parents about children's weight-related health.

Enough with simplifying: "eat less and move more": at what point are we with the treatment of excess weight in paediatrics?

BACKGROUND

For years politics and healthcare, faced with the progressive increase in the prevalence of overweight and obesity in childhood, have wondered how to stem it and reduce its consequences on health without finding a valid, effective and applicable solution. Many studies have been written initially on what to prescribe, then on why not to prescribe and how to approach people in a new and more effective way to improve their behaviors, considered the main cause of excess weight. Over the last twenty years it has been highlighted that no diet or physical exercise is truly effective and not even global changes in lifestyle guarantee the large weight reductions traditionally expected, despite offering significant health advantages. A new approach is necessary and we must begin by working on ourselves.

MAIN BODY

We examined literature on weight stigma and considered expert opinions, as well as feedback from parents/caregivers and patients. Literature on stigma has grown enormously in recent years, and finally considers the opinion of parents and patients. By interviewing patients with obesity, it was discovered that very often healthcare workers do not communicate the diagnosis and, if they do, they have a blaming attitude, holding patients responsible for their weight. Furthermore, when these people become aware of their obesity and seek treatment, they do not find adequate professionals and centers. Failure was mostly due to the enormous burden of obesity stigma and discrimination which, especially in children and young people, encourages internalization of the problem and takes away their self-efficacy, desire and ability to take care of themselves.

CONCLUSIONS

New actions are needed to change all this. We propose "Training, Networking and Contrasting Weight Stigma". Now that we've figured out where to start, we should get going. And yet, nothing is changing!

An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents

Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.

Cute Kid? Patient Obesity Status and the Use of Nonmedical Descriptors in Presentations by Pediatric Residents

Nonmedical descriptors, adjectives that are not related to a medical condition, such as "cute," are often used in presentations in pediatrics. We hypothesize that patterns of their use may reflect obesity bias. Descriptors used by pediatric residents presenting cases of children <9 years in an outpatient clinic during the 2018-2019 and 2019-2020 academic years were recorded. The primary outcome was the association of the use of positive nonmedical descriptors with children's obesity status using logistic regression. Positive descriptors were used in 14% of 994 presentations. Most addressed the appearance of the child with variations of "cute" and "adorable." There was no variation in use of positive descriptors by obesity status. On multivariate logistic regression, the odds of using positive descriptors were higher among female residents, and positive descriptor use declined with patient age. Negative descriptors were rare and often focused on weight.

Isolation in a Sea of "Experts": Identifying the Parental Struggles Caring for Children With Early-Onset Obesity

Background: Severe early-onset childhood obesity is diagnosed by having a BMI >120% of the 95th percentile before age 5 years. Treatment for early-onset obesity is frequently unsuccessful. Prior studies have shown parents of children with obesity often face stigmatization and those who experience weight bias also experience poorer medical care. Home environment influences many risk factors, and parents are crucial for intervention. Research on the parental perspective of care is lacking and greater understanding could increase the effectiveness of treatment. We sought to understand the common stressors and obstacles parents encounter caring for a child with early-onset severe obesity. Methods: Parents of children with early-onset severe obesity participated in semistructured interviews. Interviews were digitally recorded, transcribed verbatim, coded, and analyzed using hybrid thematic analysis. Results: We identified a global theme of "Isolation in a sea of 'experts'," supported by three organizing themes: (i) Facing barriers at every turn; (ii) Carrying all the burdens; and (iii) Struggling to get their child seen as an individual. Within each organizing theme, subthemes emerged that highlighted the struggles that parents encountered. These included significant conflict with others when attempting to implement dietary changes (e.g., spouses, other children, and extended family), protecting their child's self-esteem, perceived weight bias from medical staff, lack of experienced obesity clinicians, lack of access to weight management services, and judgment from others (e.g., family, friends, and strangers). Conclusions: This study highlighted that many parents of children with early-onset severe obesity felt significant struggles, both internal and external. Understanding the barriers parents face when caring for their children is critical to improving relationships and medical care.

Physical and psychosocial determinants of quality of life in children with obesity

Background

Obesity has a negative impact on the physical and psychosocial quality of life of children. As rates of obesity continue to increase, it is important to recognize the widespread effects obesity has on children and their families.

Methods

This clinical investigation evaluated the self-reported quality of life of children with obesity in a weight management program and compared this to a parent/guardian's perspective of the child's quality of life using the Pediatric Quality of Life survey 4.0. The quality of life of children with obesity was compared to children with other chronic diseases and healthy children.

Results

An association was discovered between the guardians' responses to the Pediatric Quality of Life survey and the child's age. Guardians with children younger than 11 years reported higher quality of life scores than guardians of children 11 years and older. Race, comorbidities of obesity, insurance type, household structure, and parental education attainment were not significantly associated with a child's quality of life. Children with obesity had a lower quality of life compared to children who were organ transplant recipients and children with organic gastrointestinal disease.

Conclusions

These results emphasize the need to evaluate and treat the physical and psychosocial components of wellbeing in children with obesity at an early age.

Weight stigma and bias: A guide for pediatric clinicians

Introduction

Many children and adolescents with obesity experience weight stigma and bias, which can have detrimental mental health, medical, and social consequences. Weight stigma in the healthcare setting threatens the therapeutic relationship between health care providers and their pediatric patients and families.

Methods

Data supporting this guidance were derived from cited references.

Results

Based upon referenced citations, this review offers 7 best practices for pediatric providers to work to reduce weight stigma including: assess for personal weight bias, improve communication, provide a welcoming clinic environment, seek out additional training and informative experiences, evaluate the messaging and culture of the organization, screen for trauma and bullying, and enlist the help of board-certified obesity medicine specialists.

Conclusions

Providers have an important role in mitigating the harmful effects of weight stigma. It is our hope these recommendations, as well as the other resources provided, will help providers to begin to address their own individual weight biases, as well as the institutional weight biases where we care for patients.

Parents of Children With High Weight Are Viewed as Responsible for Child Weight and Thus Stigmatized

Courts in seven U.S. states have removed children with "obesity" from parental custody until children could maintain "healthy weights." These rulings-alongside qualitative reports from parents of children with high weight (PoCHs)-suggest that PoCHs are judged as bad parents. Yet little work has tested whether people genuinely stigmatize PoCHs or what drives this phenomenon. In three experiments with U.S. online community participants (N = 1,011; two preregistered), we tested an attribution theory model: Social perceivers attribute children's weights to parents and thus stigmatize those parents. Experiments 1 and 2 support this model (across parent and child gender). Experiment 3 manipulated attributions of parental responsibility for child weight, revealing attenuated stigma with low attributions of responsibility. Findings are among the first to describe and explain stigma toward a large demographic (parents of children with obesity)-with real-world implications (e.g., for family separation, health care)-and may additionally illuminate the psychology underlying stigma toward parents of children with other potentially stigma-evoking identities.

Management of eating disorders for people with higher weight: clinical practice guideline

INTRODUCTION

The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population.

AIM

The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations.

METHODS

The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience.

RECOMMENDATIONS

Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed.

CONCLUSIONS

This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

Beliefs About Body Weight and Practices of Regulating Food and Physical Exercise Patterns of Children Among Parents in Southern Ethiopia

Background

The problem of childhood obesity is often associated with cultural values of body weight which includes the belief that voluptuous body size is a sign of good health status and better parental care. We examined the beliefs and behaviors of parents pertaining to preferred body weight of children, including practices of management of feeding and physical exercise patterns of children in southern Ethiopia.

Methods

Using cross-sectional survey study design, a structured questionnaire was distributed to randomly selected parents. Quantitative data were collected from 215 respondents, inserted into SPSS software, and analyzed by frequency and percentage distributions, charts, and multinomial logistic regression techniques.

Results

Most (59.1%) respondents want their child’s body weight to be normal/neither fat nor thin. In addition, 58.2% of the study participants held the opinion that average body size is an indication of good health status. Furthermore, 72.6% of respondents revealed that they control the amount of food their child consumes with the aim of preventing obesity/overweight. Moreover, 79.5% of respondents encourage their children to sometimes walk on foot, instead of always relying on vehicles while 87% of them replied that they regulate the amount of time their children spend watching TV. Above all, parents’ preference of voluptuous body size of children is significantly associated with age (OR=61.52.448, P < 0.001, 95%C.I: 57–66.14), educational status (OR = 35.605, P < 0.001; 95%C.I: 6.050–209.524), sex (OR = 0.237, P < 0.05; 95%C.I: 0.078-0.724) and grownup area (OR = 2.869, P < 0.05; 95%C.I: 1.062–7.749).

Conclusion

Parents not only have adequate level of awareness regarding the health risks of children’s heavy body weight but also engage in the body weight management practices of their children such as by regulating the food consumption patterns of children, encouraging them to undertake physical exercises, and by being role models while doing physical exercises for themselves.