Parental perceptions of weight terminology that providers use with youth

Weight Bias and Stigma in Pediatric Obesity

Weight stigma is pervasive during childhood and adolescent years. Well-established physical and psychosocial health consequences of weight stigma, like disordered eating behaviors, low self-esteem, and higher depressive symptoms, make it especially harmful during a critical period of development for youth. Lasting negative health impacts of these experiences highlight the importance of addressing weight stigma early on. The pediatric health care setting, both physical and social components, can be one of many sources of weight-stigmatizing experiences for youth. This observation has prompted calls for action in the health care setting to reduce weight biases and stigmatizing behavior among pediatric providers.

Medical Home Access Among Children with Obesity: The Role of Family-Centered Communication

Objective: The American Academy of Pediatrics recommends all children receive care in a patient-centered medical home. With weight stigma potentially hampering family-centered communication in the care of children with overweight or obesity, we aimed to determine how children's weight status was associated with access to a medical home and its components. Methods: We analyzed 2016-2021 data on children age 10-17 years in the National Survey of Children's Health. Children's weight status was classified as underweight/normal weight, overweight, or obese, based on caregiver-reported height and weight. Outcomes included receiving care in a medical home and each category of the medical home definition (personal health care provider, usual source of health care, family/patient-centered care, care coordination, and assistance with referrals). Results: Based on the study sample (n = 105,111), we estimated that 16% of children were overweight and 16% were obese, while 42% had access to a patient-centered medical home. On multivariable analysis, obesity compared to normal weight was associated with lower access to a medical home (odds ratio: 0.87; 95% confidence intervals: 0.80, 0.95; p = 0.003) and, specifically, with lower access to family-centered care and assistance with care coordination. Conclusions: Children with obesity encounter barriers to accessing care meeting medical home criteria, with one plausible mechanism being that weight stigma disrupts family-centered communication. Lower access to care coordination among children with obesity may also indicate a need to improve the integration of obesity-related specialty care with pediatric primary care services.

Photos Sculpt the Stories of Youth: Using Photovoice to Holistically Capture the Lived Experiences and Pain of Youth Who Underwent Spinal Fusion Surgery

Spinal fusion surgery is one of the most common major surgical procedures in youth. Adolescent idiopathic scoliosis (AIS) is the most frequent reason for corrective spinal fusion. AIS (∼25%-47% of cases) and spinal fusion surgeries are associated with pain, including the development of new onset chronic pain for up to 15% of youth. This research used photovoice approaches to explore the journeys of youth from before, during, and after spinal fusion surgery, to demonstrate their experiences both of and beyond pain. Twenty participants were recruited from a previous study conducted by the senior author's lab. Participants captured photos/videos in their daily life (Phase 1); collected previously taken photos/videos from before/during/after their surgery (Phase 2); and participated in individual interviews to reflexively discuss the meaning behind photos/videos (Phase 3). Before interviews, a questionnaire was administered to assess pain characteristics. Nineteen girls/women with scoliosis and one boy/man with kyphosis (12-19 years old, Mage = 16 years) participated; they identified as white (80%), other (15%), and Southeast Asian (5%). The researchers used a reflexive thematic analysis approach, which generated five themes: (1) body aesthetic versus machine; (2) expectations and anticipation of surgery/outcomes; (3) desire of normalcy and freedom; (4) navigating a hoped-for positive surgery experience; and (5) the journey sculpts identity formation and sense of self. Findings support youth advocacy, underscoring the need to validate youth concerns and inform healthcare professionals of the importance of individualized care. Youth perspectives highlighted opportunities for optimizing surgery/healthcare experiences and the psychosocial impacts of scoliosis on body image and appearance.

Use of person-centered language in obesity-related publications across sports medicine journals: a systematic review of adherence to person-centered language guidelines in sports medicine

CONTEXT

Stigmatizing language or non-person-centered language (non-PCL) has been shown to impact patients negatively, especially in the case of obesity. This has led many associations, such as the American Medical Association (AMA) and the International Committee of Medical Journal Editors (ICMJE), to enact guidelines prohibiting the use of stigmatizing language in medical research. In 2018, the AMA adopted person-centered language (PCL) guidelines, including a specific obesity amendment to which all researchers should adhere. However, little research has been conducted to determine if these guidelines are being followed.

OBJECTIVES

Our primary objective was to determine if PCL guidelines specific to obesity have been properly followed in the sports medicine journals that are interacted with most frequently.

METHODS

We searched within PubMed for obesity-related articles between 2019 and 2022 published in the top 10 most-interacted sports medicine journals based on Google Metrics data. A predetermined list of stigmatizing and non-PCL terms/language was searched within each article.

RESULTS

A total of 198 articles were sampled, of which 58.6 % were found to be not compliant with PCL guidelines. The most common non-PCL terms were "obese" utilized in 49.5 % of articles, followed by "overweight" as the next most common stigmatizing term at 40.4 %. Stigmatizing labels such as "heavy, heavier, heaviness," "fat" as an adjective, and "morbid" appeared in articles but at a lower rate.

CONCLUSIONS

Our study shows that there is a severe lack of adherence to PCL guidelines in the most-interacted sports medicine journals. Negative associations between stigmatizing language and individuals with obesity will only persist if a greater effort is not made to change this. All journals, including the most prestigious ones, should adopt and execute PCL guidelines to prevent the spread of demeaning language in the medical community.

Increasing Screening Rates for Comorbidities in Adolescents with Elevated Body Mass Index in Pediatric Primary Care

Introduction

Adolescents with elevated body mass index are at increased risk for comorbidities such as dyslipidemia, diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease. Guideline-based screening can identify impacted patients early, allowing for lifestyle modifications and other treatments to improve long-term health. Unfortunately, only 20% of pediatric patients with obesity receive recommended screening.

Methods

A multidisciplinary quality improvement team designed and implemented a project to improve comorbidity screening utilizing the Model for Improvement. Provider education and incentive, clinical decision support, and regular performance feedback were chosen as interventions. Screening rates were tracked on a statistical process control chart.

Results

From March through December of 2022, 9547 pediatric patients aged 10 years and up with body mass index greater than or equal to the 95th percentile were seen for preventive care visits. Screening rates for comorbidities increased from a baseline of 19.5%-58% and were sustained for over 3 months. Numerous patients at risk for chronic disease were identified.

Conclusions

Evidence-based clinical decision support, along with provider education and engagement, can effectively increase screening rates for comorbidities in pediatric patients with obesity.

"A balancing act": parents' longitudinal perspectives of weight-related discussions with their children following obesity treatment

Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.

The Role of the Pediatrician in the Promotion of Healthy, Active Living

Few children and adolescents meet federal nutrition or physical activity recommendations, and many experience poor or inadequate sleep and negative health effects from screen use and social media. These lifestyle factors exacerbate physical and mental health risks for children and adolescents. This clinical report provides guidance to help pediatricians address the nutritional, physical activity, sleep, media and screen use, and social-emotional factors that affect child and adolescent health and wellness. The recommendations in this clinical report aim to promote health and wellness practices for infants, children, and adolescents across several domains of influence, including the individual, interpersonal, institutional, community, and public policy levels.

Pediatric healthcare professionals' attitudes and beliefs about weight stigma: A descriptive study

PURPOSE

Children face weight-based stigma from their healthcare providers at a disconcerting rate, and efforts to mitigate this have been scant. This study aimed to quantify pediatric healthcare professionals' attitudes and beliefs about weight stigma and to determine stigma reduction interventions that are most supported by pediatric healthcare providers.

DESIGN AND METHODS

Participants completed two validated instruments which measured implicit and explicit weight bias, respectively. They then completed a researcher-designed questionnaire to assess their attitudes and beliefs about weight stigma, and demographic questions. ANOVA models were used to examine associations between bias measures and participant characteristics, chi-square analyses were used to examine associations between questionnaire responses and participant characteristics, and Spearman's rank was used to determine correlations between weight bias and questionnaire responses.

RESULTS

Participants exhibited moderate-to-high levels of implicit and explicit weight bias (mean Implicit Association Test score = 0.59, mean Crandall Anti-Fat Attitudes Score = 38.95). Associations were noted between implicit bias and years in practice (p < 0.05), and implicit bias and occupation (p < 0.05). There was a significant correlation between explicit bias and multiple questionnaire items, suggesting that healthcare providers with greater weight bias are aware of those biases and are ready to take action to address them.

CONCLUSION

Though pediatric healthcare exhibit weight-based biases, they are invested in taking steps to mitigate these biases and their impact on patients.

PRACTICE IMPLICATIONS

The results of this study can inform the design of future interventions that aim to reduce healthcare-based weight bias, thus improving the quality of pediatric healthcare.

The psychosocial beliefs, experiences and expectations of children living with obesity

BACKGROUND

Childhood obesity has been shown to impair psychological health. However, psychological factors are often overlooked in both research evaluations and treatment interventions, and children's perspectives on managing obesity are underexplored. Neglecting psychosocial factors might undermine interventions. This research explored the psychological beliefs, expectations and experiences of children living with obesity (range 7-13) and attending a weight management programme (WMP).

METHODS

Thirty-four participants (19 females, 15 males, average age 9.5 years) completed a semistructured interview. Recorded interviews were transcribed verbatim and analysed using thematic analysis.

RESULTS

Four overarching themes were developed: (1) defining health and self-recognition; (2) external influence; feedback, stigma and comparison; (3) recognising emotions and (4) future expectations: obesity is a reality. These themes interact to influence the children's psychosocial status.

CONCLUSIONS

This study highlights a range of psychosocial and emotional difficulties that children living with obesity experience and suggests that these remain regardless of their attendance at a WMP. Interventions for children living with obesity should address psychosocial factors, including stress management, peer victimisation and handling feedback from others.

PATIENT OR PUBLIC CONTRIBUTION

As proposed by the two young people acting as patient and public involvement and engagement representatives, the utilisation of scrapbooks as a preinterview tool was particularly helpful in aiding discussion during the interviews. This innovative approach could be considered a valuable methodological technique for investigating sensitive topics with children in future 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.

Referral to Adolescent Weight Management Interventions: Qualitative Perspectives From Providers

OBJECTIVE

Current guidelines for treatment of obesity in adolescence include screening and referring youth with obesity to appropriate weight management (WM) care. However, prior work has not explored the referral process to adolescent WM programs, especially for youth from lower-income backgrounds, who are at increased risk of obesity and related negative health outcomes. This qualitative study sought to understand pediatricians' current practices regarding referrals to adolescent WM interventions with a focus on adolescents from lower-income backgrounds.

METHODS

Individual interviews were conducted with 11 medical providers that had referred at least 5 adolescents from low-income backgrounds to WM interventions. Applied thematic analysis was used for data analysis.

RESULTS

Identified themes included weight-related discussions with adolescents as potentially fraught, as providers want to address weight-related health concerns while being thoughtful about potential harm. Providers also noted varied factors affecting their decision to refer to WM programs, including health implications, perceived motivation of the patient and family, and availability of programs. Providers identified that many families experience shame or guilt around referral to WM. Few themes were identified regarding impact of income on weight-related conversations with adolescents.

CONCLUSION

Findings were novel in regard to discussions of weight in adolescents with obesity leading to WM referral. Despite being a primary focus of the present study, few themes were identified regarding specific considerations for adolescents from low-income backgrounds. Future clinical research should focus on provider-focused interventions to increase sensitivity regarding weight-related discussions and attention to diversity, equity, and inclusion.

Understanding Weight Talk in Racially/Ethnically Diverse Homes: A Qualitative Analysis With Parents

OBJECTIVE

To explore weight talk in the homes of racially/ethnically diverse immigrant/refugee children and their families.

DESIGN

Qualitative interviews were conducted with parents of young children.

SETTING

Twin Cities, Minnesota.

PARTICIPANTS

Parents from 150 families (25 families each from White, Black, Latino, Hmong, Native American, and Somali households) were recruited from primary care clinics. Eligibility criteria included: participating parent lived with a child aged 5-7 years, shared a meal with this child at least daily, and had another child living in the home.

MAIN OUTCOME MEASURES

Weight talk (ie, weight-related conversations, teasing), intergenerational transmission of weight talk.

ANALYSIS

Qualitative content analysis using Nvivo software.

RESULTS

Themes were found for each of our 4 research questions. Themes included: (1) parents experienced weight talk in their own homes growing up; (2) parents believed their community or culture influenced weight talk in their home; (3) parents described different ways of approaching weight talk, including not discussing weight, being direct about weight, and playful teasing; and (4) parents described various strategies for addressing concerns about their children's weight.

CONCLUSIONS AND IMPLICATIONS

Results suggested weight and health were salient issues for racially/ethnically diverse parents. Further research is needed to investigate why some parents engage in weight teasing, what prompts weight teasing, and the differences between weight- and health-focused conversations to identify potential targets for intervention. Recommendations for health providers working with families with young children, such as training using nonstigmatizing language, are discussed.

Should We "Wait and See"?: Change in Weight Status Among US Adolescents in the Population Assessment of Tobacco and Health Study

Background: Many parents and providers adopt a "wait and see" approach to obesity (OB) management. The goal of this study was to determine the likelihood that youth with overweight (OW) or OB would become normal weight over time. Methods: Data from the nationally representative Population Assessment of Tobacco and Health Study were used to examine the proportion of teens (aged 12-17 years) with OW/OB who tracked into a lower weight category over four waves of data collection (2013-2018). Analysis was restricted to those who completed all four waves of assessments (n = 10,086). Repeated-measures logistic regression models were used to describe the odds of having a BMI within the normal weight range at Waves 2-4, given an OW or obese weight status in the previous wave. Results: At Wave 1, 65% of the sample was normal weight, 18% had OW, and 17% had OB. By Wave 4, 24% had OW and 20% had OB. The adjusted odds of reporting a normal weight relative to OW/OB decreased by 13% each year. In Wave 4, only 2% [standard error (SE) 0.4%] of boys and 2% (SE 0.3%) of girls transitioned from OB to normal weight. For youth with OB in Wave 1, the probability of being in the normal weight category in Wave 2 was 0.04 (95% confidence interval 0.035-0.052), and decreased thereafter. Conclusion: Very few teens were able to return to normal weight once they developed OW/OB. Adopting a "wait and see" approach to OB management may be detrimental to a child's health.

Pivot from Pain to Productive: Conversations about Weight Management in Youth with Obesity

ABSTRACT

The prevalence of childhood obesity is almost 20% and affects 14.7 million youth. It is not a matter of if but when and how often sports medicine clinicians will care for patients with obesity. Considering the social, emotional, medical, and physical impact of obesity, we need a nuanced approach to communicate with patients and develop effective treatment plans to maintain or encourage physical activity. Neuromusculoskeletal impairments, physical complications, pain, biomechanical differences, and physical deconditioning act as potential barriers to treatment. This article introduces ways to pivot the conversation from musculoskeletal pain to a productive, well-received conversation about a holistic approach to weight management that also promotes physical activity and overall wellness in youth with obesity. Special attention is given to equipping clinicians with recommendations that incorporate the use of inclusive language, health behavior theories, and tenets of motivational interviewing to deliver equitable treatment regardless of body habitus.

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.

Person-centered language and pediatric ADHD research: a cross-sectional examination of stigmatizing language within medical literature

CONTEXT

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and often goes untreated. A major barrier to treatment is the stigma surrounding the disorder, including from the educational and scientific community. Person-centered language (PCL) is associated with positive health outcomes, and its implementation is recommended by multiple professional groups, but its use has not been quantified for ADHD.

OBJECTIVES

The goal of this study is to quantify the adherence to PCL among ADHD-related journal publications utilizing a cross-sectional study design.

METHODS

We conducted a cross-sectional examination including a systematic search of PubMed, which encompasses MEDLINE, for ADHD-related articles from January 2014 to March 2021. All journals with at least 20 ADHD-related search returns, human research, and in the English language were included, totaling 5,308 articles from 88 journals. Articles were randomized, and the first 500 were screened for inclusion of prespecified, non-PCL terminology. After exclusion, 311 articles were retained.

RESULTS

Of the 311 retained articles, 131 (42.1%) adhered to PCL guidelines. Among articles with non-PCL, stigmatizing language such as "problem(s) with [the/a] child or problem child" and "suffers from" was found most frequently- occurring in 47.6% (148/311) and 5.8% (18/311) of the articles, respectively. We found no significant association between PCL adherence and study characteristics.

CONCLUSIONS

Our findings revealed that over half of the current ADHD literature did not adhere to PCL guidelines. Adherence to PCL by the scientific and medical community will increase the overall efforts to mitigate stigma and increase support for individuals with ADHD.

How do looking patterns, anti-fat bias, and causal weight attributions relate to adults' judgements of child weight?

Prevailing weight-normative approaches to health pressure adults to visually categorise children's weight, despite little understanding of how such judgements are made. There is no evidence this strategy improves child health, and it may harm children with higher weights. To understand decision-making processes and identify potential mechanisms of harm we examined perceptual and attitudinal factors involved in adults' child weight category judgements. Eye movements of 42 adults were tracked while categorizing the weight of 40 computer-generated images of children (aged 4-5 & 10-11 years) varying in size. Questionnaires assessed child-focused weight bias and causal attributions for child weight. Participants' eye movement patterns resembled those previously reported for adult bodies. Categorisation data showed a perceptual bias towards the 'mid-range' category. For higher weight stimuli, participants whose category judgements most closely matched the stimulus's objective weight had higher child-focused anti-fat bias and weaker genetic attributions for child weight - i.e,. adults who 'label' higher weight in children in line with BMI categories report more stigmatising beliefs about such children, suggesting a possible mechanism of harm. Overall, adults' judgements reflect both unalterable perceptual biases and potentially harmful attitudinal factors, calling into question the feasibility and appropriateness of public health efforts to promote visual child weight categorisation.

Perspectives of healthcare professionals on facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle

Objective

To explore the perspectives of healthcare professionals (HCPs) within an integrated care approach on the facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle.

Methods

Semi-structured interviews were conducted with eighteen HCPs working within a Dutch integrated care approach. The interviews were analyzed by performing a thematic content analysis.

Results

Main facilitators identified by HCPs were support from parents and the social network. Main barriers were first and foremost family's lack of motivation, which was singled out as a precondition for starting the behavior change process. Other barriers were child's socio-emotional problems, parental personal problems, lack of parenting skills, parental lack of knowledge and skills regarding a healthier lifestyle, parental lack of problem awareness and HCP's negative attitude. To overcome these barriers, main needs that HCPs suggested were a tailored approach in healthcare and a supportive HCP.

Conclusion

The HCPs identified the breadth and complexity of underlying factors of childhood obesity, of which the family's motivation was pointed out as a critical factor to address.

Innovation

Understanding the patient's perspective is important for HCPs to provide the tailored care needed to address the complexity of childhood obesity.

Patient and Family Perspectives on Terms for Obesity

OBJECTIVES

Parent communication about body weight is a sensitive topic, but limited research has studied youth preferences for words used to talk about their weight with parents. We assessed perspectives of weight-based terminology in 2 racially/ethnically diverse samples of youth and parents.

METHODS

We collected online survey data from 2 panel survey samples between September and December 2021: youth aged 10 to 17 years (n = 2032) and parents of youth aged 10 to 17 years (n = 1936). Participants rated 27 different terms and phrases to describe body weight; parents reported on their usage of this terminology and youth reported their preferences for and emotional responses to terminology. Patterns were examined across sex, race/ethnicity, sexual orientation, and weight status.

RESULTS

Youth reported preferences for words such as "healthy weight" and dislike of terms such as "obese," "fat," and "large," which induced feelings of sadness, shame, and embarrassment. Differences in youth preferences and emotional reactions were present across sex, sexual orientation, race/ethnicity, and weight status. This included a general pattern of lower preference ratings among girls (versus boys) and sexual minority (versus heterosexual) youth, and stronger preferences for words such as "thick" or "curvy" among racial/ethnic minority, sexual minority, and higher-weight youth. Use of most weight terms was higher among fathers compared with mothers, and by Hispanic/Latinx parents compared with white and Black/African American parents.

CONCLUSIONS

Our findings underscore diversity of youth preferences and the need for individualized approaches that support effective parent and youth communication by using their preferred terms when discussing weight-related health.

Use of person-centred language among scientific research focused on childhood obesity

BACKGROUND

Stigma towards children with obesity can begin as early as 3 years old, leading to increased risk for poorer mental health outcomes and lower quality of life. This includes discriminatory language used by peers and adults, which may be compounded by use within the medical community and in published research.

OBJECTIVES

Our primary objective was to investigate adherence to person-centred language (PCL) in childhood obesity-related medical publications.

METHODS

We searched PubMed for childhood obesity-related articles from 2018 through 2020, from journals frequently publishing childhood-obesity-related research. Articles were randomized and searched for a list of predetermined, stigmatizing terms.

RESULTS

Of the sample of 300 articles, only 21.7% were adherent to PCL guidelines. The most frequent labels found were 'obese' appearing in 70.33% of articles and 'overweight' in 63.7%. Labels such as 'chubby', 'large', and 'fat' were less common, but still appeared in the medical literature.

CONCLUSIONS

A majority of childhood obesity-related articles did not adhere to PCL guidelines. Given the negative effects of stigma among children with obesity, it is imperative to advocate for PCL use within the medical community. Increased stringency by journal editors and publishers may be the next step in this process.

Perception of body size and body dissatisfaction in adults

Self-perception of body size seems to be not always in line with clinical definitions of normal weight, overweight and obesity according to Word Health Organization classification. The effect of self-perception of body size disturbances and body dissatisfaction may be the development of eating disorders, such as anorexia nervosa or binge eating disorder-a major risk factor of obesity development. Therefore, the study aimed to assess separately the perception of weight status and body size as well as body dissatisfaction in adults with normal weight, overweight and obesity. The study included 744 adults (452 women; 35.9 ± 12.4 years; 21 underweight, 326 normal weight, 221 overweight, 176 obese) referred to Metabolic Management Center and volunteers. Body size perception and body dissatisfaction were assessed based on Stunkards' Figure Rating Scale (FRS). Additionally, participants' were asked: 'Do you think you are: underweight/normal weight/overweight/obese?' to assess perception of weight status. Participants' weight and height were measured to calculate body mass index (BMI) after completing the FRS. Individuals within the overweight BMI range have rated themselves as underweight (1.4%), normal weight (30.8%) and obese (2.8%). Also individuals within the obesity BMI range have rated themselves as normal weight (2.6%), and overweight (41.6%). Compatibility of self-assessment of weight status with BMI category according to the measured values was moderate-Kappa coefficient was 0.59 (95% CI: 0.54-0.64). Underestimation of weight status was significantly more common among men than women. There were statistically significant differences in the distribution of body dissatisfaction according to the weight in both women and men. Normal-weight subjects less often than overweight and obese were dissatisfied with their own body size. The degree of body dissatisfaction was greater among women than among men. Adults subjects frequently underestimate their own weight status and body size. Women with overweight and obesity more often than men are dissatisfied with their own body size.

Children's, Parents' and Healthcare Professionals' Preferences for Weight-Based Terminology in Health Care

The current study explored the preferences for and knowledge of weight-based terminology used in healthcare-related conversations, and descriptively compared the preferences of children, parents and healthcare professionals. In total, 86 children with overweight or obesity, 90 parents of children with overweight or obesity and 572 healthcare professionals indicated their preferences for 22 terms. When applicable, children and parents could indicate unfamiliarity with a term. Many children were unfamiliar with terms such as "adiposity^"adipositas"" (93%), "BMI" (60%) and "morbid obesity" (53%). Children, parents and healthcare professionals disliked "fat^adjective". All groups liked the terms "healthier weight" and "above a healthy weight". To conclude, children's, parents' and healthcare professionals' preferences for weight-based terminology are predominately congruent, except for "BMI". "BMI" is a popular term among healthcare professionals. It is recommended that healthcare professionals use terms that can be perceived as neutral or positive, such as "healthier weight", as this may contribute to a positive conversation which may lead to better compliance, and to avoid terms that can be perceived as judgmental, such as "fat^adjective", as this may worsen the dialogue and relationship between families and healthcare professionals, and increase weight-based stigma. Healthcare professionals should be aware that children may be unfamiliar with some terms.

Pediatric Obesity and Sports Medicine: A Narrative Review and Clinical Recommendations

OBJECTIVE

To review what is known about sports medicine and pediatric obesity, with a focus on injuries and MSK concerns.

DATA SOURCES

Systematically searched MEDLINE (PubMed) for all years, using search combinations to best identify potential publications. Manuscripts were reviewed, summarized, and discussed in detail. Experienced clinicians in sports medicine and pediatric obesity reviewed the final searches for substantive content. Inclusion criteria include English language publications, children ≤18 years old, related to the practice of sports medicine and pediatric obesity. Publications excluded that dealt with non-sports medicine aspects of pediatric obesity, such as increasing physical activity or exercise, or the prevention or treatment of obesity.

MAIN RESULTS

Twenty-eight publications were included for review. Papers fell into 5 groupings: (1) MSK-increased incidence of MSK injury in children with obesity, hypothesized to be a result of changes in biomechanics; (2) weight management-gradual loss while maintaining proper hydration and nutrition for sports performance; (3) fitness/conditioning-children with overweight/obese showed decreased fitness measures and cardiopulmonary conditioning; (4) exertional heat illness-a concern for adolescent athletes with obesity, specifically in football; and (5) differential diagnoses-3 key differential diagnoses were identified for increased awareness: slipped capital femoral epiphysis, Blount's disease, and pes planus. Clinical topics pertinent to sports medicine and pediatric obesity were discussed.

CONCLUSIONS

Sports medicine clinicians should be aware of the common MSK and sports-related conditions in children with obesity. Few studies have focused investigations on issues related to children with obesity participating in sports and other physical activities.

Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study

Background

The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care.

Objective

The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions.

Methods

The PUPPY study builds on an existing research program exploring patients’ access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data.

Results

This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020.

Conclusions

To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient’s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice.

International Registered Report Identifier (IRRID)

DERR1-10.2196/29984

Preferences and emotional response to weight-related terminology used by healthcare professionals to describe body weight in people living with overweight and obesity

Previous studies have explored people's perceptions of weight-related terminology; however, to date, limited data has explored the emotional response to weight-related terms used by healthcare professionals (HCPs). This study explored the preferences and emotional responses of terms used by HCPs to describe body weight and of parents to describe their children's weight. A total of 2911 adults completed an online cross-sectional survey, with 1693 living with overweight or obesity (mean age 49.2 years [SD 12.5], female (96%), median body mass index (BMI) 31.4 kg/m² [28.1, 36.5]). The survey explored preferences of 22 weight-related terms using a 5-point Likert scale and their emotional response to these terms (using 7-core emotions). Parents also indicated preferences and emotional responses to terms used to describe their children's weight. Respondents completed the modified weight bias internalization scale to examine how this may impacted preferences. 'Weight', "unhealthy weight" and "overweight" were the three preferred terms, while "super obese", "chubby", and "extra-large" were least preferred in people living with overweight and obesity. Parents preferred 'weight', "unhealthy weight" and "body mass index", and least preferred "fat", "extra-large" and "extremely obese" when describing their children's weight. All terms elicited a negative emotional response. The most commonly emotion was sadness for terms to describe adult's bodyweight, and anger for terms used to describe children's weight. All BMI categories reported disgust with terms incorporating "obese". Our results offer novel insight into the preferred terminology and emotional responses to terminology used by HCPs for both adults and parents to describe their children's weight.

The Use of Effective Language and Communication in the Management of Obesity: the Challenge for Healthcare Professionals

PURPOSE OF REVIEW

Initial conversations about weight with patients are important to set the tone for future dialogue and management of obesity. There is often reluctance in raising the topic of overweight or obesity in consultations. We aimed to evaluate literature to discover the perceived barriers to optimal discussion about weight status and preferred weight-based terminology for adults, adolescents and parents of younger children.

RECENT FINDINGS

Fear of offending patients, insufficient training and lack of knowledge of referral pathways were identified as factors hindering healthcare professionals' ability to discuss weight with patients. Neutral terms, such as 'weight', were preferred by patients, with 'fat' and 'obese' viewed as undesirable and stigmatising words. There is a need for greater support and provision of specific training, including education on communicating weight status, for those involved in the management of obesity. More research is necessary to assess the impact of interventions to improve initial discussions with patients about weight.

The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings

PURPOSE OF REVIEW

While obesity-related comorbidities are frequently addressed and treated in primary care (PC), obesity itself is undertreated. We review the current treatments for obesity and provide potential provider and system-level strategies for integrating weight management and improving longer term obesity care within PC settings.

RECENT FINDINGS

We now understand that the body develops multiple mechanisms to resist weight loss and promote weight regain, making both weight loss and weight loss maintenance challenging. Therefore, weight management often requires medically supervised interventions and should be treated on a long-term basis. However, there are multiple barriers to improving obesity care within PC settings. Clinically, utilizing strategies such as a shared decision-making approach and the 5As to discuss treatment options can facilitate formulating an obesity treatment plan. Utilizing telehealth, a team-based approach, and community partnering can increase patient access to intensive behavioral interventions. Future studies should evaluate other cost-effective methods to implement obesity care into the PC setting.

Parental Perception of Weight Status for Adenotonsillectomy Patients

OBJECTIVE

Weight status can affect outcomes in pediatric adenotonsillectomy performed for obstructive sleep disordered breathing. Parents frequently underestimate their child's weight and are unaware weight status may affect adenotonsillectomy success. Accurate understanding of a child's weight status is important for shared decision making with the family and perioperative care. The purpose of this study is to analyze the accuracy of the parent's perception of their child's weight status.

METHODS

A retrospective analysis was performed of prospective data collected from families of children undergoing adenotonsillectomy from June 2018 through June 2019.

RESULTS

A total of 522 children met the inclusion criteria. Two hundred and thirty-two children were either overweight (n = 46, 9%) or obese (n = 186, 36%). Among parents of this cohort whose children were overweight or obese, 74 (32%) erroneously reported that their child was normal weight. For the 290 nonoverweight children, 99% of parents accurately reported weight status. After adjusting for ethnicity, race, BMI%, and sex, for every 1-year increase in age of the child, the odds of the parent correctly identifying their child as overweight increased by a factor of 1.18 (95% CI: 1.09, 1.27).

CONCLUSION

One-third of families with children who were overweight or obese undergoing adenotonsillectomy for obstructive sleep disordered breathing underestimated their child's weight. This study highlights the need to facilitate family understanding of weight status' potential impact on both obstructive sleep disordered breathing severity and adenotonsillectomy success, especially for younger children.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:2121-2125, 2021.

Do Registered Dietitians, Nutrition Students, and Laypeople Perceive Individuals with Obesity Differently?

(1) Background: Obesity is associated with significant social consequences, and individuals with obesity are regularly affected by weight-related stigmatization experiences. This study compares antifat attitudes among registered dietitians (RD), nutrition students, and laypeople and assesses which factors related to the perceived causes of obesity influence these attitudes. (2) Methods: An online survey was conducted in Brazil with RD (n = 336), nutrition students (n = 300), and laypeople (n = 403) with questionnaires assessing antifat attitudes and perceived causes of obesity. (3) Results: All groups presented low antifat attitudes. Minor differences in antifat attitudes were found among the three groups. Compared to RDs and nutrition students, laypeople presented higher Weight Control/Blame scores, but with a small effect size (η² = 0.01). Weight bias was predicted by age, sex, and body mass index. External, social, and financial factors were not perceived to be very important in the development of obesity by RD and students. (4) Conclusions: Since slight differences were seen among RD and students compared to laypeople, and some perceptions of the causes of obesity indicate a stigmatized view. It is essential to place a greater focus on educating and updating these health professionals and students about weight stigma and its consequences for the mental and physical health of individuals.

Pediatric weight bias in prehealth profession undergraduates: an idiographic approach

Bias toward individuals with overweight/obesity (OV/OB) exists among health professionals and trainees with the potential to affect the quality of healthcare interactions. Given most research is adult-focused, this study aimed to examine the influence of weight status on clinical judgments in a pediatric context. Sixteen virtual human scenes representing hypothetical medical encounters of pediatric patients and their mothers were presented to prehealth profession undergraduates (n = 92). Characteristics, or cues, of patient and mother weight status (healthy weight vs. obese) and dyad race (Caucasian vs. African American) were manipulated across scenes. Participants provided ratings for assessment questions, including perceived treatment adherence and responsibility for health, for each scene. Data were examined via idiographic (i.e., individual-level) analysis, which involved generation of separate multiple regressions per participant per assessment question to capture the influence of the cues on participants' ratings. Results represent secondary outcomes from another study published elsewhere. Current analyses revealed that 12%-22% of participants relied on cues of weight status when making assessments about patient and mother adherence and responsibility for health. The majority of these participants equated higher weight status with poorer anticipated treatment adherence and greater health responsibility. Results suggest that the weight status of pediatric patients and their mothers' plays a considerable role in prehealth profession undergraduates' clinical judgments, with the future potential to affect disparities in pediatric care. This study highlights the importance of considering child and maternal factors and utilizing a novel approach that may serve as a model for further investigation of this issue.

Motivational Interviewing and Caregiver Engagement in the Family Check-Up 4 Health

Motivational interviewing (MI) is a therapeutic style in which a provider elicits client motivation and helps strengthen commitment to change (Miller and Rollnick 2002). The original Family Check-Up (FCU; Dishion and Stormshak 2007)-and the adapted version for improving health behaviors in primary care, the Family Check-Up 4 Health (FCU4Health; Smith et al. 2018a)-are brief, assessment-driven, and family-centered preventive interventions that use MI to improve parent engagement in services to improve parenting and prevent negative child outcomes. This study examines the role of MI in the Raising Healthy Children project, a randomized trial to test the effectiveness of the FCU4Health for the prevention of obesity in pediatric primary care, with data from the 141 families assigned to receive the FCU4Health. Families were eligible for the study if the child was between 5.5 and 12 years of age at the time of identification and had a BMI ≥ 85th percentile for age and gender at the most recent visit to their primary care provider. MI skills at the first session predicted caregiver in-session active engagement, attendance at follow-up parenting sessions, and improvements in motivation to address child health and behavior goals. Baseline characteristics of the family (i.e., child health diagnosis, caregiver baseline depression, motivation, and Spanish language preference) had differential associations with responsiveness and MI skills. This study has implications for program development, provider training, and fidelity monitoring.

Recognizing and treating child overweight and obesity

Primary care providers can help prevent and address child overweight and obesity, conditions that can affect children's present and future health as well as their psychologic, emotional, and social well-being. This article describes approaches to preventing, identifying, and addressing overweight and obesity using empathetic, practical, family-focused recommendations and actions.

Complexity and Stigma of Pediatric Obesity

Weight stigma is rooted in a fundamental misunderstanding of the origins of obesity, wherein the interplay of behavioral, environmental, genetic, and metabolic factors is deemphasized. Instead, the widespread societal and cultural presence of weight stigma fosters misconceptions of obesity being solely a result of unhealthy personal choices. Weight stigma is pervasive in childhood and adolescence and can affect individuals throughout their life. Although the prevalence of pediatric obesity remains high throughout the world, it becomes increasingly important to understand how weight stigma affects weight and health outcomes in children and adolescents with overweight or obesity, including in those with rare genetic diseases of obesity. We identified and reviewed recent literature (primarily published since 2000) on weight stigma in the pediatric setting. Articles were identified with search terms including pediatric obesity, weight bias, weight stigma, weight-based teasing and bullying, and weight bias in health care. In this narrative review, we discuss the stigma of pediatric obesity as it relates to the complex etiology of obesity as well as describe best practices for avoiding bias and perpetuating stigma in the health care setting.

Pediatrician Delivered Smoking Cessation Messages for Parents: A Latent Class Approach to Behavioral Phenotyping

OBJECTIVE

Message framing can be leveraged to motivate adult smokers to quit, but its value for parents in pediatric settings is unknown. Understanding parents' preferences for smoking cessation messages may help clinicians tailor interventions to increase quitting.

METHODS

We conducted a discrete choice experiment in which parent smokers of pediatric patients rated the relative importance of 26 messages designed to increase smoking cessation treatment. Messages varied on who the message featured (child, parent, and family), whether the message was gain- or loss-framed (emphasizing benefits of engaging or costs of failing to engage in treatment), and the specific outcome included (eg, general health, cancer, respiratory illnesses, and financial impact). Participants included 180 parent smokers at 4 pediatric primary care sites. We used latent class analysis of message ratings to identify groups of parents with similar preferences. Multinomial logistic regression described child and parent characteristics associated with group membership.

RESULTS

We identified 3 groups of parents with similar preferences for messages: Group 1 prioritized the impact of smoking on the child (n = 92, 51%), Group 2 favored gain-framed messages (n = 63, 35%), and Group 3 preferred messages emphasizing the financial impact of smoking (n = 25, 14%). Parents in Group 2 were more likely to have limited health literacy and have a child over age 6 and with asthma, compared to Group 1.

CONCLUSIONS

We identified 3 groups of parent smokers with different message preferences. This work may inform testing of tailored smoking cessation messages to different parent groups, a form of behavioral phenotyping supporting motivational precision medicine.

Caring for US Children: Barriers to Effective Treatment in Children with the Disease of Obesity

In 2020, impediments to pediatric obesity (PO) treatment remain pervasive, even though these barriers are clearly documented in medical literature. Providers must invest considerable resources to overcome these barriers to care. Notable barriers include gaps in medical education, misperceptions of the disease, weight bias and stigma, exclusion of coverage in health plans, and thus an unsustainable financial framework. Hence, this review offers an updated social-ecological framework of accessibility to care, wherein each barrier to care or variable is interdependent on the other and each is critical to creating forward momentum. The sum of all these variables is instrumental to overall smooth function, configured as a wheel. To treat PO effectively, all variables must be adequately addressed by stakeholders throughout the health care system in order to holistically comprehend and appreciate undertakings to advance the burgeoning field of PO medicine.

The "Stages Towards Completion Model": what helps and hinders children with overweight or obesity and their parents to be guided towards, adhere to and complete a group lifestyle intervention

Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention.

Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the “Stages towards Completion Model”. Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches.

Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved.

Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions.

Communication tools used in childhood obesity discussions: A scoping review

BACKGROUND

Paediatric healthcare professionals (HCPs) play an essential role in the prevention and management of childhood obesity; however, many report considerable barriers to having weight-related conversations, including a lack of confidence. One way to address this is to use communication tools, such as charts, pictures and handouts. This scoping review's objective was to identify the extent and nature of available tools in the published literature that aimed to support HCPs in having positive weight-related conversations with children and families.

METHODS

CINAHL, Medline and PsycINFO were systematically searched from 2005 to 2019. Articles were selected based on (a) use of an identified communication tool; (b) tool designed for use with children between the ages of 2 and 18 and/or their parents; (c) tool designed to be used in weight-related discussions; and (d) tool designed to be used by HCPs in a formal healthcare setting.

RESULTS

Of the 3,596 articles yielded after deduplication, 13 unique communication tools were identified. Tools were grouped according to three themes: (a) help communicate child's weight status; (b) provide a communication framework for HCPs; and (c) actively engage children and/or parents in discussions. Many of the tools were recently developed and had not been evaluated in clinical practice. The clinical utility of each tool was evaluated.

CONCLUSION

This study identified 13 communication tools HCPs could use when having weight-related discussions. However, there was a lack of evaluation and clinical utility. Only one tool had high clinical utility, and not all tools would be recommended for use in practice.

Parent Preferences for Pediatric Clinician Messaging to Promote Smoking Cessation Treatment

BACKGROUND AND OBJECTIVES

Insights from behavioral economics suggests that the effectiveness of health messages depends on how a message is framed. Parent preferences for smoking cessation messaging has not been studied in pediatrics, warranting further exploration to maximize benefit. We sought to assess parents' perceptions regarding the relative importance of distinct message framings to promote their smoking cessation.

METHODS

We conducted a cross-sectional discrete choice experiment in which parent smokers rated the relative importance of 26 messages designed to encourage them to begin cessation treatment. Messages varied on who was featured (child, parent, or family), whether the message was gain or loss framed, and what outcome was included (general health, cancer, respiratory illnesses, child becoming a smoker, or financial impact). The participants were 180 parent smokers attending primary care visits with their children at 4 diverse pediatric sites. The main outcome was the importance of smoking cessation messages based on who was featured, gain or loss framing, and the outcome emphasized.

RESULTS

Parent smokers highly prioritized cessation messages emphasizing the impact of quitting smoking on their child versus parent or family. Messages focusing on respiratory illness, cancer, or general health outcomes consistently ranked highest, whereas messages focused on the financial benefits of quitting ranked lowest. Gain versus loss framing did not meaningfully influence rankings.

CONCLUSIONS

Parent smokers identified smoking cessation messages that emphasized the impact on their child, with outcomes focused on respiratory health, cancer, or general health, as most important. The clinical impact of these messages should be tested in future research.

Who's a good boy? Effects of dog and owner body weight on veterinarian perceptions and treatment recommendations

Background:

Weight bias against persons with obesity impairs health care delivery and utilization and contributes to poorer health outcomes. Despite rising rates of pet obesity (including among dogs), the potential for weight bias in veterinary settings has not been examined.

Subjects/Methods:

In two online, 2×2 experimental studies, the effects of dog and owner body weight on perceptions and treatment recommendations were investigated in 205 practicing veterinarians (Study 1) and 103 veterinary students (Study 2). In both studies, participants were randomly assigned to view one of four vignettes of a dog and owners with varying weight statuses (lean vs. obesity). Dependent measures included emotion/liking ratings toward the dog and owners; perceived causes of the dog’s weight; and treatment recommendations and compliance expectations. Other clinical practices, such as terms to describe excess weight in dogs, were also assessed.

Results:

Veterinarians and students both reported feeling more blame, frustration, and disgust toward dogs with obesity and their owners than toward lean dogs and their owners (p values<0.001). Interactions between dog and owner body weight emerged for perceived causes of obesity, such that owners with obesity were perceived as causing the dog with obesity’s weight, while lean owners were perceived as causing the lean dog’s weight. Participants were pessimistic about treatment compliance from owners of the dog with obesity, and weight loss treatment was recommended for the dog with obesity when presenting with a medical condition ambiguous in its relationship to weight. Veterinarians and students also reported use of stigmatizing terms to describe excess weight in dogs.

Conclusions:

Findings from this investigation, with replication, have implications for training and practice guidelines in veterinary medicine.

What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology

Evidence of weight stigma and its harmful consequences have led to increased attention to the words that are used to talk about obesity and body weight, including calls for efforts to carefully consider weight-related terminology and promote respectful language in the obesity and medical fields. Despite increased research studies examining people's preferences for specific words that describe body weight, there has been no systematic review to synthesize existing evidence on perceptions of and preferences for weight-related terminology. To address this gap, the current systematic review identified 33 studies (23 quantitative, 10 qualitative) that examined people's preferences for weight-related terminology in the current research literature (from 1999 to 2019). Across studies, findings generally suggest that neutral terminology (eg, "weight" or "unhealthy weight") is preferred and that words like "obese" and "fat" are least acceptable, particularly in provider-patient conversations about weight. However, individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Of priority is future research that can improve upon the limited diversity of the existing literature, both with respect to sample diversity and the use of culturally relevant weight-related terminology, which is currently lacking in measurement. Implications for patient-provider communication and public health communication are discussed.

Youth perspectives on weight-related words used by healthcare professionals: A qualitative study

BACKGROUND

Although healthcare professionals often consider body weight a sensitive and difficult topic to discuss with children, a contextualized and comprehensive understanding of youth perspectives on weight-related words used in healthcare has yet to be established. This qualitative study aims to explore perspectives of Dutch children on the terminology healthcare professionals use when discussing weight.

METHODS

Fourteen interviews and one focus group discussion were held with children (age 8-16) who were in care because of their weight. A toolkit with customizable interview techniques was used in order to facilitate reflection and tailor the interview to each respondent. A narrative content analysis was conducted.

RESULTS

Respondents attached both clear and subtle differences in meanings to (certain) weight-related words. Their perspectives were not unanimous for any single word. Moreover, at times, respondents framed certain words in positive or negative ways or used a word they disliked to describe themselves. This illustrates that meanings of weight-related words are not fixed but context and situation specific.

CONCLUSION

This study revealed that meanings children assign to weight-related words are shaped by their experiences in the broader social context, especially at school, as well as with (previous) healthcare professionals. It pointed towards the importance of bedside manner, acquaintanceship, and support. Healthcare professionals treating children because of their body weight are advised to invest in a good patient-caregiver relationship, pay attention to children's previous (negative) social weight-related experiences, and reflect critically on their own preconceptions about body weight and the impact these preconceptions might have on their patient-caregiver relationships.

Family members' experiences with adult participation in weight management programs: Triadic perspectives from patients, partners and children

OBJECTIVE

Spouses are known to influence the outcomes of an individual's attempt at weight loss, but little is known about the broader influence of, and on, the family. The objectives were to explore: (a) the effects of an adult weight management program on the family and (b) family factors that help or hinder patient weight loss.

METHODS

A qualitative design was employed to explore triadic family members' experiences of patient participation in a weight management program. Semi-structured interviews were conducted with patients, partners and children (ages 7-18). Questions included support for patient participation and weight loss, dietary choices, meal preparation, physical activity routines, the home-food environment, communication about health and family dynamics. Thematic analysis was used, where codes and categories of codes were then grouped together to create themes and subthemes.

RESULTS

Nineteen triadic interviews were conducted (57 total). Seven themes emerged, including four related to Outcomes (objective 1): (a) shift in family dynamics, (b) family behaviour change, (c) child observations of family change, (d) indirect benefit to partner; and three related to Process (objective 2): (e) level of accountability, (f) patient perception of support and (g) support is essential and flexible.

CONCLUSIONS

Future research and clinical applications from these themes should seek to determine the positive behaviour change that was evident in the families that were interviewed, where the culmination of family interactions, expectations and concurrent partner weight loss indicates the potential longevity of weight management programs beyond patients' own participation.

Talking About Childhood Obesity: A Survey of What Parents Want

OBJECTIVE

Determine parent preferences when discussing their child's weight with regard to weight-based terms, terms that are the most motivating, preferred setting, and whether or not awareness of their child's weight status impact these preferences.

METHODS

Parents of children ages 3 to 17 years (N = 349) presenting for health supervision visits completed a survey to assess the degree of offensiveness and motivation for change of commonly used weight-based terminology, as well as the preferred setting for discussion of weight. Parents were asked to assess their child's weight status using recommended terminology ("obese," "overweight," "healthy weight," "underweight"), and their responses were compared to the children's objective body mass index (BMI) percentile.

RESULTS

The children had a median age of 10.3 years; 47.3% were female, 15.8% had overweight (85th-94th percentile BMI), and 11.5% had obesity (≥95th percentile BMI). Of children with overweight/obesity, 84.2% of parents underestimated their child's weight status. The least offensive terms were "at-risk weight," "BMI is high," "BMI is above 95%," and "unhealthy weight." The more offensive terms (P < .001) were "overweight" and "obese." The parent's perception of their child's weight did not affect offensiveness ratings. "Obese" was the strongest motivator for change (P < .001), and "unhealthy weight" was next. Well visits were preferred for discussing weight (P < .001). Most parents preferred to have the child remain in the room (P < .001), especially if the child was older (P < .001).

CONCLUSIONS

Providers should use preferred terms when discussing excess weight regardless of a parent's perception of their child's status and should also consider the motivational value of the term. "Unhealthy weight" was both preferred and motivating, but "obese" was the most motivating.

US Pediatrician Practices and Attitudes Concerning Childhood Obesity: 2006 and 2017

OBJECTIVE

To compare primary care pediatricians' practices and attitudes regarding obesity assessment, prevention, and treatment in children 2 years and older in 2006 and 2017.

STUDY DESIGN

National, random samples of American Academy of Pediatrics members were surveyed in 2006, 2010, and 2017 on practices and attitudes regarding overweight and obesity (analytic n = 655, 592, and 558, respectively). Using logistic regression models (controlling for pediatrician and practice characteristics), we examined survey year with predicted values (PVs), including body mass index (BMI) assessment across 2006, 2010, and 2017 and practices and attitudes in 2006 and 2017.

RESULTS

Pediatrician respondents in 2017 were significantly more likely than in 2006 and 2010 to report calculating and plotting BMI at every well-child visit, with 96% of 2017 pediatricians reporting they do this. Compared with 2006, in 2017 pediatricians were more likely to discuss family behaviors related to screen time, sugar-sweetened beverages, and eating meals together, P < .001 for all. There were no observed differences in frequency of discussions on parental role modeling of nutrition and activity-related behaviors, roles in food selection, and frequency of eating fast foods or eating out. Pediatricians in 2017 were more likely to agree BMI adds new information relevant to medical care (PV = 69.8% and 78.1%), they have support staff for screening (PV = 45.3% and 60.5%), and there are effective means of treating obesity (PV = 36.3% and 56.2%), P < .001 for all.

CONCLUSIONS

Results from cross-sectional surveys in 2006 and 2017 suggest nationwide, practicing pediatricians have increased discussions with families on several behaviors and their awareness and practices around obesity care.

Do Schools That Screen for Body Mass Index Have Recommended Safeguards in Place?

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

Preferred weight-related terminology by parents of children with obesity

AIM

In order to improve weight-related discussion with patients and minimise their discomfort, the terminology used by medical staff should be carefully chosen. The aim of the study was to identify the most motivating weight-related terminology to use with children with obesity.

METHODS

Focus groups were used to generate a list of 12 weight-related terms in Hebrew, sent by a questionnaire to parents of children and adolescents with obesity. Terms were graded according to how desirable, stigmatising, blaming or motivating they were perceived. We identified the most positive and negative weight-based terms and conducted linear regressions to predict child motivation to lose weight when positive terms are used.

RESULTS

The least stigmatising and most motivating and desirable terms were 'unhealthy body weight' and 'unhealthy lifestyle'. Medical staff mostly used 'overweight', which was relatively inoffensive yet not very motivating. 'Fat/obese' ('Shamen') was the most stigmatising and blaming term and the least desired. Only 20% of parents endorsed a nonverbal graphical tool to describe body size.

CONCLUSION

Our findings encourage using health-based terminology over weight-based terminology to promote treatment and lifestyle changes in children with obesity. Healthcare professionals should adopt patient-centred care and improve the weight-related terms they use with children with obesity.

How Should We Approach and Discuss Children's Weight With Parents? A Qualitative Analysis of Recommendations From Parents of Preschool-Aged Children to Physicians

The primary objective of this study was to describe parents' preference for how physicians should approach diet and weight-related advice for their child. Semi-structured interviews were conducted with parents (n = 40) of preschoolers, transcribed verbatim, and double-coded using an inductive thematic analysis approach. Parents identified recommendations for how physicians should approach conversations about weight. Themes included (1) Tone and Approach are Important, (2) Avoid Judgment, (3) Have Regard for Parental Expertise, (4) Consider the Timing of the Discussion with Parents, and (5) Equip Parents with Concrete and Individualized Recommendations. Future research should focus on developing brief, effective communication tools to guide discussions with parents about child nutrition and weight. Opportunities to learn about and practice the use of these brief interventions should be incorporated into medical education with the goal of providing clinicians the learning opportunities, skills/tools, and resources needed to adequately and respectfully discuss weight and diet with parents and children.

Obesity in Adolescents with Psychiatric Disorders

PURPOSE OF REVIEW

This narrative review synthesized recent research related to obesity in adolescents with psychiatric disorders, with a focus on epidemiology, mechanisms, and weight management approaches. The paper reviews literature on depressive and anxiety disorders, bipolar disorder, and schizophrenia spectrum and other psychotic disorders.

RECENT FINDINGS

Depression has a bidirectional relationship with obesity. Bipolar disorder and schizophrenia spectrum disorders, and their treatments, increase the risk of developing obesity. Mechanisms underlying this weight gain include lifestyle and environmental factors and psychiatric medications, though emerging evidence has also suggested the role of genetic and neuroendocrine processes. Evidence about the most effective treatments for obesity in adolescents with psychiatric disorders remains limited. Adolescents with psychiatric disorders are at high risk for obesity. Close monitoring for increases in weight and cardiometabolic risk factors with use of antipsychotic and mood-stabilizing medications is recommended. Clinical trials are needed that test the efficacy of weight management strategies for this population.