Sticks and stones: how we talk about weight, shape and size with our children

By Sarah Armstrong, MD, for KidsFirst

What images come to mind when you think of “childhood obesity?” Likely, it will be one of the many stereotyped images of obesity that are so common in media these days. Perhaps your mind conjures an image of the backside of a child with one hand grasping his parent’s hand (who also has obesity) and the other hand grasping a fast food bag, or maybe a teen who struggles with her weight, looking sad, hopeless, and lonely. Even in children’s movies stereotypes are reinforced. Kung Fu Panda (“Po”) is a “jolly” character who is also lazy, sloppy, and lacking in willpower. Cookie Monster plays a similar role on “Sesame Street.” It is no wonder that children as young as three years of age, when asked whom they would rather play with, will pick an image of a normal weight child rather than that of an overweight child. 

Obesity is a medical condition, not a choice. It is true that lifestyle changes can help some people achieve a healthy weight. However, this is the exception and not the norm. Some people are genetically predisposed to be hungrier, to absorb more nutrients, to have a slower metabolism, or to prefer lower levels of physical activity. The scientific community is only beginning to understand now why it is harder for some people to lose weight than others, and why some people can sustain very unhealthy lifestyles and yet never suffer from obesity. Society is quick to blame individuals affected by obesity while making far-reaching assumptions about their lifestyles and personal qualities that may or may not actually be accurate. 

Society is quick to blame individuals affected by obesity while making far-reaching assumptions about their lifestyles and personal qualities that may or may not actually be accurate.

Unfortunately, bias and stigma affect people with obesity in harmful ways. For many people, eating is a coping mechanism for emotional stress. Children who feel marginalized or teased by peers for their body shape or size may turn to food for security, happiness, or comfort. Youth with obesity are vulnerable to victimization for weight; in fact, weight-based teasing is one of the most prevalent forms of bullying. Healthcare providers may unintentionally reinforce stereotypes by telling patients they need to “just lose weight,” or – worse - by quickly assuming that physical symptoms are related to weight rather than a treatable injury or illness.

One positive step everyone can take – starting now – is by changing how we talk about obesity. Typically, people use “obese” as an adjective, “the obese child.”  That language allows obesity to come before the child, to define him. However, we would never say “the cancer child.”  A Google Scholar literature search shows 2,710,000 hits for obesity-first language, and only 218,000 hits for other conditions such as autism, asthma, and diabetes. Language matters. Our children and patients are listening. Let’s start saying, “the child with obesity,” and put children first.

Take-home points:

  • Weight bias is very common, and still considered “fair game” by many people
  • Kids make healthy changes from a place of confidence and pride, not shame and embarrassment.
  • Use “person-first” language to check your own bias, and encourage others to do the same.
Sarah Armstrong

 Sarah Armstrong, MD is the director of the Healthy Lifestyles Program at Duke University in Durham, NC.


Related Resources

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[Obesity Action Coalition]

For immediate help, the National Eating Disorders Association offers support through text messaging, online chat and a phone hotline available five day a week (800) 931-2237.

“KidsFirst” is a blog, hosted by the Duke Department of Pediatrics, that provides high quality information to families on a wide range of important child health topics.