Stigma in Children’s Healthcare

Asheley Skinner, PhD

I was talking with one of my public health students, the mother of an eight-year-old, when she told me that she was worried about taking her little girl to the doctor. She was embarrassed because she knew the doctor was going to tell her that her child was “overweight.” How awful, I thought, that advice about a child’s weight could be so uncomfortable that a parent, even a student of public health, would rather just avoid the visit.

Is this real? Are doctors stigmatizing children affected by obesity and their parents? If they are, how are they making their judgments, and communicating them to patients?

What exactly do we mean by stigma? It’s not easy to define. Stigma is the judgment of some aspect of a person’s physical appearance, health or behavior. This includes a person’s weight. Stigmatization happens when people are treated badly, blamed for their characteristic, or have assumptions made about their behaviors. For example, many people with obesity are judged for their size, with other people thinking that they are lazy or lack control.

Although we are used to seeing stigmatizing ideas and pictures on TV and in press, we don’t expect it at the doctor’s office. The unfortunate truth is that, although some doctors are careful to avoid bias, healthcare providers regularly pass judgment on children affected by obesity and their families.

Few doctors are stigmatizing children and families on purpose. Whenever a doctor sees a child for a regular visit, he or she has a long list of information and advice they want to share with the child’s parents. They want to see that the child is growing well, learning well, creating healthy friendships, and getting the right vaccines, among many other things. All of this is shared before the parents even get to ask their own questions; it can be too much to squeeze into just a few visits a year.

In the midst of all these discussions, doctors use growth charts to tell parents that their child is affected by excess weight or obesity. Many parents are surprised – children with obesity don’t look like adults would expect. Children are naturally very thin, and can look thin even if they are heavier than they should be.

This takes time to explain, and time is very limited in most doctor visits. The conversation can be difficult for parents and children. Many patients feel like their doctor is judging them because of their weight. They are often right to feel this way, as studies have shown that a majority of medical students and doctors have negative beliefs about their patients with obesity. It’s easy to see how these beliefs can affect how they talk with their patients, even if they don’t intend to be hurtful.

While most doctors agree that we should not pass judgment on children, some do believe it is beneficial to put pressure on parents for the child’s weight-loss, something that has been called “stigma lite.” Yet we know that stigma in any form just doesn’t work. In fact, it usually backfires, making families less motivated to make healthy choices.

Most doctors who are trying to provide advice about obesity are not knowingly stigmatizing the child or the parent. But, without a careful approach to the subject, it is easy to see how parents may feel that way. Doctors often give advice that seems easy, but is hard for many families. When faced with the difficulties of daily life, it can be hard to imagine how to help a child “just” be more active.

About the Author:
Asheley Skinner, PhD, is an Associate Professor of Pediatrics at the University of North Carolina at Chapel Hill. She has written many papers about the childhood obesity, including health outcomes and obesity stigma. She is committed to developing ways to improve obesity without causing unintended harm. 

Next Week…

Join us next week as we will talk about how to talk to your child’s doctor about weight, and how to help combat stigma with your healthcare providers.

Disclaimer: This blog post does not reflect the views of the OAC, the National Board of Directors or staff. Information contained in this blog post is not based on scientific research and has not been validated. The OAC does not endorse any merchandise or program mentioned in this blog post.



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