Weight Based Terminology

Puhl RM, Peterson JL, Luedicke J. Parental perceptions of weight terminology that providers use with youth. Pediatrics. 2011;128:e786-e793

I came across an article from Medscape that had to do with doctors addressing obesity or overweight with their young(child) patients.  I had just posted my comments about kids and calories when the Medscape Week In Review landed in my inbox, so I saved it.

I took a break from my studies today, just to give it a quick read for the purpose of summarizing it here.  Well, of course, the advice to physicians comes from the results of a research study.  A survey based one at that (my favorite).  So you know I had to track it down and read about the sample, methods and data analysis.  I am a nerd that way.

These tangents were fine when I was in Florida, but are an indulgence with a price these days.  

So bottom line:

• docs need to address the issue because overweight/obesity lead to adverse  psychological and physical outcomes (teasing, alienation, disease)
• parents respond differently to the language doctors use
• the least stigmatizing or blaming terminology should be used - suggestions are based on the survey responses of nearly 500 parents  (70% of the sample was white and the majority had more than a HS education) 
• the words used (along with some personal traits of the parents) has an impact on the parents response to the physician's assessment
• even when the doctors used the words that the parents found the most blaming or stigmatizing the majority (71%) still said that they would encourage their children to lose weight
• the researcher is concerned that other parents will either find another doctor, not follow up with health care, or worse - put their child on an extreme diet

The survey results found that the terms the parents found most motivating (for weight loss) and least blaming were "weight problem", "unhealthy weight" or just "weight."

The words that were most stigmatizing and least helpful were "obese", "fat" and "extremely obese."
My favorite way to say it is "unhealthy weight."  I think that parents need to hear the connection between weight and health.  

The responses or answers were compared by some demographics and other traits (called psychographics).  For example, did the choice of most helpful response (unhealthy weight) change based on a persons race, gender, income, education level, own weight status, history of personal victimization or child's victimization, or the parents score on the fat phobic scale.  Yeah, thought that last one might get you.  I looked it up and it is attached below.  

The answers were pretty consistent by all traits with only subtle differences noted.

Here is a link to the Fat Phobia Scale (I would call it the fat negativity scale myself)

Here is the summary for the research article by Dr. Puhl.

Childhood Obesity and Adult Outcomes

Juonala, M. M. D. P. D., Magnussen, C. G. P. D., Berenson, G. S. M. D., Venn, A. P. D., Burns, T. L. M. P. H. P. D., Sabin, M. A. M. D. P. D., . . . Raitakari, O. T. M. D. P. D. (2011). Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors. New England Journal of Medicine, 365(20), 1876-1885.

The purpose of the study that is referenced above was to determine if people who were overweight or obese as children but who were NOT overweight or obese as adults would have similar cardiovascular risk factors as people who remained overweight/obese or who became overweight/obese as adults.

I know,  a lot to wrap your mind around.  If you figured out that they were comparing outcomes between 4 groups, then you are on the right track.

It has already been established that being overweight or obese as a child greatly increases the risk of adult obesity.  It has also been established that the heart disease (cardiovascular) risk factors associated with overweight and obesity are hypertension, diabetes, low HDL, high LDL, high triglycerides and thickening of the carotid artery. It is those six outcomes that the researchers measured in this study of over 4000 persons.

The current research involved four studies that were started about 23 years ago and which took place in USA, Canada and Finland.   The average age of the student at the start of the 4 studies (when their BMIs were collected the first time) was 11.  AT the end of the individual studies, the BMIs were collected again and each study had information on the risk factors for heart disease that I mentioned above.

Here are just a couple of things from the current study that I found interesting: 

Of the students who were normal weight at the start of the study - over 14% became obese adults.
Of the students who were overweight/obese as children, over 64% became obese adults.
OF the students who were obese, as other research has suggested, 82% became obese adults.


Everyone who was obese/overweight as an adult had 2 to 3 times greater risk of all of the above outcomes with few exceptions. 

The children who were overweight or obese and became normal weight adults had the same level of risk as normal weight adults. (this is great news)

The two things that need to be done with the findings are
1) prevent our children from becoming obese
2) provide treatment to obese children so they do not become obese adults. The best chance at reversing the weight is going to come in early childhood - before age 11.