Physicians need to review bias when caring for children with obesity

Counting calories shouldn’t be the focus of weight-loss strategies for children with obesity, according to an expert who said pediatricians need to change the way they talk about weight with their patients.

During an Oct. 9 plenary session of the American Academy of Pediatrics (AAP) 2022 National Conference, Joseph A. Skelton, MD, professor of pediatrics at Wake Forest University School of Medicine, Winston-Salem, North Carolina, said pediatricians acknowledge the behavior should , physical, environmental and genetic factors that contribute to obesity. For example, food deserts are on the rise, eroding parents’ ability to feed their children healthy meals. Also, more children are less physically active.

“Obesity is much more complex than calorie intake and calorie intake,” Skelton said. “We have chosen to treat obesity issues as a personal responsibility — ‘You did this to yourself’ — but when you look at how we move and live our lives, our food systems, our policies, the social and ecological changes change causes our behavior.”

According to Skelton, stereotypes about children with obesity can damage their self-image and reduce their motivation to lose weight. In addition, stereotypes surrounding obese children may change the way doctors treat them. These stereotypes are often reinforced in media portrayals, Skelton said.

“Typically when children or adults who are overweight or obese are portrayed, they are portrayed in a negative way,” Skelton said. “There is increasing evidence that weight bias and weight discrimination increases the morbidity that we see in patients who develop obesity.”

For many children with obesity, a visit to the pediatrician is often about weight, regardless of the reason for the visit. According to a 2019 study, weight stigma and prejudice from healthcare providers can increase stress and health outcomes in children. Skelton recommended that pediatricians listen to their patients’ concerns and create a personalized treatment plan.

Skelton said doctors can benefit from projects like Health at Every Size, which provide templates for personalized health plans for children with obesity. It has a strong focus on a weight-neutral approach to pediatric health.

“There are several ways to control weight in a healthy and safe way,” Skelton said.

Evidence-based methods of treating obesity include focusing on health and healthy behaviors rather than weight, and using body mass index as a screening tool for further conversations about overall health rather than as an indicator of health based on weight.

Skelton also encouraged pediatricians to be on the lookout for signs of eating disorders, which may include dieting, teasing or talking excessively about weight at home, and reading misinformation about dieting online.

“Your job is to educate people about the dangers of following unscientific information online,” Skelton said. “We can address weight health issues in a way that is patient-centric and very safe, with no unintended consequences.” Brooke Sweeney, MD, professor of internal medicine and pediatrics at the University of Missouri-Kansas City School of Medicine, Kansas City, Missouri , said that problems with weight bias in society and in clinical practice can lead to misconceptions about people with obesity.

“It’s normal to gain fat or adipose tissue at different times in life, during puberty or pregnancy, and some people typically gain more weight than others,” Sweeney said.

The body will attempt to maintain a weight target. This set point is influenced by many factors such as genetics, environment and lifestyle.

“When you lose weight, your body is trying to get you back to setpoint, lowering energy expenditure and increasing hunger and reward pathways,” she said. “We have gained so much knowledge through research to better understand the pathophysiology of obesity, and we are making good progress in improving advanced treatments for obesity in children.”

Skelton reports no relevant financial relationships.

American Academy of Pediatrics (AAP) National Conference 2022: Plenary Session. Presented on October 9, 2022.

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