Sunday, July 5, 2015

Should you tell your child she is 'too fat?'

A recent study found that 10-year-old girls who were told they were "too fat" by family members, friends, or teachers had a greater chance of obesity when they were measured again at age 19 than those who had not been weight labeled.

Should you tell your child she is 'too fat?'


Parents, it turns out you probably shouldn’t use the f-word around your children.

No, not that f-word. 

The other one.


In a research letter published last week in JAMA Pediatrics, researchers found that 10-year-old girls who were told they were “too fat” by family members, friends, or teachers had a greater chance of obesity when they were measured again at age 19 than those who had not been weight labeled.

You might be thinking “well, of course girls who were overweight at age 10 were more likely to be obese at age 19.” Well, the authors of the study thought of that, too, and they statistically controlled for the girls’ initial BMI. Regardless of what a girl actually weighed at age 10, being labelled as “too fat” (and 58 percent or 1,188 of them were) still predicted greater chance of obesity in early adulthood. Risk for obesity at age 19 was slightly higher if the girls had been told they were “too fat” by family members than by friends or teachers.

The authors of the study note that their results are in line with previous research showing that stigmatization of overweight children has negative consequences for their emotional and physical well-being. Moreover, research with adults has already indicated that weight-based discrimination is associated with weight gain rather than weight loss, possibly because being made to feel bad about your weight might lead to overeating as a coping behavior.

The researchers conclude that interventions aimed at stigmatizing or shaming the overweight aren’t likely to work to improve health, and instead recommend non-stigmatizing approaches.  What would that look like?  Lead author Jeffrey Hunger (Yes! That’s his real last name!) states, “I think a non-stigmatizing approach to improving health is one that focuses on that -- health. We have a laser focus on weight, which is an imprecise indicator of actual health.  There's no need to say the "f" word at all if you want to improve your child's health. You can encourage healthy eating and physical activity without ever commenting on his or her weight.”  

So what's a parent to do if your child comes home, likely in tears, complaining that a classmate, teacher, or coach called her "too fat?" I recommend that you:

  1. Practice assertiveness skills with your child with role plays (first she plays the bully while you answer back, then you play the bully while she answers back). This way she'll be prepared to answer back if teased again.
  2. Ask her how she personally feels about her body. She may very well like the way she looks. But, if she is distressed about her size, don’t give advice, just listen and empathize ("I can hear that you are sad today").
  3. Emphasize a healthy lifestyle for ALL members of your family, so that one child does not feel stigmatized. Getting enough sleep, staying active and exercising regularly, and eating nutritious foods are something everyone should do.

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Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
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About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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