March 2, 2012

No More Sugarcoating: A Response to the Georgia Child Obesity Campaign

Joanna Dolgoff, MD, FAAP
Child Obesity Specialist

A blunt new ad campaign in Georgia, “Stop Sugarcoating,” featuring images of miserable-looking overweight children is stirring up national controversy. While the ad campaign aims to increase awareness of childhood obesity, many parents are concerned it will only cause more stigmatization of overweight kids.

While I agree that these ads are quite shocking and understand why they have been met with criticism, I do believe that a hard-hitting campaign may be the wake-up call needed to prevent a catastrophic public health crisis.  The point of these ads was to spark discussion about childhood obesity.  As anyone with a Twitter account can attest to, this has been accomplished.  While it is uncomfortable to watch these ads, it is when people are uncomfortable that change occurs. 

With nearly 1 million, or 40 percent, of kids in Georgia considered overweight or obese, it is imperative that parents understand that this is a grave issue that cannot be ignored.  The truth is, as the campaign points out, 50 percent of people surveyed don’t recognize childhood obesity as a problem. What’s more, 75 percent of parents with obese kids don’t acknowledge their children as having weight issues.  Most seem to think this is somebody else’s problem. Sparking this discussion forces parents to confront the problem.  Overweight kids can’t be helped if their parents don’t acknowledge that help is needed.

As a pediatrician and child obesity expert, I have seen firsthand the bullying and stigmatization these children endure. Given the experiences I have witnessed firsthand, I don’t believe these ads will increase the bullying of overweight kids; they are already being bullied daily.
Pediatricians can, and should, use the controversy these ads have stirred up as an opportunity to address the issue at hand; our kids are overweight and we need to help them get healthy. 

Here are some do’s and don'ts for pediatricians when it comes to talking to their patients and their parents.

1. Don’t Avoid The Subject:  Researchers analyzed data on roughly 5,500 people who took part in government health surveys between 2005 and 2008. One-third of the obese participants and 55% of overweight participants had never been told by a doctor that they were overweight. Nearly 20% of obese people whose doctors hadn't brought up their weight described themselves as "not overweight," compared with just 3% of those whose doctors had discussed the issue.
If a doctor did comment on a patient's weight, it seemed to make an impression.  Obese and overweight patients who discussed the issue with doctors were more than twice as likely to have tried to lose weight in the ensuing year.
Addressing the subject makes a difference. Many people who are overweight or obese want assistance in setting and achieving weight-loss goals but hesitate to broach the topic during office visits.

2. “Excess Weight” versus “Obese”:  While it is important to discuss the fact that a patient is overweight or obese, the manner in which you broach the subject is important as well. A study, from the Rudd Center for Food Policy and Obesity at Yale, found that parents prefer when healthcare professionals describe a patient’s weight as “unhealthy” instead of “fat, obese or extremely obese.” The findings, published in PEDIATRICS, September 2011, reported that parents feel the latter terms stigmatize children rather than motivate them to lose weight.

3. Establish A Rapport: Many patients want to talk about weight with healthcare professionals. However, before starting a conversation about weight control, allow your patient to discuss other issues that may be affecting their physical or emotional well-being.  Explain that you want to help them lose weight and improve their health but assure patients that your interest in their health is not dependent on their success in losing weight.

4. Open the discussion: Open the conversation by asking if your patient is willing to talk about weight, and express your concerns about how his weight may be affecting his health. Next, you might ask your patient to describe his weight. Here is a sample discussion opener.
“Jason, could we talk about your weight? I’m concerned that your weight may be causing you health problems. What are your thoughts about your weight?”

5. Prescribe healthy eating and physical activity behaviors:  Give your patient concrete actions to take in order meet his or her weight goal. Write a prescription for healthier eating and increased physical activity. Another option is to refer patients to either a weight-loss program, a registered dietitian specializing in weight control, or a certified fitness professional.

6. Follow up: When you see your patient again, note progress made and offer praise to motivate and boost your patient’s self-esteem. Likewise, discuss setbacks and provide encouragement to overcome challenges.