Uncomfortable Conversations about Childhood Obesity

Concern over uncomfortable conversations about childhood obesity should not be a reason for avoiding the subject altogether, according to a new editorial in the September issue of Pediatrics. Confidential letters from schools in Massachusetts to parents of children with obesity have stirred up controversy. Derisively labeled “fat letters,” these missives have prompted parents to seek legislation to prevent schools from sending them.

This subject has been controversial since Arkansas started screening students for obesity and notifying parents in 2003. At stake is a careful balance between acknowledging a health problem and making weight-related stigma and bullying worse.

Research makes it pretty clear that childhood obesity is an uncomfortable subject for both parents and doctors. A study published recently in Obesity Research and Clinical Practice found that each group would prefer the other to raise the subject. So it’s not surprising that roughly a quarter of parents of children with excess weight report ever having been told about this by a doctor or health professional.

The ironic thing about this whole brouhaha is that so much energy is going into simply telling parents that excess weight is a problem. That’s a message that’s hard to miss, even without these so-called “fat letters.” (Duh!)

Michael Flaherty, author of the editorial in Pediatrics, more or less concedes that pediatricians are unable to have an adequate effect. And regarding those “fat letters,” he admits that “There remain to be any large-scale studies demonstrating their effectiveness in reducing pediatric obesity.”

All the energy devoted to arguing about BMI screening and notification is likely wasted. Nothing suggests that it’s being done in a way that would either increase or decrease the intolerable amount of weight discrimination that parents and children already face.

Energy and creativity really is needed to implement scalable childhood obesity interventions with evidence that they work to reduce the disease. And we need a bigger commitment to eradicating the weight-based bullying and discrimination that kids routinely face in school.

To accomplish these things, professionals, schools, parents, and communities need to work together on solutions — not fight over who should tell junior he’s too heavy.

Click here to read the editorial in Pediatrics, click here to read more from HealthDay, click here to read the study in Obesity Research and Clinical Practice, and click here to read a study of doctors communicating with parents about obesity.

Child Life Magazine, September 1928, illustration by Hazel Frazee

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