Respect Will Grow

Why Is Respectful Care for Childhood Obesity Remarkable?

A new viewpoint in JAMA Pediatrics yesterday reminds us that respectful care for childhood obesity is remarkable. Why? How can it be that good care for one of the most common health problems of childhood is unusual?

Respectful Language Is a Start

Fatima Cody Stanford and Ted Kyle point out that respectful language is an important place to start:

Language can set the tone for productive dialogue with youths and parents or it can prevent dialogue from ever happening. Research suggests that a physician labeling a child with stigmatizing language can lead to parents seeking a different physician or avoiding medical appointments for their children altogether.

Using people-first language means that the patient comes first and obesity surfaces as only a medical condition.Physicians should take cues from patients and parents about acceptable terminology. Motivational interviewing skills can help in finding constructive language. In addition, the clinic environment, including staff and physical facilities, can play a role in either stigmatizing or welcoming patients and families with obesity. But in no case does labeling a patient as an obese child enhance a child’s self-concept.

But It’s Only a Start

Of course, respectful language, by itself, accomplishes nothing without good clinical care. Language alone cannot guarantee effective care that meets the needs of patients and families, say Stanford and Kyle. And the fact is that good evidence-based care – especially for severe childhood obesity – is rare.

The reasons are many. Presenting at the National Academy of Sciences last year, Susan Woolford pointed to many factors. High costs, poor reimbursement, and low reach are at the top of the list. Fewer than 50 clinics in all of the U.S. offer comprehensive care for more than 5 million children with severe obesity. With so few places to go, we almost guarantee that good care is unavailable for most children with severe obesity.

Why? It all boils down to money. Because of poor funding and reimbursement, Stage 4 centers for childhood obesity care almost always lose money. Clinicians don’t seek training for obesity care, because they will have nowhere to practice. Innovation is slow because funding is scant.

Because of this neglect, the healthcare system is facing a tidal wave of chronic diseases. Children with untreated severe obesity become adults with multiple chronic disesases. Neglected medical needs don’t go away. They multiply.

We can surely do better for our children.

Click here for the commentary in JAMA Pediatrics and here for proceedings of the National Academies workshop. For more on unmet needs click here. And finally, for clinical practice guidelines, click here.

Respect Will Grow, graffiti from San Francisco’s Mission District, photograph © Thomas Hawk / flickr

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September 5, 2018