Conversations Around Pediatric Obesity: Communicating with Compassion

Dominique Williams, MD, MPH

Obesity affects more than 14.7 million children and adolescents in the United States, with prevalence increasing as children age.¹ We know that giving children a foundation of healthy habits is crucial to their current and future well-being, but how do we initiate informative conversations about pediatric obesity in a way that empowers children and their families?

These are sensitive discussions, requiring that healthcare professionals understand how to address and treat the physical and emotional aspects of weight management. Initiating and sustaining productive patient engagement begins with evaluation and continues with ongoing conversations and personalized treatment plans.

Evaluating pediatric patients for obesity

Providers typically track patients’ growth patterns using a series of charts from the Centers for Disease Control and Prevention or the World Health Organization, and these can be beneficial in understanding the patient’s history and health trajectory. In addition, body mass index (BMI) is used to calculate the proportion of weight to height and plotted on a specific curve based on age and sex. The higher the BMI, the higher the risk. For pediatric patients, a BMI over the 95th percentile would indicate obesity. These measurements can offer a snapshot of the problem, but numbers don’t tell the whole story.

Obesity is a complex disease caused by the interaction of multiple factors, including family history, emotional health, social and economic conditions.² Additional risk factors should be explored as well, including:

• Family history of diabetes, hypertension, hypercholesterolemia, or obesity
• Symptoms like headaches, snoring, and disrupted sleep, which are often indicators of obstructive sleep apnea
• Emotional and mental health conditions like depression or anxiety
• Thigh or hip pain and limping, which can be associated with slipped capital femoral epiphysis
• Psychosocial considerations including bullying, history of trauma, problems at school
• Socioeconomic factors like access to nutritious foods, safe neighborhoods, or stable housing

Taking a step back and using multiple points of reference helps clinicians create a clearer and more complete picture of a patient’s situation. With a perspective that encompasses both physical and emotional well-being, we can move forward with productive discussions about improving their health.

Creating non-stigmatizing discussions

Children and adolescents face a constant barrage of messages about their bodies. As a result, they are far more susceptible to developing insecurities or issues with body image. In the media and parts of society, thinness is often depicted as the exemplar of beauty. We have the opportunity to help patients dismantle long-held beliefs that equate body size with success and popularity, and instead focus on their health.

Conversations about weight management and obesity treatment are critical, but what’s of equal or more importance is how healthcare providers approach those discussions with patients and their families or caregivers.

Some important strategies to keep in mind to foster effective conversations about weight management include³:

• Ask permission to discuss weight and inquire about the patient’s concerns.
• Don’t use words like “fat” or “obese” in discussions about weight.
• Avoid making assumptions about the patient’s lifestyle or social and economic conditions.
• Focus on ways to improve health, strength and stamina.
• Avoid labeling foods as “good” or “bad” or assign more permissive food rules to other family members who “don't have a weight problem.”

We also need to acknowledge and educate ourselves on weight bias and stigma. Children don’t just face weight stigma at school, it can happen everywhere. Weight-based victimization can lead to depression, avoidance of physical activity, and unhealthy behaviors. Healthcare professionals have a key role in recognizing and addressing this important aspect of obesity treatment.

Individualizing treatment based on the patient’s unique needs

The pillars of obesity treatment include nutrition, physical activity, behavior therapy, and medical management. It’s up to the clinician and the patient to decide together how best to combine these pillars to create customized goals. Creating an effective framework for patient-physician interaction requires that we understand age-appropriate nutrition and also be knowledgable about additional factors that contribute to obesity, such as prenatal history, adverse childhood experiences, social determinants of health, medical history, and medications.

Remember, too, that children and adolescents want a say in their treatment. They don’t want a template for weight management; they want to collaborate and infuse their plan with engaging activities and customized goals. Learn about their hobbies and interests, gauge their readiness and confidence, and then create a personalized treatment plan designed for the individual, not for the scale.

Resources to enhance your practice

For healthcare professionals who are interested in deepening their knowledge and enhancing their practice, the Obesity Medicine Association’s Pediatric Obesity Algorithm is an insightful resource that can help clinicians make informed decisions about pediatric obesity treatment.

With age-specific recommendations and staged treatment approaches, the evidence-based algorithm was created by clinicians and pediatricians who specialize in obesity treatment for children and adolescents. The Obesity Medicine Association also offers additional resources and a network of providers who specialize in obesity treatment.

1. Centers for Disease Control and Prevention. Childhood Obesity Facts. Accessed 24 October 2022.

2. Cuda S, Censani M, O’Hara V, Browne N, Paisley J. Pediatric Obesity Algorithm eBook, presented by the Obesity Medicine Association. 2020-2022. www.obesitymedicine.org/childhood-obesity (Accessed October 24, 2022)

3. Pont SJ, Puhl R, Cook SR, Slusser W. Stigma experienced by children and adolescents with obesity. Pediatrics. 2017;140(6). e20173034

Dominique Williams, MD, MPH, works in The Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital and serves as Assistant Professor of Clinical Pediatrics at The Ohio State University College of Medicine in Columbus, Ohio. She has special interests in education and curriculum development, as well as pathways for professional development. She currently serves as Chair of the Obesity Medicine Association's Pediatric Committee.