ENDOCRINOLOGY: Crafting the conversation on overweight and obesity

Pediatricians have a critical role in addressing childhood overweight and obesity. However, their success in achieving positive outcomes with individual patients depends on the spoken and unspoken messages delivered during the clinical encounter.

According to Stephen Pont, MD, practitioners interacting with overweight and obese children and their parents should remind themselves that, by using a proper approach in their communication, patients will achieve better results faster. The key points are to be sensitive and collaborative. He spoke about point-of-care strategies for encouraging healthy-weight trajectories and lifestyle changes during a joint symposium on obesity. Pont’s presentation was the third session, "Strategies at the Point of Care: Communication, Family Engagement, and Behavior Change.”

When addressing weight issues with children and their parents, the goal of the discussion is to create empowerment, Pont said. Basic techniques for achieving the desired effect are to:

• Express empathy-acknowledging the challenges of being overweight and adopting new ways helps take pressure off children and their families.

• Keep it positive inside the examining room and out-avoiding comments that create guilt or assign blame and ensuring that patients do not feel stigmatized about their weight by any aspect of the visit.

• Be realistic-encouraging small steps toward a better lifestyle with permanent and sustainable modifications rather than drastic and short-term actions.

• Make it a team effort-involving the family’s support and cooperation in making healthy choices.

• Build confidence and be on their side-telling patients you believe they will be successful in lifestyle change and that you will work with them.

Pont noted that while his advice seems like common sense, it is sometimes hard to practice in the setting of a busy office. In addition, evidence showing that health care professionals are some of the worst offenders when it comes to weight bias supports a need to remind clinicians to be careful about how they speak and what they say.

Stephen J. Pont, MD, MPH, FAAP, is a pediatrician at Dell Children’s Medical Center of Central Texas, Austin, and chair, American Academy of Pediatrics (AAP) Section on Obesity.

With about a third of children overweight and obese, it is important for pediatricians to have collaborative, culturally competent, and motivating conversations about healthy dietary and physical activity lifestyles with all children. Parents really want to know whether their children are at a healthy weight, so we need to plot children using standardized BMI curves. Many parents are fearful that their children are too thin. In those cases, we usually can be reassuring. When there are concerning trajectories that children are gaining weight too quickly, we need to communicate that as well. However, most of the conversation should be about health and the path to health-healthy habits and healthy body image.

Pont’s session argued for the importance of small steps in that direction, which still can be realistic even for busy families. He also emphasized the need to be supportive and positive, and discussed the importance of recognizing and avoiding weight bias. Sessions reinforcing these goals are incredibly important. Pediatricians can help families as they navigate a fairly “obesogenic” world and can be key advisors in these areas. There are many messages in society that encourage children to eat calorie-dense and nutrient-poor foods at the same time that society propagates the stigma about obesity. Pediatricians can help families to keep the focus on health and support families to achieve healthy lifestyles throughout key transitions.

Eliana M. Perrin, MD, MPH, is associate professor of pediatrics, University of North Carolina at Chapel Hill School of Medicine, and director, Child Health Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.