New mindset needed to better address the growing prevalence of childhood obesity and the weight stigma that comes with it

Andrea Haqq led a team that recently published an academic review examining the complexity and stigma of pediatric obesity.

Andrea Haqq is a leading pediatric endocrinologist at the University of Alberta who is on the front lines of research to better understand the causes of childhood obesity, find solutions to prevent it and identify steps that can be taken to eliminate the stigma surrounding it. Haqq, who is a member of the Alberta Diabetes Institute, Obesity Canada and the Women and Children’s Health Research Institute, led a team that recently published an academic review examining the complexity and stigma of pediatric obesity. The review, supported through the assistance of Rhythm Pharmaceuticals, gives insight into a complex condition that Haqq believes is often oversimplified.

Learn more about Haqq’s findings in the Q&A below.

Q: What is the prevalence of childhood obesity and how has it changed over the past several decades?

It is estimated that obesity affects more than 107 million children worldwide, with the prevalence of pediatric obesity in high-income countries exceeding 20 per cent. This represents a two- or threefold increase of obesity rates among children at the country-specific level within the past 40 years. In children and adolescents, recent research shows the long-term health effects of obesity may last a lifetime and include obesity persisting into adulthood. 

Q: What are the primary reasons for the change?

Pediatric obesity is a multifactorial chronic disease with a variety of phenotypes, clinical presentations and treatment responses that result from the complex interplay of behavioural, environmental, genetic and metabolic factors. 

It is these factors in the environment (such as reduced physical activity, increased caloric consumption, reduced sleep duration, increased screen time, etc.) that are acting on genetically or metabolically susceptible individuals to now bring out the obesity phenotype to a greater degree over time. 

Q: What is weight stigma? How does it impact children who are overweight or obese?

Weight stigma is defined as negative attitudes towards, and beliefs about, others because of their weight. Children with excess weight suffer a great deal from weight stigma. This may lead to increased activation of physiologic pathways, including those involved with metabolism and inflammation, and thus contribute to further weight gain and increase risk of obesity comorbidities. Weight-based teasing among children and adolescents is associated with increased depression and anxiety, disordered eating and decreased self-esteem. Children and adolescents who are stigmatized because of their weight may internalize weight-biased attitudes, leading to self-directed shaming and stereotypes about themselves. This also can cause harm such as poor self-reported health and health-related quality of life, binge-eating and maladaptive health behaviours. 

Q: How has weight stigma changed over the years?

Longitudinal data, although scarce, suggests that this problem has worsened over time. Weight stigma is ubiquitous. Children with obesity experience stigma from peers, educators, health professionals, the media and even from friends and family. A possible explanation is that rates of obesity escalated during the same time period of rising trends in weight stigma. Shaming, harassing or criticizing people about their weight and/or eating patterns are often used in the media to motivate people to change their behaviour. Sociocultural messages reinforce the notion of personal responsibility for weight gain. This may also play a contributing role in the increased rates of weight stigma. 

Q: What are some of the common myths around weight management?

Many hold the view that weight is within the control of an individual and incorrectly attribute overweight or obesity to individual failure in willpower or responsibility. But oversimplifying the causes of obesity and implying that easy solutions (“eat less, move more”) will lead to quick and sustainable results mask the difficult challenges children with overweight or obesity can face in managing their weight. Important biological, social and environmental factors that drive weight gain but are beyond individual control are often neglected. Shaming is often used to provide motivation for weight loss and behaviour change. In reality, research shows that fat-shaming causes stress and may lead to people overeating and avoiding physical activity. 

Q: As a society, what can be done to overcome negative or harmful stereotypes that lead to weight stigma? What interventions are possible—in society in general and in the health-care setting?

Recognizing obesity as a disease will help alleviate the stigma associated with overweight and obesity. Awareness and knowledge of rare genetic diseases of obesity may promote a broad understanding of the complex contributing factors to obesity and reduce weight stigma and facilitate a new scientifically grounded narrative of obesity.

Health-care providers can help by doing the following: 

• avoid using stigmatizing language and practices and strive to make their clinical practices safe and accessible to their patients
• adopt people-first language in health systems and public health-care services, such as a “patient or person with obesity” rather than “obese patient”
• explore all possible causes of a presenting problem and avoid assuming it is a result of an individual’s weight status
• emphasize the importance of realistic and sustainable behavioural changes, while acknowledging the difficulty of achieving sustainable and significant weight loss