Discussing Obesity (Especially With Kids)

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Obesity often tends to be uncomfortable. Excess weight can be uncomfortable to carry, particularly when there is enough excess weight to impede function or interfere with favored activities. There is obvious discomfort involved if obesity leads to complications, such as type 2 diabetes. But the most common of all affiliated discomforts is simply talking about the matter.

For one thing, the language of obesity is troubling—beginning with the word “obesity” itself.

There is no reason why that word should sound insulting or convey stigma, but our culture has caused it to do just that. The word “obesity” is apt to induce, in many quarters, an involuntary wince.

The more traditional word for obese—fat—is obviously no better. And the various attempts at navigating around the discomfort of words we don’t like with words we might like better (bulky, beefy, etc.) generally only compound the problem by highlighting our efforts to find a way around it.

Talking about obesity is uncomfortable. So, unsurprisingly, I have been presented this very challenge innumerable times over my 25-or-so years of patient care: How do I talk to my _______ about their weight?

There are many potential occupants of that “_______.” I have had parents ask how to have this conversation with their own parents. More often, I have had it in the other direction: grandparents asking about their grown children.

I have had friends ask about friends, siblings ask about siblings, and spouses ask about spouses.

Generally, though, the most challenging and fraught of these scenarios involved children. When parents or grandparents, or other loved ones, are concerned about the potentially unhealthy weight of a child, they are routinely at a loss about how to broach the topic.

To be clear, obesity should not be discussed at all with very young children, in my opinion. They won’t understand and are not in control of the relevant factors—diet, daily physical activity patterns—anyway. In such cases, the challenge reverts back to adults who are concerned talking to other adults who may be less concerned, in denial, or simply at a loss.

Direct discussions with a child only make sense when the child can understand and has some autonomy over the pertinent behaviors. There is no one-size-fits-all numerical threshold for this, but at or about age 8 is a reasonable consideration.

The Heart of the Matter

Either way—whether the discussion is directly with a child, or with another adult on behalf of that child, the solution is simple, effective, and maybe even obvious—it is love.

What I mean is that, literally, the conversation should begin with love. “I love you…” or “I love my grandchild…” In other context, when addressing the same challenge with a friend, “I care about you” would be a reasonable alternative.

Why does this matter? First, if you are not comfortable broaching the topic of weight with love, then you are not the right person to be addressing it. The only valid reasons to discuss someone’s weight with them are if (a) there is legitimate reason to be concerned that their weight does or could harm their health, and (b) you care about their health, because you care about them.

If you have any doubts about this—if, for instance, you think you might want someone to address their weight because you find it embarrassing—then you are quite right to be uncomfortable. You should not discuss it; you are—forgive the bluntness—unqualified. Love makes you qualified.

Do not discuss weight with anyone, child or otherwise, if it is weight, per se, that concerns you. Do not discuss weight if your concern is about appearance or involves judgment. If, however, you are concerned about the health effects of weight in someone you love, including a child, you are right to want to address that, just as you would want to protect that person from any other danger.

That, then, is just what you should say: “I love you, and I am concerned that your weight may be a danger to you—and I would like to help make sure it isn’t. How can I help?

That last bit, “how can I help,” will tend to make more sense with adolescents and adults than with children. Children are unlikely to know the answer, so it may not make sense to ask the question. Again, there is no one-size-fits-all script. But the general approach is fairly universal. So, if talking to your child, you might say “…and I want to help, is that OK with you?”

Similarly, if talking to an adult, asking to help may be premature. Perhaps the best, first question is: “Is this something we can discuss?

Very Real Concern

Excess body fat is not always a health threat, but all too often it is. Obesity rates continue to rise among adults and children worldwide, and the consequences of obesity—including premature death—are rising in tandem. Being concerned about this is entirely valid. Addressing it at the individual level is, too, if your motivation is love and concern, not judgment.

As for what to do after you’ve broached the topic, that depends. Sometimes it’s just a matter of working together on improving diet and activity patterns; sometimes, the effort should involve direct guidance from a healthcare professional. There is one universal, though: It should all play out at the level of family, not individual child.

When the focus is health rather than weight, and love rather than judgment, there is never a reason why a child should have to “fix” their weight on their own. They should, instead, be part of a family working together at being healthy, and supporting one another, because they love one another. In unity, there is strength.

If whatever you do to address a weight problem in a child you do as a family, and you address because of love, you simply can’t go too far wrong. Start your conversations accordingly.

Dr. Katz was the founding editor-in-chief of the peer-reviewed journal, Childhood Obesity.

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