Professor Fiona Gillison from the Department for Health at the University of Bath discusses her research on how to talk to children about weight.
Sam knew her son was being bullied about his weight, but she was worried that raising it with him would only make things worse. She felt left with the difficult choice of either saying nothing, which would leave him to deal with the bullying on his own, or starting a conversation that could risk him feeling worse about himself. Having struggled with her own weight and body image all her life, Sam didn’t want the same for her son.
Sam is not alone – many parents find themselves in a similar position. Weight-related bullying is extremely common across the UK’s primary and secondary schools, particularly for children who have a higher body weight. In the last school year, 26.4% of children in Reception and 49.72% in Year 6 were considered above a healthy weight, according to figures from the National Child Measurement Programme. This is the highest proportion since the programme began in 2006, apart from a temporary peak during the Covid-19 pandemic (2020-21).
Most local authorities provide feedback to parents whose children fall outside of the healthy range for their age and height when weighed through the National Child Measurement Programme. While some parents find the feedback useful, others can respond negatively. They may challenge whether the information is correct, or whether it is legitimate to provide feedback on weight at all. They can be angry and upset, and/or anxious about how to deal with this information and what it means for their child. These concerns often relate to the belief that talking to a child about their weight could lead to lower self-esteem, poorer body image and, at worst, the development of eating disorder symptoms.
It is not just parents who have these concerns. Our research highlights that school nurses and other health professionals are also uncertain about the best way to advise parents on talking to children about weight. Until recently, there was no evidence-informed guidance to draw on – nothing to advise parents like Sam on how to decide what is best for her son, or how to navigate a positive conversation about their child’s weight when they need to.
Why is it so difficult to talk about weight?
Having a higher body weight or living with obesity attracts stigma, which is often perpetuated through the media, culture and, importantly, everyday social interactions. This stigma can lead to negative emotions, such as guilt and shame, and a low sense of self-worth. To protect themselves, people may cope by denying that they (or their child) have the stigmatised condition, or by avoiding settings where others might notice or comment. Consequently, weight stigma can contribute to social withdrawal and school avoidance among children and young people. It can also explain why parents hesitate to involve their children in discussions about weight. Indeed, even pre-school children show negative bias towards people with higher body weights, so the impact of weight stigma starts early in life.
What should parents do?
Talking about weight is undoubtedly an emotive topic, and people have very different and often strongly held views on whether or not we should discuss weight with children at all. However, it may not be something parents can avoid. Many children who are overweight or living with obesity will experience weight-related comments and stigma outside the home – regardless of what their parents do. These experiences can raise questions or worries, and research shows that children look for reassurance and support from their parents and caregivers, including on how to be healthy. Therefore, parents may benefit from access to clear advice in preparation for responding to their child, even if they don’t intend to initiate a conversation themselves.
Every child and family are different, and there is no single approach that works for everyone. However, different types of approaches can have different outcomes. For example, commenting more frequently on a child’s weight – even when it’s not intended to be critical – is associated with poorer wellbeing, according to our review of published research. Conversely, positive conversations, particularly those that focus on health and wellbeing rather than weight, can support children’s wellbeing. Building on this evidence, we have developed guidance for parents, caregivers and healthcare professionals on how to have positive conversations with children about weight.
The guidance – developed through work with parents, children, school nurses, clinical psychologists, GPs, public health specialists and researchers – has been tested with parents who have received feedback on their child’s weight, as well as with school nurses and GPs. They all agreed that it provided reassurance, new ideas and useful ways of phrasing a difficult topic, and that it aligned with their own aims to reduce the blame and stigma associated with heavier body weights. We also ran it by children themselves, who agreed that it reflected what they expect and want from their parents.
We see this guidance as essential reading for everyone working with children who may be considered overweight or living with obesity. As well as supporting positive conversations that focus on health (rather than weight) and avoid blame, it aims to reduce stigma by challenging readers to reduce their comments on others’ appearances and to raise children’s awareness of how social media misrepresents how people really look. Currently, awareness of the guide is inconsistent, and only a small proportion of parents who could benefit receive it. We would like to see wider access, including publication on the NHS website and greater promotion among GPs.
What additional support to parents need?
In recent decades, we have seen great strides in other areas where stigma was holding people back – whether from reaching their full potential, feeling included in their communities, or accessing health and other services. Mental health and sexual health are clear examples. None of these advances came from avoiding the issue. To reduce weight stigma, we will have to get better at talking about weight. This doesn’t necessarily mean talking about it more often, but rather choosing the right moment and approaching the conversation with greater skill and more thoughtfulness. We also have a responsibility to consider how, and how often, we comment on others’ weight and appearance, to challenge media stereotypes and to respond to our children’s questions openly, honestly and without bias.
Ultimately, people working in public health have known for many years that reducing obesity requires tackling the obesogenic environment we live in (that is, a physical, financial and social environment that promotes gaining weight and hinders weight loss), not placing responsibility or blame on individuals. In the meantime, we must actively support everyone to feel valued and included regardless of their body weight. We hope this guidance contributes to that goal.
The researchers’ guidance for parents on talking to children about weight is available online and in video format.
All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.
