Table 1.

Communication guidelines to help pediatricians discuss obesity prevention with parents of children ages 0 to 24 months, findings from human-centered design activities with parents and pediatricians, Indianapolis IN, April-June 2021.

DO….	Excerpt from the Script Activity	Relevant Quote from the Show and Tell Activity
Share relevant personal parenting experiences	“If the pediatrician had a child of her own, she may relate her own experiences to reinforce the point, saying something like ‘My little Logan was the pickiest eater until he tried things at least five or ten times!’” [parent stakeholder]	“I always like it when the doctors feel like they can relate to us and give us their own experience on it, because it’s like, oh, okay, you’re not just telling me this because you’re a doctor. You’re also telling me because your mom as well, right? I know that would help me put it more in consideration, like yeah, okay, she’s a mom. She’s understands, it’s not that easy.” [parent stakeholder]
Show empathy	“The pediatrician acknowledges that kids this age can definitely be picky eaters and it can be a struggle to get them to eat healthy. She reassures mom that she knows that mom is doing the best that she can and that the child is otherwise healthy and developing well.” [pediatrician stakeholder] “Mom says: ‘He’s a picky eater. He fights me on eating healthier foods.’ The pediatrician responds by telling the parent ‘Most kids are!’ and ‘In fact, it usually takes several tries for a child to embrace the taste of a new type of food.’ The parent is reassured and feels encouraged that he or she may find success through persistence.” [parent stakeholder] “Dr.: Now I know you mentioned that your other daughter, Miranda, is starting pre-K and your husband just got a new job. With all that on your plate, I can imagine it can be a challenge with a little one like Margaret.” [parent stakeholder]
Validate parents’ struggles and concerns	“The pediatrician listened and needs to meet the parent where she’s at. She’d say, ‘It can be challenging to have a pickier eater. Luckily he’s at the age where he can only choose to eat what you provide for him. I’ve never seen a child with access to food starve themselves.” [parent stakeholder]
Prepare for set-backs, encourage small changes over perfection	“The pediatrician emphasizes that…she believes that the child may put up a bit of a fight about the decreased juice, but if mom sticks with it, the child will get used to it.” [pediatrician stakeholder] “Mom: ‘That sounds great. I still can’t dictate what they feed him at day care though.’ Pediatrician: ‘And that’s okay, we will work on a plan for home for now and then after we see how that is going we can see what we need to adjust at day care.’” [pediatrician stakeholder]
Follow up	“We can check in next visit to see how you’re doing, whether this goal-setting has made things seem smoother and see how Margaret is doing.” [parent stakeholder] “It sounds like we have a bit of a plan in place. Why don’t you make an appointment in 1–2 months so we can follow-up on how everything is going?” [pediatrician stakeholder]
AVOID….
Social stigma	“Your baby’s weight is far too high for her age. What are you feeding her? Do you not worry about her health and if she stays this way what will other kids and parents think!?” [drama script, parent stakeholder] “The other kids may make fun of him if he is too heavy when he’s older, you don’t want that, do you?” [pediatrician stakeholder]	“Another good example of what not to do, is using the following as a reason to eat healthier ‘kids will make fun of him for his weight.’” [pediatrician stakeholder]
Judgement	“Wow look how chunky he has gotten, cute though! I’m glad you decided to come in today after missing two appointments. I have been trying to bring you in about Eric’s weight…My goodness what have you been feeding him?” [parent stakeholder] “She soon gets to feeding and nutrition and she just blurts out… ‘Your baby is really fat, by the way. How did you let her get that way already?! Don’t you know how to feed your kid?!’” [pediatrician stakeholder]	“It is human nature to be defensive when one is being attacked (whether actually or perceived as such). In this story, the pediatrician clearly sets a tone where the parent feels attacked and judged, which makes progress in addressing the health issues at hand difficult. It is important to take a non-judgmental viewpoint and attitude in approaching patients, especially so when dealing with topics that are known to be touchy/triggering.” [parent stakeholder]
Commenting on the weight of other family members	“It seems you are overweight yourself so I’m concerned that you’re pushing your unhealthy habits onto your child.” [parent stakeholder] “Mom: ‘I’m not worried about his weight now. I’ll worry if he’s overweight when he’s older.’ Pediatrician: ‘You know that might not be true if we look at big brother. You said yourself that you’re having trouble finding clothes that fit your older son. Weight problems start early.’” [pediatrician stakeholder]
Hyperbole and emotional language	“You know you’re setting her up for health complications and early death right? Do you just not care about your child?” [parent stakeholder] “The weight is way too much. He is going to [be] obese. What do you feed him only junk food, probably no fruits or vegetables.” [pediatrician stakeholder] “[The pediatrician] soon gets to feeding and nutrition and she just blurts out… ‘Your baby is really fat, by the way. How did you let her get that way already?!’” [pediatrician stakeholder]	“…doctors should be professional. Do not involve too much emotional words.” [parent stakeholder]
Framing behavior change as a diet	“Mom: ‘Instead of focusing on weight, perhaps you can provide strategies to help my child maintain good health overall. If the weight continues to trend upward as he gets older, then we can focus on diet. Until then, he is too young.’” [parent stakeholder] “Mom: ‘Although I don’t think babies should have a restricted diet, I am open to help with meal planning, especially because babies and toddlers can be picky eaters.’” [parent stakeholder] “Mom: ‘Putting a baby on a diet is just wrong.’ Pediatrician: ‘I agree! I definitely don’t want to put him on a diet! But what I would like to do is to work with you to figure out how we can make his daily schedule and eating habits reflect the amount of food and activity that is healthy for him at this age.’” [pediatrician stakeholder]
Accusations or shaming	“I have heard that excuse before and it is a lame one.” [pediatrician stakeholder] “Rather than presenting solutions as easy opportunities to improve the baby’s health, the pediatrician uses words and phrases that suggest the parent’s actions are the root cause on which to blame the baby’s obesity. Parent becomes defensive, perhaps argumentative, providing excuses and retort instead of addressing the child’s issue.” [parent stakeholder]	“Dr. Pepper starts with blaming attitude to the family from the start.” [pediatrician stakeholder] “I also liked that she didn’t take any kind of an accusatory tone. It was more of a let’s talk about what’s going on and how maybe we can modify it.”