III.

Tackling weight stigma in children:recommendations for pediatricians and health professionals

• Ask for permission to discuss the child’s/adolescent’s weight before addressing the topic.

• Respectfully evaluate the weight status of each child/adolescent, with the body mass index z score, and communicate the diagnosis to children and parents in a nonjudgmental way. Help the patient and family to understand the complex nature of obesity and the responsibility of the current obesogenic environment.

• Provide a comprehensive evaluation of each child/adolescent on a physical and psychological level.

• Investigate with adequate language about previous episodes of ridicule, discrimination, internalization of stigma (possible questions: “Do you think that your weight influences the evaluation you have of yourself?”; “How do you see yourself?”; “What do you think of yourself?”).

• Contextualize the official recommendations for the care of obesity to the family and the child/adolescent and ask for their participation in making a personalized and sustainable care plan; arrange for integration with other professionals in specific cases. Explain the changes and avoid unjustified simplifications (eg, the presumption that “small, easy daily changes in diet and physical activity are enough”).

• Periodically provide a global assessment of the child/adolescent, to empathically support strategies to improve behavior and well-being. Don’t assume that if weight hasn’t changed, neither have behaviors.

• Help parents become aware of weight stigma and to investigate any incidents of ridicule, discrimination, bullying, and cyberbullying at school or in the family itself, and to address them appropriately.

• Refer children/adolescents with severe or complicated obesity who do not respond to treatment to second-level centers, accompanying them and taking care of their transition to the general practitioner.