Doctors, be careful what you say to children who are overweight, says new American Academy of Pediatrics policy

Kids and their parents do not want to be told they need to lose weight.

Their doctors might actually be encouraging weight gain if they aren’t careful about how they talk to their patients who are overweight — so found American Academy of Pediatrics research that has been turned into a policy statement.

Austin doctor Stephen J. Pont, who is an assistant professor at the Dell Medical School at the University of Texas, is the lead author for this policy statement.

The MEND program at the YMCA of Austin teaches families how to have fun exercising while encouraging them to make healthier choices.

Doctors have a lot of learning to do about child obesity and the science behind it, Dr. Pont says.

One positive step is the Academy creating a section on obesity and helping to develop new tools — many of which have been tested in Austin — including developing better approaches to creating behavior changes.

Dr. Stephen Pont is an assistant professor at the UT Dell Medical School and helped develop the American Academy of Pediatrics’ policy on obesity.

Childhood obesity is a big deal. The new policy statement lets us know that one-third of U.S. children are considered overweight and 17 percent are obese. It’s the most common chronic condition our kids have.

The policy looked at the stigma behind being overweight and the effect it has on our kids. It found that kids as young as 3 already have experienced weight-based stereotypes. By elementary school, weight-based stereotypes are common.

Children who are overweight or obese have weight-based stigma re-enforced through many sources: peers, teachers, parents. It also comes from media. A study of recent children’s movies found that 70 percent included weight-related stigmatizing content and 90 percent targeted a character that was obese. Kids’ content is also more likely to have content that stigmatizes a character around weight.

The policy notes that kids who are overweight or obese:

  • Are more likely to be bullied. One study of kids who were seeking weight loss, found that 71 percent had been bullied in the last year about their weight.
  • Are less likely to be offered help if they are bullied.
  • Believe they will have more friends if they can just lose weight.
  • Become disengaged in school academically and socially.
  • Have worse quality of life scores than children with cancer.
  • Are more likely to be suicidal. In fact, adolescence who have been teased about their weight are twice as likely to have thought about suicide or attempted it.
  • Are more likely to engage in self-harm.
  • Are more likely to engage in unhealthy eating habits such as emotional eating or binge eating or develop an eating disorder.
  • Are given lower expectations for academic success by their teachers.
  • Are teased by their parents. That same study of kids entering a weight loss program found that 37 percent had been teased by their parents in the last year.

The most interesting thing the policy statement notes is that people might believe that by shaming children about their bodies, it will inspire them to lose weight. Instead, it actually has the opposite effect.

One of place children often feel stigmatized is in a health care setting like their doctor’s office.

In one study of women who are obese or overweight, two-thirds reported that a doctor has stigmatized them because of their weight. Another study found that doctors believe that obesity means that a patient will be noncompliant to medical advice, hostile, dishonest or have poor hygiene. They saw obese or overweight patients as lazy, less intelligent and lacking self-control.

Because of that feeling doctors gave them, obese or overweight patients were less likely to get preventative care. These women were skipping mammograms, pelvic exams and other cancer screenings.

Researchers also found cases where patients who did seek care from their doctors were then denied care, or not given size-appropriate medical equipment.

In kids, the policy writers found that doctors used hurtful language to refer to their patients, including calling them fat, obese or extremely obese. Instead doctors should use words like weight and unhealthy weight.

“Some of that comes out of frustration on the medical provider’s part,” Pont says about what language doctors use. “They should partner with the patient rather than telling them what to do. They should always believe in the patient.”

Skip the guilt, blame and judgment, Pont says.

Why does it matter what words doctors use to let patients and their parents know that their weight is not healthy and should be addressed?

Doctors can be part of the stigmatization problem.

Kids who have been stigmatized will then exercise less in the future and will feel less confident in their physical abilities to do exercise.

One study looked at girls who are overweight. Those who had been stigmatized about it had a 64 percent to 66 percent increase in developing worsening obesity.

In another study, kids who were teased had a worse BMI 15 years later than their peers who were not teased.

What does the policy want doctors to do?

Be professional and nonbiased.

Choose their words wisely including using “people-first” language. A child with obesity rather than an obese child.

Document obesity as a medical diagnosis.

Create behavior change that is specific to that child and child- and family-centered. That means they create their own goals, not ones that doctors create for them.

Create a physical environment in their office that fits different body types. (Think about those narrow chairs in the waiting room or too narrow exam tables.)

Do a behavioral health screening. Is there more than just the weight? Is there a mental health component, too.

Be better trained about weight stigma in medical school and residency as well as in continuing education courses. Doctors, Pont says, “don’t have the tools to address it.”

Doctors are interested, though, he says. It’s one of the most requested topics doctors ask for in continuing education.

“We need to recognize that obesity is very complex,” Pont says.

Instead of thinking about a short-term fad diet, doctors and their patients need to think about long-term changes that are doable, and discuss weight and making changes in a way that is sensitive.

“A teenager has taken a long time to get to where they are,” Pont says. Providers and families need to think about working together for a long time. Pont likes to start out with one, small doable thing such as cutting out sugary drinks and then build on that success, but he always lets families decide what it is that they want to try doing.

Above all, it should be positive and not about blame and guilt. He encourages parents to go out of their way to praise kids when they make good choices.

It also should be about the whole family, not just the kid who has been singled out because of his or her body mass index.

The key message for doctors is to “be nice and be patient,” Pont says. “It’s going to take time. It’s not going to change quickly and happen overnight,” but the more enjoyable they can make the visit, the more encouraging they can be, the faster and healthier the patient and the family will be.

New research done in Austin helping more women get and stay pregnant

Couples trying to get pregnant, there’s even more hope on the horizon. At the recent American Society for Reproductive Medicine Scientific Congress & Expo in San Antonio, doctors and scientists presented their research. Seven of those studies were being done here at Texas Fertility Center.

“We’re excited about what we’re doing,” says Dr. Kaylen Silverberg. He likens get accepted to present so many of their findings as like getting all of your college acceptance letters back with a “Yes.”

New research done in Austin is helping more women achieve pregnancy. Photos.com

He walked us through some of what they’ve found. Sometimes, he says, “it reinforce that what we’re doing is right,” he says. Other times, with the advancement of science, they found a better way of doing things.

In an international study, they looked at what is the value of doing genetic testing on embryos. Could they see before implanting an embryo if it would be chromosomally normal? Yes, by doing a preimplantation genetic screening, they determined they could see all 23 pairs of chromosomes and rule out abnormalities.

Does that mean those embryos will grow up to be normal, healthy babies? Not necessarily, he says. There are many things we still don’t have a genetic test for, but for parents who have lost babies or a family member to a chromosomal abnormality, they now have a chance to screen for that abnormality and only have embryos implanted that don’t have that abnormality.

Dr. Kaylen Silverberg of the Texas Fertility Center

Another study also looked at the embryos to determine which ones were viable. Sometimes after the embryo has been sitting in a incubation solution for 18 hours, lab technicians won’t like what they see. They’ll be looking for two pronuclei in that embryo to signify that it’s a healthy embryo. “Sometimes is not so clear cut,” Silverberg says. “It doesn’t have two pronuclei. It has one or zero.”

Up until this point, they would throw those embryos away. In a study, researchers kept cultivating those embryos to see if anything would happen.

What they found was that 40 percent of those embryos that would have been thrown away, actually grew into normal embryos, he says. They just needed more time.

Another study helped doctors determine when the right time to implant an embryo into the uterus during in vitro fertilization will be. For years, doctors were arbitrarily choosing the sixth day after beginning progesterone as the day to implant the egg. “Why does that make sense?” Silverberg says they began asking.

Looking at embryos before implanting them is giving women better odds for healthy babies. Texas Fertility Center

Now they can better determine when the embryo and the endometrium will be better in sync by doing a biopsy of the endometrium in advance.

Doctors have a woman go through the hormonal cycle for in vitro one month before actual implementation. They will then take a biopsy during that cycle on day six and send it to a lab in Barcelona to analyze her endometrium to see if it was ready to accept the egg. If it was, the next month, they would implant an egg on day six. If it wasn’t, based on the endometrium’s levels, they might try to implant on day 5 or give her more progesterone and implant on day 7 or 8.

Through this study, they determined that only 40 percent of the endometrium were ready on day 6.

Doing the extra cycle and biopsies, might cost an additional $700 than not doing them, but that’s well worth it, Silverberg says, if it ends in a pregnancy and not a wasted embryo because the woman’s body wasn’t ready to receive it.

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In another study, they looked at the luteal-placental shift, that’s when the placenta takes over progesterone production to sustain the pregnancy. Before that the corpus luteal, the part of the egg’s follicle that remains after ovulation, is the main supplier of progesterone.

Women who have been implanted with an embryo rather than becoming pregnant on their own receive progesterone and estrogen during the first trimester to make her body able to carry the embryo. Doctors were wondering when it is that the body will take over.

By monitoring hormonal levels in 262 women who had a frozen embryo transfer, they were able to determine when the luteal-placental shift happened and make recommendations of how long to give each hormone. They found that women should receive estradiol replacement until at least seven weeks gestational age and progesterone replacement until at least eight to nine weeks gestational age.

This knowledge can help reduce miscarriages in women whose babies were perfectly normal, but the moms had a low progesterone level, Silverberg says.

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All of this research is helping more women become pregnant, Silverberg says. It’s also cut down on the multiple pregnancy rates because now they feel more confident about the quality of the embryo and the readiness of the woman’s body to receive it and nurture it for nine months.

“Our patients are anxious to enroll in any study,” he says. They see it as a way for them to give back to the progress that is being made.

“It’s a great time to be doing infertility medicine,” Silverberg says. “There’s so many advances.”

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