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11 March 2020

Claire Semple: “Childhood obesity needs understanding and compassion, not stigma and blame”

Bristol Royal Hospital for Children clinical psychologist, Claire Semple, writes about the complexities of childhood obesity, following on from the Channel 4 documentary '100 Kilo Kids: Obesity SOS'. Claire is part of Bristol children's hospital's weight management clinic, the leading childhood obesity service in the UK, which is featured in the documentary.

Claire Semple

There are many factors which contribute to childhood obesity, making it a complex health issue.

I work as a child and family clinical psychologist at Bristol Royal Hospital for Children's weight management clinic. I see the hurtful impact of weight related stigma and blame directed towards children and parents. This is hugely detrimental to the psychological wellbeing of children and the willingness of families to engage in conversations about the challenges they face. These conversations are crucial to being able to understand the situation faced by families and establish the best way to support them to work towards achieving their goals.

The paediatric weight management team feature in a new Channel 4 documentary 100 Kilo Kids: Obesity SOS, which follows three of our families and their experiences of living with obesity. The causes of obesity are varied and are often not clearly visible. The young people featured in the documentary show us that there is not one single reason for their weight-gain. It's a mixture of lifestyle, health and emotional factors. The documentary shows that genetic factors can sometimes play a role too, further tests at a specialist lab help us to understand that for a five-year-old featured on the programme who is experiencing constant hunger a rare genetic condition is a contributing factor.

Their stories demonstrate the complexity of childhood obesity and that it can be caused by a combination of many factors - easily accessible, high calorie low cost foods, sedentary activities, snacking, genetic factors, sleep patterns, portion sizes, lack of awareness of the calorie content in foods, family mealtime routines, early experiences with food, to name but a few.

This is a growing problem for society as a whole. Our relationship with food has and continues to change. We don't just eat when we are hungry, eating is an activity in itself and part of our entertainment culture. We eat when we are sad, we eat when we are bored and we use food as a reward. You can see it is much more complicated than the common argument "eat less - move more" and that the causes of obesity are not easy to change. A lack of understanding of this can lead to negative attitudes and beliefs known as stigma.

Children who are managing the physical and emotional burden associated with obesity experience stigma in many ways. Children are often bullied, excluded and others can hold different expectations of them when compared with their peers.

The effects of weight related stigma cause children to feel embarrassed, isolated and ashamed, which can lead to anxiety, depression and low self-esteem. Young people often use food to manage these emotions which can result in them eating more and hiding foods to avoid arguments with parents and further feelings of shame and embarrassment. Such psychological distress often makes it harder for young people to socialise with friends, be as active as others, and have a regular sleep pattern. All of these factors can also lead to further weight gain and the cycle repeating itself.

The physical challenges placed upon children and young people by obesity affect self-confidence and self-esteem. Not feeling able to play sport for as long as their friends or to be as fast as others means that children are vulnerable to bullying and this can lead to them avoiding PE sessions or even avoiding school altogether.

Creating a culture whereby children and young people feel confident to talk about weight issues is essential to reduce the associated stigma and increase body confidence and the likelihood of young people asking for help.

The use of language is an important way to do this, it is important that young people and families don't feel blamed.

All the families we see want the best for their children. All of them want to protect their child and use their love to guard them from society's criticisms. I, along with the whole team of health professionals, work hard to support families to carefully work towards a healthier lifestyle.

If young people and their families feel blamed it creates a negative environment which isn't helpful and can have an impact on the positive conversations that can ultimately lead to change. Young people and families have often had difficult experiences before they seek the help of our service, and it is really important that we create an environment in which young people feel understood and parents don't feel judged.

The issues raised in the documentary can feel difficult to talk about. This can be due to a fear of upsetting children and parents, creating awkward situations and a feeling of not knowing how to help. To help children, young people and families it is crucial to use non-blaming language such asliving withobesityrather than using stigmatising language such as referring to people asobese, this allows the opportunity to separate the condition from an individual's identity. Taking the time to actively listen to families is essential to understand more about the challenges they face and the things which make change difficult. That way more can be learned about what can be done to help and the most appropriate support can be identified earlier.