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Family, peer support needed to address pediatric obesity
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For a child struggling with obesity, the issue of weight touches every aspect of life, including daily interactions at home, at school and in the wider social environment. Children with overweight or obesity are often mischaracterized as lazy or gluttonous and may be shamed or mocked by their peers or family members.
Conversely, peer groups and family members can have a tremendously positive influence in terms of helping to foster healthy lifestyles and self-esteem.
“Peers and family play an important role, and sometimes it can be a force for good, and sometimes it can make [childhood obesity] more difficult,” said Eleanor Mackey, PhD, a clinical psychologist who works with the Obesity Institute at Children’s National Health System in Washington, D.C. “Research shows that social support for exercising and eating healthily is important, and the more people a child has on their side, doing it with them and supporting them, the better off they’ll be.”
Endocrine Today talked with Mackey about the psychological implications of obesity for families, peer relationships and self-esteem.
How can peers positively affect children and teens with obesity?
Mackey: Peers can be helpful by engaging in healthful eating, and being role models in healthful behaviors and trying different types of food. Environments can contribute to this; for instance, some schools emphasize healthy snacks and have a wide range of different snacks available. If a couple of more adventurous kids try some unusual foods, then other kids might be more willing to try them, too. The school or day care environment can also do things to make healthy snacks fun. Schools can help kids prepare an unfamiliar food, try it out, try to mix things together. When you see a peer trying that cucumber, you might be more willing to try it, too, more so than if a parent encouraged you to try it.
Group sports are another great example of positive influence from peers — they’re getting exercise, making it part of their routine and having fun.
How might peers model unhealthy behaviors?
Mackey: What we see, especially as kids enter adolescence, but sometimes even earlier, are a lot of social activities that are built around food — and not healthy food. A lot of teenagers tell me that when they go out with their friends, they’re going to fast food restaurants, and their friends are eating a lot, and so they do as well. Also, in the era of social media, people can spend a lot of time on their phones, interacting with their phones, playing video games, and that just makes them more sedentary.
Can you discuss the weight stigma these kids face?
Mackey: Weight stigma is probably one of the most important aspects of the difficulty these kids and their families face. There is still, despite all the evidence, a lack of understanding that obesity is a complex medical disease that is brought on by a whole range of factors. There is still this belief that obesity is somehow a personal responsibility or failing on the part of the parents or the child. It can be difficult for these kids, and people are not kind about reserving their judgment.
A lot of the kids who come through our clinics report teasing. It is particularly difficult when the teasing comes from a family member, such as a sibling, because that leaves no place that is safe. We also see a lot of kids who have a naturally healthy-weight sibling, and they are eating better and exercising more than their healthy-weight sibling. It’s frustrating, but it’s just luck; they’re just made in a different way. The research shows that this kind of stigma has a powerful impact on the psychological health of kids, and not only during childhood. It stays with them for a long time.
Until it becomes a priority, until we can destigmatize obesity and treat it like the medical disease that it is, we’re going to continue to have this issue.
How can obesity be a problem for families?
Mackey: There are a number of ways. One is that family members may share the root problem because the genetic component of obesity can often run in the family. So, there is an intergenerational transmission of obesity, often accompanied by intergenerational transmission of the psychological issues surrounding it. There is often a sense of helplessness and hopelessness because maybe the parents have tried hard to be fit with limited or no success, and that can trickle down to the kids, where the parents have sort of given up because they’ve tried to maintain a healthy weight all their lives, and it’s very upsetting to see their kids in the same boat.
On the flipside, there can be a real advantage when weight problems run in the family. The other family members can have a better understanding and more empathy, and those families can come together to make changes as a whole. That’s where we see our most successful kids — they are the ones who come from families who say they want to be healthy, and they’re going to do it together, and they make a big effort together, as a team. This teamwork is so important. If someone in the family is refusing to change their health behavior, that can be a real source of conflict, but when families work together, it is an incredibly strong bonding experience and seems to have a positive impact on the overall physical and psychological health of the family.
What are some ways families can show support to a child struggling with obesity?
Mackey: One of the first things families can do is not talk or think about weight, but talk about health, and think about what behaviors they can do that will make and keep them healthy. Parents and families can decide to say, “Look, we love ourselves, we love each other, and we want to be healthy because staying healthy makes us feel better and lets us do the things we love.”
That helps because it comes from a more positive end goal. It’s not just about weight or weight loss or about the way you look; it’s about being healthy. There are things that any one of us could do to be healthier. To look at health and not weight is important and helps build the child’s self-esteem. We’ve seen that, in kids, the lower their self-esteem, the more difficult it is to make changes because they don’t feel strongly enough about themselves to make those hard changes. On the other hand, if the child is encouraged to feel good about themselves, to feel positive and that they’re worth it, they’re going to be more willing to say, “I do want to be healthy, I do want to take care of myself.” Parents can rebuild self-esteem, focus on health and be the role model.
For me, a lot of frustration comes from seeing a family where parents are expecting the kid to make these huge changes, but aren’t making any effort themselves. It doesn’t send the right message. Parents can make a big difference by being good role models and eating healthy food and making it a special time, cooking a healthy meal together, taking a walk together. That’s the positive way to approach it.
Do the challenges of obesity differ between younger kids and teenagers?
Mackey: Yes. Some things are consistent across the way, like the stigma and teasing. But when kids are younger, parents play a much more important role because they are in complete control of their children’s food, their exercise possibilities, even their peer relationships, such as who they are setting up play dates with. Kids can have a harder time the older they get, especially as they move into those later childhood/early adolescent years when they become more aware of themselves as individuals. There is less parental buffer between them and their peers. Social media can be challenging, with bullying, particularly through the middle and high school years. It’s certainly meaningful before then, too, but parents can do more to protect them in the early years.
What message would you want to convey to the public about pediatric obesity?
Mackey: The most important take-home is that obesity is a disease, and it is easy to pick up on the behaviors that can contribute to or improve it, but that is only a small part of the puzzle. The more important priority is for families and kids and the general public to understand the complexity of obesity and treat it as such. Families and children should be provided with support. We should never underestimate the importance of a good social environment and strong family cooperation and encouragement. – by Jennifer Byrne
For more information:
Eleanor Mackey, PhD, can be reached at
Disclosure: Mackey reports no relevant financial disclosures.