Higher weight and mental health in children: Parent guide

Parenting Research Centre, Australia, September 2022

Resource Summary

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You may be talking with your health professional about your child’s weight. While not all children with higher weight experience poor wellbeing, many do. This resource can help you to support your child’s mental health and wellbeing.

Talking about weight and wellbeing

Young people have said that words like ‘fat’ or ‘obese’ can make them feel ashamed, sad or embarrassed, especially if used by their parents (Pont et al, 2017). In this resource we use the more neutral term ‘higher weight’. You can help to reduce children’s negative feelings by using neutral, non-judgmental language, and by focusing on health and a healthy lifestyle rather than weight.

The term ‘mental health’ is often confused with ‘mental health conditions’ (e.g. depression or anxiety). But ‘mental health is about wellness, not illness’.1 It’s our ability to adapt and respond to life’s challenges, engage with the world around us, and reach our full potential.

Child mental health exists on a continuum, ranging from positive mental health, through to mental health vulnerabilities. It incorporates behavioural, social, mental and emotional strengths, and is a facet of child development.

You might have heard ‘mental health’ referred to as part of broader concepts like ‘psychosocial wellbeing’ or ‘social and emotional wellbeing’. This resource defines ‘mental health’ as something bigger, encompassing a child’s mental, emotional, social, cultural and spiritual wellbeing.

What causes higher weight?

Around 1 in 4 Australian children are at a higher weight.2 Although eating and drinking too much while moving too little may lead to weight gain, it’s not that simple. There are many things that can lead to higher weight in childhood, including:

  • biology (e.g. genetics, health problems, medications)
  • behaviour (e.g. screen time, physical activity, sleep quality, routines)
  • environment (e.g. the marketing of unhealthy foods and drinks to children; availability of parks and green spaces).2,3

The causes of higher weight are complex. Many will be outside of your or your child’s control. Also, health is not based on body size or weight – healthy children come in a wide range of body shapes and sizes. But being higher weight does put your child at increased risk of experiencing bullying and mental health concerns. By understanding and focusing on the factors that you can control, you can help your child to thrive at any size.

How can weight-based attitudes, beliefs and behaviours affect my child?

How children with higher weight are treated – and how they feel about themselves – can affect their mental health.

  • Children with higher weight are often teased and bullied about their weight. They can be left out of activities or rejected by other children.4 Weight-based teasing can lead to negative body image, disordered eating behaviours (e.g. eating too much or not enough, vomiting after eating, being really strict about which foods they eat), as well as depression.5
  • Negative attitudes and behaviours, such as teasing, can also come from adults such as family members, teachers and health professionals.6
  • Some parents and professionals make the mistake of believing that focusing on a child’s weight or the benefits of weight loss will help them to lose weight. In reality, negative comments and behaviours can lead to children putting on weight. They can also increase the chances of poor outcomes such as body dissatisfaction, social isolation and a reduction in physical activity. 3,5,6,7

Children with higher weight are more likely to be unhappy with their weight or appearance.8,9,10 It is these concerns, rather than their actual weight, that put children at increased risk of poor outcomes.3

What do we know about mental health in children with higher weight?

The links between weight and wellbeing are complex and still being researched. But what we know so far suggests the following:

  • Children at a higher weight can experience low self-esteem1,2,6 and their quality of life can be affected. Thinking about children’s wellbeing, this can look like:
    • emotional difficulties (e.g. feeling angry, sad, afraid or scared, or having trouble sleeping)
    • social difficulties (e.g. having problems getting along with other children, being teased by other children)
    • physical difficulties (e.g. having trouble walking more than one block or lifting something heavy).3,7,11,12
  • How a child feels about their weight may increase their risk of depression. But common depressive symptoms, such as losing interest in doing physical activities or spending time with their friends, and spending more time sitting or lying around the house, can also affect their weight.5,7,13,14,15
  • Teasing and bullying about their weight, and associated body image concerns, can increase the chances of problematic eating behaviours (e.g. skipping meals, restrictive dieting).5,7,16 Factors such as a belief in ‘thinness’ as the ideal (often influenced by the media, video games and family and friends17), and unhappiness with their weight/shape, can increase a child’s risk of disordered eating.18
  • Behaviours, medications and sleep problems that are commonly associated with developmental disorders (e.g. autism spectrum disorder, attention deficit hyperactive disorder) may affect a child’s weight.8 For example, behaviours that are common in children with autism, such as fussy eating or increased eating, can affect weight.9

What can I do to support my child’s mental health?

The following strategies are designed to promote positive parental involvement. Your support and non-judgemental care can help to protect your child from the negative impacts they may experience as a result of their higher weight.

 

Focus on a positive, healthy lifestyle. Encourage a healthy lifestyle without talking about weight or weight loss. For example, encourage your child to eat a wide range of healthy foods and to participate in physical activities they enjoySee the ‘Further resources’ section for links to ideas.

Practice body kindness and use positive language. Focus on your child’s health and healthy behaviours. Ask them what terms they would like you to use.  Avoid speaking negatively about your own and other people’s weight, as it sends a message that weight is important and that the way someone feels relates to whether they’re feeling good about their body. It is also helpful to avoid comparing your child’s weight to that of their peers or siblings. Every child is unique and healthy children come in a range of shapes and sizes.

You may be worried that talking with your child about their weight will make things worse or lead to poor outcomes like low self-esteem or disordered eating. If your child approaches you with concerns or questions about their weight, this means that they’re already aware of it. Without proper knowledge or support from you, they may make their own attempts at weight loss, which can lead to further negative health consequences.

By being open to your child’s concerns, you can help them understand that their health and wellbeing is what is important and that it involves more than just their weight. Remind them that people of all body shapes and sizes can be healthy.

Take a supportive, curious and non-judgemental approach with your child. This encourages open communication so that your child can tell you about any concerns they might have (e.g. bullying at school, worries about their size/health).

Look out for any signs of teasing or bullying your child may be experiencing. If you notice anything concerning, let them know that they didn’t deserve this, that it’s not their fault, and remind them of their strengths. You can find links to bullying resources for parents in the Further Resources section of this guide.

Encourage siblings, friends and others to get involved if they see your child being teased, bullied or left out. Help your child to identify safe adults or friends who will support them if they’re feeling isolated or targeted.

Be an advocate for your child. Identify settings where the focus is on weight, or where you are concerned your child may feel shamed or judged, and think about how you can support their wellbeing. For example, you might discuss with your doctor when it’s not OK to talk about your child’s weight – for instance, if you’re attending the doctor for an unrelated matter, such as a vaccination. You might also discuss whether you would like to have conversations about weight with your child present or not. As part of this, it’s important to think about how your child might want to be involved in the professional process, and, depending on their age or development, to ask them whether they would like to be part of conversations which focus on them.

Focus on qualities that aren’t related to weight. Highlight your child’s strengths (e.g. that they’re kind, hardworking, imaginative…) and skills (e.g. school-, sport- or activity-related) to help them see themselves positively. You could have them list five things they like about themselves that aren’t related to how they look.20 This can help your child appreciate their whole self and be kinder to themselves. See the ‘Further Resources’ section for information on how  to help promote a positive body image.

Promote acceptance of diverse body shapes and sizes. You can encourage acceptance of different shapes and sizes by identifying and talking about positive role models with your child. It can be difficult for children to find role models with different bodies (especially in the media and online). Think about family, friends, sports people, musicians and others with diverse bodies who can show your child that health, success and happiness are not related to how a person looks. Highlight how all people are unique and have strengths and skills. Talk to your child about how people come in different shapes and sizes and can be healthy regardless of their body size.

Take a whole-of-family approach to health. Rather than focusing solely on your child, work together as a family to identify health-focused, rather than weight-focused, goals. For example, think about physical activities you enjoy doing together or healthy meals you can cook and eat as a family. Discuss the importance of sleep for wellbeing and set a good sleep routine (e.g. regular bedtimes). See ‘Further resources’ for more information.

If you’re concerned about your child’s mental health, seek support. Being aware of the potential connections between higher weight and children’s mental health can help you to identify early warning signs of mental health difficulties, support your child and, where necessary, seek professional help. If you’re concerned about your child’s mental health, speak to a primary health professional such as your GP or child health nurse. They will be able to assess your child and may refer them to a specialised service (e.g. paediatrician, psychologist) if needed.

If you’re concerned about your own wellbeing, seek support. You may have struggled with your own concerns about your body shape and size, growing up or as an adult. Talking about these issues with your child may bring these feelings to the surface. Children thrive when you are well, so it’s important for you to look after yourself. It may be helpful for you to talk to your primary health professional. Again, they will be able to offer you support and may refer you to a specialised service.

Further resources

What are some other supports for families?

Beyond Blue provides information and support to help everyone in Australia to achieve their best possible mental health. The service supports people experiencing depression, anxiety or who are just going through a difficult time. The phone service 1300 224 636 operates 24/7, while the website offers online chat, email support and online forums.

Healthdirect is a national, government-owned, not-for-profit organisation supporting Australians in managing their own health and wellbeing. Healthdirect offers a range of virtual health services, including information, health advice (via their Symptom Checker), a service finder and a free helpline (1800 022 222).

Kids Helpline is a free, private and confidential 24/7 phone and online counselling service for children aged 5–12 years and young adults aged 18–25 years. Qualified counsellors are available via phone on 1800 551 800 or via chat or email.

Lifeline is a national charity providing all Australians experiencing emotional distress with access to 24/7 crisis support and suicide prevention services. Help is available via phone on 13 11 14 or via chat or text.

Parentline is a confidential telephone service providing professional counselling and support in Queensland and the Northern Territory. Available via phone on 1300 301 300.

Raising Children Network is a comprehensive and trusted online resource for parenting information. Their website includes information on children’s health and wellbeing across the ages. It includes videos, fact sheets and downloadable toolkits on child development, behavioural problems and health issues.

 

Where can I go for further information on higher weight and related topics?

Confident Body, Confident Child is an evidence-based resource that offers parenting strategies to help you promote positive body image, healthy eating and physical activity in children aged 2–6 years. It aims to support and guide you to create an environment in which your children can develop body satisfaction and healthy eating patterns. It was developed for use in early childhood, but the ideas will also be valuable for older children.

This resource from the Raising Children Network offers guidance on building self-esteem in children aged 1–8 years.

Butterfly Foundation is the national charity for all Australians impacted by eating disorders and body image issues, and for the families, friends and communities who support them. The foundation provides innovative, evidence-based support services, treatment and resources, delivers prevention and early intervention programs, and advocates for the needs of our community.

The National Eating Disorders Collaboration is a government initiative that aims to apply a consistent, evidenced-based approach to the prevention and treatment of eating disorders. It provides information on eating disorders and support for people living in larger bodies. The website explains eating disorders, including prevention, early intervention, treatment and recovery. Support is available on 1800 334 673

This resource from UK organisation Kidscape provides practical advice around bullying.

This resource from the Raising Children Network offers guidance on supporting your school-aged child (5–8 years) if they’re experiencing bullying.

References

  1. Beyond Blue. (n.d.). What is mental health? Melbourne, VIC: Beyond Blue.
  2. Australian Institute of Health and Welfare (AIHW). (2020). Overweight and obesity among Australian children and adolescents. Cat. no. PHE 274. Canberra: AIHW.
  3. Russell-Mayhew, S., McVey, G., Bardick, A., & Ireland, A. (2012). Mental health, wellness, and childhood overweight/obesity. Journal of Obesity, 281801. doi: 10.1155/2012/281801.
  4. Puhl, R. M., & Latner, J. D. (2007). Stigma, obesity, and the health of the nation’s children. Psychological Bulletin, 133(4), 557–580.
  5. Harriger, J. A. & Thompson, J. K. (2012). Psychological consequences of obesity: Weight bias and body image in overweight and obese youth. International Review of Psychiatry, 24(3), 247-253. doi: 10.3109/09540261.2012.678817.
  6. Pont, S. J., Puhl, R., Cook, S. R., & Slusser, W. (2017) Stigma experienced by children and adolescents with obesity. Pediatrics, 140(6), e20173034. doi: 10.1542/peds.2017-3034.
  7. Sanders, R. H., Han, A., Baker, J. S., & Cobley, S. (2015). Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. European Journal of Pediatrics, 174(6), 715–46. doi: 10.1007/s00431-015-2551-3.
  8. Austin, S. B., Haines, J., & Veugelers, P. J. (2009). Body satisfaction and body weight: gender differences and sociodemographic determinants. BMC Public Health, 9. doi: 10.1186/1471-2458-9-313.
  9. Moradi, M., Mozaffari, H., Askari, M., & Azadbakht, L. (2020). Association between overweight/obesity with depression, anxiety, low self-esteem, and body dissatisfaction in children and adolescents: A systematic review and meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition, 62(2), 555–570. doi: 10.1080/10408398.2020.1823813.
  10. Tatangelo, G., McCabe, M., Mellor, D., & Mealey, A. (2016). A systematic review of body dissatisfaction and sociocultural messages related to the body among preschool children. Body Image. 18, 86–95. doi: 10.1016/j.bodyim.2016.06.003. Epub 2016 Jun 25. PMID: 27352102.
  11. O’Connor, M., Warren, D., & Daraganova, G. (2017). Eating problems in mid‑adolescence. Chapter 11: LSAC Annual Statistical Report. Melbourne: Australian Institute of Family Studies.
  12. Rankin, J., Matthews, L., Cobley, S., Han, A., Sanders, R., Wiltshire, H. D., & Baker, J.S. (2016). Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolescent Health, Medicine & Therapeutics, 14(7), 125–146. doi: 10.2147/AHMT.S101631.
  13. Lindberg, L., Hagman, E., Danielsson, P., Marcus, C., & Persson, M. (2020). Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC Medicine, 18(30). doi: 1186/s12916-020-1498-z.
  14. Pizzi, M. A., & Vroman, K. (2013). Childhood obesity: Effects on children’s participation, mental health, and psychosocial development. Occupational Therapy In Health Care, 27(2), 99–112. doi: 10.3109/07380577.2013.784839.
  15. Sutaria, S., Devakumar, D., Yasuda, S. S., Das, S., & Saxena, S. (2019). Is obesity associated with depression in children? Systematic review and meta-analysis. Archives of Disease in Childhood, 104, 64–74. doi: 10.1136/archdischild-2017-314608.
  16. Smith, J. D., Fu, E., & Kobayashi, M. (2020). Prevention and management of childhood obesity and its psychological and health comorbidities. Annual Review of Clinical Psychology, 16, 351–378.
  17. Haines, J., Neumark-Sztainer, D., Hannan, P., & Robinson-O’Brien, R. (2008). Child versus parent report of parental influences on children’s weight-related attitudes and behaviors. Journal of Pediatric Psychology, 33(7), 783–788.
  18. Butterfly Foundation. (n.d.). Eating disorders: Risks and warning signs [webpage].
  19. Dhaliwal, K. K., Orsso, C. E., Richard, C., Haqq, A. M., & Zwaigenbaum, L. (2019). Risk factors for unhealthy weight gain and obesity among children with Autism Spectrum Disorder. International Journal of Molecular Science, 20(13), 3285. doi: 10.3390/ijms20133285. PMID: 31277383; PMCID: PMC6650879.
  20. National Eating Disorders Association. (2022). 10 steps to positive body image [webpage].
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