Dr. McComiskey: Those of us who work with obese children have long recognized that these patients, like adults, suffer from bias, bullying, and weight stigmatization, and thus suffer discrimination. This weight-based bullying is, frankly, horrifying, and often results in depression, thus altering the children's already fragile self-esteem, especially during this developmental era, when all children seem vulnerable.
I am hoping today to define what we mean when we discuss weight bias, to discuss how big and pervasive this problem is, where it occurs and by whom. I would like each of you to have the opportunity to tell the stories of your experiences and the stories of those teens for whom you care.
Further, I would like to discuss what the effects of this might be, what the consequences are, and how and what resources exist to get the kids the help that they might need.
I would like to start this discussion by asking each of the panel members to introduce him- or herself, your organization, and your role.
Ms. Browne: Thanks, Carmel. My name is Nancy Browne, and I am a certified pediatric nurse practitioner and a certified bariatric nurse. I am the former Program Director of the New Hope Pediatric and Adolescent Weight Management Program at the University of Illinois–Chicago. I am currently writing about this topic.
Mr. McPeters: My name is Steadman Lee McPeters. I am a certified acute care pediatric nurse practitioner. I currently work as the nurse practitioner for pediatric general surgery at Tennessee Valley Pediatric Surgery in Huntsville, Alabama.
Ms. Lynch: Hi. My name is Lori Lynch. I am a pediatric nurse practitioner, certified in primary care. I work for the Division of Pediatric Surgery at the Morgan Stanley Children's Hospital of New York, which is affiliated with Columbia University Medical Center.
Ms. Phipps: I am Amy Phipps. I am also a certified pediatric nurse practitioner, and I currently work in a private, bariatric surgery practice; we intend to build an adolescent program that will parallel the adult program.
Ms. Haynes: I am Beverly Haynes. I am the Bariatric Nurse Coordinator at Children's of Alabama in Birmingham, Alabama.
Ms. Dharia: My name is Bela Dharia, and I am a pediatric nurse practitioner in general surgery at the Hospital for Sick Children in Toronto, Ontario, Canada. Our hospital recently started a weight management program for obese adolescents. We offer bariatric surgery as a treatment option.
Ms. Barefoot: Hello, I am Leah Barefoot, and I am a pediatric nurse practitioner at Children's National Medical Center in Washington, DC. I work for the Department of General Surgery and the Obesity Institute, where we offer a medical and a surgical obesity program.
Dr. McComiskey: Prior to asking the first question, I also want to state that we are very fortunate to be together today as a result of the American Pediatric Surgical Nurses Association's Bariatric Special Interest Group (SIG), and it is because of the SIG that we came to know that we shared a passion for this population and made a commitment to educating our colleagues about their unique needs. We are committed to the care of obese children who require bariatric surgery. Therefore, it makes sense that we would care for and be passionate about assuring that the obese in our practices receive the same compassionate care, focused to address these special considerations.
I am going proceed and ask Nancy Browne to begin the conversation. Nancy, I know because of everything you have taught me that weight bias is a broad topic. Can you clarify for us the definitions of bias, bullying, and victimization?
Ms. Browne: Thanks, Carmel. I will provide a little background to the discussion so that we are all speaking the same language. There are a lot of terms that are used somewhat interchangeably, and of course in any topic that brings emotion to the conversation, some words have more intense meaning than others, and so I want to try to clarify these terms.
Bias is more of an intellectual process. It is the inclination to form unreasoned judgments; that is the official definition. Prejudice is the outcome. Prejudice is what happens; it is the opinion that is the outcome of the bias. And stigma is the label. Stigma is the name that is attached, that the individual carries. So in the case of the obese teenager, the stigma is the term or the name that is used, perhaps very unfairly; a term that denotes unfair treatment, discrimination, or loss of status. These are basic terms and they apply across the board.
And then there is weight stigma or victimization, which is any of the terms used in relation to increased weight. So weight victimization is a global term. Within weight victimization, behaviors range from teasing to bullying, and all of these actions can be done either verbally, physically, have a relational component, or now, a cyber-component to them. These are the terms you will find in the literature.
Dr. McComiskey: Thanks, Nancy [Browne]. Can each of you or all of you comment on how pervasive this issue is in your practices?
Ms. Browne: Carmel, may I start? I will give the global perspective, what I glean from the literature, and then the others can speak specifically to their practices.
Dr. McComiskey: Absolutely.
Ms. Browne: There is really such a huge variation in the literature based on what we just said. There are all types of bias and bullying weight victimization terms, and often the questions asked do not necessarily get at all of the things that might be happening to an individual. For example, if you ask, “Are you bullied?” children may think that they are, but that what is happening to them is not that severe: “I am just teased.” So they fail to mention the teasing. There is no tool that quantifies the range of abuse.
The bullying numbers are around 30% of the population in much of the literature, but individuals will tell you that it is a much higher. I just want to quote one study that asked adolescents about their perception when observing obese peers: 92% said they had seen them made fun of, 91% had heard them called names, 88% teased meanly, 76% ignored or avoided, 67% excluded from activities, 57% verbally threatened, and 54% physically harassed.
I think the real answer is that we really do not know the true numbers. I would be interested in the observations and experiences of the other panelists, because based on my previous experience, I have not personally met an obese adolescent who has not been victimized in some way.
Dr. McComiskey: Are you suggesting that when kids are asked about whether or not they have been teased, because they are sensitized, they might not know how to answer that question, but when children are surveyed about what they observe about obese children, they report all of those things?
Ms. Browne: The percentages were based on watching their obese peers within their school system. That is what they had seen.
Dr. McComiskey: Would other participants like to add to this discussion and share what this might look like in your own practices and what has been reported to you?
Ms. Phipps: When I worked with Nancy [Browne] in Chicago, one thing that struck me is that whatever the reported numbers are, I never met a heavy kid that had not experienced some form of harassment. Part of the problem is that it is insidious, and some of these kids even live with it on a daily basis in their own homes. They experience harassment from their own families; so when it occurs by a person outside the home they consider it bullying, but inside their families, they live with it as part of the family dynamic. They do not categorize it the same as outside harassment, although it does hurt them on the inside when you really get them talking about it. When you ask them about their problems, unless you are specific with bullying, they frequently will not report it as such. With further specific questioning, you hear that even parents in their own nuclear family as well as others in their extended family are calling them names and snickering and making verbal comments.
When the kids actually report being bullied, many times the bullying is not even addressed because of bias in the adults who are working with them. For example, I had a patient who, when she was attending high school and was waiting in the lunch line, had an experience where a kid would run up and grab her “fat rolls” from behind and then run away. Although, she would report this to the teachers who proctored the cafeteria, there was no resolution. The parents brought the matter to the attention of the school authorities, and it was still not addressed. They finally went and filed physical assault charges against the kids whom she could identify. That charge was still not taken seriously, and was dismissed. There are a lot of kids who suffer in silence or become sensitized to this treatment. Not only do they not recognize the bullying nor want to discuss it because it hurts, but when there is an issue, it frequently does not get addressed in a manner that results in a change.
Mr. McPeters: I would like to comment concerning what Ms. Phipps and Ms. Browne are saying. It is a critical situation when an obese child is getting bullied and/or stigmatized by peers and educators. The school is a place to learn and the teacher is meant to be a leader and an advocate for the student in all things.
I would like to express to you an example of bullying that I witnessed in my clinic. An obese mother of an obese patient bullied and harassed her child, as well as talked to her in a derogatory manner about her diet and weight. One could tell that the child would lash back out at her in anger. However, I could see the frustration and hurt in the child's eyes. Second, there are parents of obese children who state that the child “eats everything and I cannot get them to stop.” We as healthcare providers must take the initiative and be an advocate for such a vulnerable situation.
A recent article by Rebecca Puhl, PhD, reports that our kids are being victimized not only by their educators but by healthcare workers as well. Often when there is an obese child seeking healthcare, you can witness the disgust and the dread of healthcare workers having to care for that child. This is all part of bullying.
Within my area of the south, the prevalence of obesity is very high. We are performing laparoscopic cholecystectomies and laparoscopic nissen fundoplications on a regular basis partly as a result of poor dietary habits and obesity. Cholecystitis and gastroesophageal reflux disease are just two comorbidities of obesity.
Ms. Lynch: I would like to expand on what Steadman [McPeters] said, if I may. This is more about the healthcare worker and the bias within the healthcare system. I am going to use an example of a patient of mine. She is a very bright college-bound student. She is morbidly obese, with a BMI of 54.6, who recently graduated high school. She graduated with a full scholarship for field hockey. Although she was very active, she struggled with obesity her entire life.
In addition to her hometown rejecting her for being morbidly obese, she had an unpleasant experience of being a victim of weight bias with a healthcare provider. She had her scholarship to look forward to, and the one thing she enjoyed the most, field hockey. Unfortunately, she injured herself by tearing her anterior cruciate ligament (ACL). She was required to wear a brace and was told that she needed surgery, which resulted in the eventual loss of her scholarship. She went to several different orthopedic doctors but was rejected for surgery because of her weight. A healthcare provider told her that she needed to lose weight before having the ACL repaired because the strain of her weight would impede recovery. He said, “Why don't you try and lose the weight? This may not have happened if you weren't obese.”
Since her ACL injury, repair, and recovery, her ability to exercise was limited and somewhat restricted. As a result, she gained more weight. Tearfully, she explained that the insensitivity of that healthcare provider's statement and the loss of her scholarship subjected her to depression. Her depression manifested as an eating disorder and consuming increased poor selections of food. Weight bias is certainly evident within the healthcare environment.
Ms. Phipps: I have cared for many patients who have dropped out of high school and college because there is not a desk large enough or the physical surroundings are not conducive for them to be able to learn. The harassing looks, stares, and comments that they endure when they cannot sit in a desk have caused them so much embarrassment they actually drop out of school. Again, as Lori [Lynch] said, these are bright kids who absolutely have the intellectual ability to continue their education, but because their physical limitations are not addressed by the school, they quit.
Ms. Dharia: It really seems that these children have accepted an altered level of normalcy. They tolerate being called names that most would consider cruel and derogatory. It's as if these children have created a shell around themselves. This “shell” is used as a means of self-preservation in the only way they know how to deal with daily life.
I would also like to comment on the point about physical space. I once had a patient who said, “You know, at school, we have desks, and I cannot fit into my desk and so the teacher makes me sit at a table by myself at the back of the classroom.” My internal dialogue was saying, “If you're going to make one student sit at a table, have everyone sit at a table.” This is a classic example of being ostracized. I think everyone participating in this discussion can remember being in school and knowing that anything that was perceived as different was not accepted. In the case of our patients, this can lead to decreased attendance and subsequently higher drop-out rates.
Ms. Haynes: I agree with everything that has been said so far. I see all this in our practice and these kids break my heart. But the one thing that I want to comment on is that I think that we may not pay as much attention to the bullying and the teasing that comes from the family members. We comment on it, but I do not think that people work with these families as much as maybe we should. There is one little line on our intake form that says, “Do you experience any teasing?” Quite often, I am horrified to see—and have the children say—“Yes, from family members, from siblings, from cousins and parents.” Their own family members are giving them a really hard time about their weight.
For example, we have parents that say, “Well, it is her problem,” or “He is just fat, always has been fat.” And I will look at the child sitting there listening to this and he or she just has a blank stare. I feel like they have just become numb to it. It is just so, so sad for me to watch.
Dr. McComiskey: I am sitting and listening, horrified, actually. It is heartbreaking to hear a story of a kid who has lost that spark in the eyes, because you know the look in the eye when there is a spark and when they are happy. As you are describing it, I am creating a clear picture in my head of what it looks like when a child is past the point of allowing any of it to penetrate anymore. It is devastating.
I think in your centers, and many others, certainly in this medical center, where we operate on bariatric adults, there has been a great effort made to look at the system and the physical layout of the buildings and equipment with regard to accommodating our larger patients, families, and children, including even our waiting spaces. How is that addressed in the children's hospitals? Have there been those kinds of accommodations made for larger kids? Because it seems to me the little, intentionally tiny, pediatric furniture that looks so cute in the waiting room must present problems for the overweight child and his/her family members.
Ms. Haynes: I am so excited because here in Alabama we have just finished a brand-new hospital, and Dr. Harmon, the surgical director of our weight management program, and I worked diligently to ensure that it was designed so that it could accommodate very large children and parents. I took a tour of this new facility, and I am pleased to see that chairs do not have arms. There are big parent beds. There are floor-mounted toilets. I am surprised and pleased that we have been able to accommodate children and their families in these ways.
Dr. McComiskey: We have to celebrate the victories when they occur, because I think some of these stories are so poignant that we need to recognize when people have anticipated and made accommodations. These are victories.
Mr. McPeters: At Women's and Children's Hospital in Huntsville, Alabama, we have also been able to change all beds, as well as in our adult hospital, to accommodate the obese population, whether it be a child or an adult.
Dr. McComiskey: So again, at least when the teens come to our facilities, they have the opportunity to feel welcomed in the physical plant. I think this is important.
This brings me to a question with regard to our nursing and physician colleagues inside the organizations who might not share our passion. Can any of you speak to the education that you might have had to provide regarding sensitizing people to their physical or internal struggles when providing care for this population? What stigmas have you observed at the bedside?
Ms. Barefoot: We have definitely encountered a lot of stigmatization—just as the literature shows. Unfortunately, even nurses are not immune to this stigma and bias. One of the biggest challenges is making sure that the staff are talking to overweight patients appropriately; one of the things I have witnessed is the emphasis on food conversation. For example, staff members often ask, “What is your favorite restaurant?” “What are you going to eat for lunch?” and “What did you have for dinner last night?” It is a conversation that would not be held with these patients' normal-weight counterparts.
We are currently working to develop staff sensitivity education in order to improve the staff's communication and interactions with our bariatric patients. The difficulty is that obesity is seen throughout healthcare and not just in our bariatric surgery group. So it is definitely an undertaking to ensure that every staff member who comes in contact with an obese patient is treating the patient with the respect they deserve.
Ms. Dharia: At our institution in Toronto, we (myself and one of the surgeons who does bariatric surgery) have participated in nursing education days. We developed a presentation outlining the current state of obesity in adolescents, the weight management program at our hospital, and lastly, the pathway to the different types of bariatric surgeries and what they entail.
We have also used this time to complete some health promotion training with the nurses. We explain that throughout their nursing careers they will care for pediatric patients who may not have necessarily been admitted for bariatric surgery, but who meet the referral criteria for a weight management program, for example, an obese patient who is having a cholecystectomy or an appendectomy. We empower the nurses to speak to the responsible healthcare team about a referral to a weight management program.
Our direct care nurses are also invited to the operating room to observe the bariatric procedures. Lastly, we encourage our interns to see the surgical patients in the preop clinic. These are just three of the initiatives we have taken to encourage open dialogue.
Ms. Lynch: I appreciate you sharing that, Bela [Dharia], because currently there is no education on the nursing units where I work. I work with a surgeon, Dr. Zitsman. He has performed more than 120 Lap-Bands, and we recently started performing the sleeve gastrectomy. I work in the outpatient clinic, so I see the children postoperatively. To comment further, we have improved accessibility to proper-sized chairs, proper-sized beds, appropriate-sized blood pressure cuffs, etcetera. In the past decade, or maybe even less than that, there is so much emphasis on cultural sensitivity with regard to ethnic and/or racial bias. It is necessary to emphasize more on creating a non-bullying and unbiased environment surrounding adolescent obesity issues. Ongoing feedback from adolescent obesity and surgery experts is a step forward toward educating the nurses, the doctors, the physical therapists, and everyone else who participates on the interdisciplinary team.
Dr. McComiskey: There are many myths and misunderstandings about the etiology of obesity. Do you think there needs to be an effort to educate our staff in order to improve this? Is it this misunderstanding that perhaps leads to some of the prejudice by healthcare providers in general?
Ms. Browne: I am going to give a historical answer. Amy [Phipps] and I started a weight management program that included a surgical treatment for adolescents almost as long ago as Beverly [Haynes] did, in 2005, and when we started the program we met these challenges. There was a fair amount of resistance, typified by statements like, “I will get hurt. How can I take care of these kids?”
We put together a presentation and went on the road. I mean, we talked to two nurses; we talked to three, wherever we could get a hands-on discussion. After band placement, the patients went to the PICU postoperatively for 24 hours, just because that was the way the unit was set up, not that they were that sick. We were performing adjustable gastric banding procedures through a special investigational device exemption (IDE).
What we found helped the nursing staff the most was education. You know, at the end of the day, the nurses asked all the questions, and I think they felt safe to ask. They asked questions that perhaps were not politically correct, that they might not ask in a bigger setting, but they felt comfortable in the smaller, informal group.
After having done a fair amount of adjustable gastric band (AGB) surgeries on teens, we felt comfortable sending them to the general unit. But the critical care nurses would not let the kids out of the PICU. They said, “Those are our kids. They will not be well taken care of. They will be harassed.” You know, it was very interesting. They really owned—took ownership of the total care of the kids and became very protective.
Ms. Phipps: I have to agree. Once the nurses knew the kids, then they started to love them as much as we did. It does take some time to educate and for the nurses to recognize that the patients are still kids and that it is important to address the issue of not blaming them for their obesity. There are so many things that we do not know about obesity. We do not really know exactly why people are heavy. We know some things that do contribute to it, but we do not really know all of the answers.
I am still finding that there is so much patient blame and assumption, such as, “Well, we know why they are heavy. They have psychological problems. That is why they are eating.” Or there is much assumption that the person who is expressing the bias knows the answers as to why that person is heavy, and blaming the patient.
Dr. McComiskey: So, Amy [Phipps], I hear a couple of themes, and one is around lack of knowledge about the causes of obesity, which might be addressed by education. Then lack of sensitivity around it, perhaps an unconscious reaction to people with obesity because of our own fears. Perhaps our bias centers about what is attractive in our society. Is there a preconceived idea about what caused this particular patient's obesity, and then a bias based on that, or an assumption based on that? What do you think are some of the choices? What is our responsibility? How do we make this better?
Ms. Phipps: It is easy to make an assumption that kids will not succeed. Ongoing education is needed, person to person, talking and sharing the experiences of our patients with the people who are providing care so that they can see not only the beginning but also ongoing success. I think we are at an exciting time where the science might start catching up with us. The difference in satiety and drive to eat between band and sleeve is being seen already, and further driving the science toward understanding obesity. As the science catches up and is able to explain more of the neurochemical and biochemical issues, there will be data that explain some of the areas of obesity that we do not understand. Hopefully, as understanding increases, the bias and patient blame will decrease.
Mr. McPeters: I agree with Ms. Phipps, that as nurses, we are educators, and I believe, back to what was being said earlier, much of the childhood obesity bias and obesity bias in general is related to preconceived mistaken opinions about obesity. We have, as Dr. McComiskey is saying, our own unconscious biases. However, these should not to be a deterrent factor in addressing bullying and stigmatization in our pediatric obese population.
Dr. McComiskey: I have one last discussion point to address about how we assess whether or not children are at risk to hurt either themselves or others. There is a question that we often ask kids and adolescents, “Have you ever thought about harming yourself, or are there periods of time when you are sad?” Does each of you perform a depression assessment, as is done in the primary care setting? I wonder if this should be a routine part of the assessment of obese kids when they come to be in our care. If we were to put an assessment or screening tool in place, would we then have a trigger to be able to set up some kind of counseling? Because I cannot imagine that for kids who have endured this kind of suffering and hardship, that their self-esteem does not take a pretty direct hit at a very vulnerable developmental stage.
Ms. Lynch: We currently incorporate those questions into our assessment, and there are questionnaires for the adolescent less than 18 years old who has undergone a lap-assisted band procedure to complete. It's called the Pediatric Quality of Life Inventory Teen Report, and they complete it at every visit; it is then submitted to the pediatric psychiatrist working with the adolescent bariatric team. When the patient reaches 18 years of age, we refer him/her to an adult psychiatrist. I will purposefully interview the adolescent with the parents, then alone during the same visit.
Most often, the obese adolescent patients have all experienced depression. Many experience anxiety. As a result of the anxiety, they sometimes do not sleep. Therefore, they lose their focus in class, skip school, which ultimately results in decreased school performance. I have many patients who are enrolled in GED programs. Our mental health screening is similar to the one offered in a primary care setting, with a greater focus on their mental and physical health related to being obese.
They have to feel safe in order for them to report their true feelings. Here's an example. We recently started to perform pregnancy screenings on all the girls at every visit. This is a very sensitive subject. I have had them tell me at the beginning of the interview that they cannot provide a urine sample. Then by the end of the interview, they tell me, “I already know what the answer is going to be. I know that I am pregnant.” This is another example of how they feel “safe” with us, by the end of the time we spend really getting to know them.
Modeling the Home, Educational Activity, Drugs, Sexual activity (HEADS) assessment for adolescents, I focus on the depression screening, as well as asking about suicidal ideation. I had the unfortunate experience of losing one patient to suicide. This experience has prompted me to seek further support and gather as much information as possible to prevent losing another valuable life. I hope there may be something that prompts us to ask more probing questions to help identify those who are at higher risk of hurting themselves.
Dr. McComiskey: I think you probably only have to lose one patient to suicide in this population for you to reexamine the way that you screen for depression, anxiety, and suicidal ideation in practice.
Ms. Browne: I would like to expand just a little bit on a couple of points. In some ways, I think the obese children that are in a weight management program are the lucky ones, because they have dedicated professionals. All of us can do better. Identifying our own weight prejudice is an ongoing task for all of us; there are so many things that are just ingrained in us that we do not even realize. I like to think we all continually examine our tendency toward weight prejudice on a daily basis, because it never goes away. I think weight management professionals are making that effort.
There are certainly many more children who come into the healthcare system every day who are obese and who are not coming into a weight management or a bariatric program. I think it was Steadman [McPeters] who mentioned they come for appendectomies, gall bladder surgery, trauma, routine care, and we do not necessarily assess/screen them for depression/bullying/weight victimization or suicidal ideation. The literature is quite clear that suicide is the third leading cause of death in adolescents, and there is literature that links bullying with suicide not related to weight (sexual orientation is a good example) or any child who ends up on the wrong end of being bullied. There is also literature that directly correlates weight-related teasing and bullying with suicide.
So I have come to personally believe that we have a responsibility when we are seeing any obese child in whatever way in any of our practices that we assess for weight-related victimization. As caretakers of obese children specifically, we have an obligation to educate not only the public but also our fellow pediatric caretakers that when you see an obese child. You have to ask the question, just as when you see any child who has a bruise, you have to ask the question. We have to not only assess from our own specific practices, but screen the child further for depression, bullying, and potential suicidal ideation.
Frankly, from some of the reading I have done, although every suicide is a terrible tragedy, I think it is an example of the obese children's resilience and bravery that it does not happen more often.
Ms. Haynes: This is just a very tricky thing, I think, and I am not sure that there is one tool we can use or one question even to assess whether somebody may be suicidal. It has happened among my patients, where we have a multidisciplinary clinic, and there are so many people seeing these kids during a clinic visit, including members of the psychology service, and yet patients may be able to put on a good face and deny everything and know how to answer the questions. Then at the end of the day, they are tired, the defenses break down, and maybe that one last person asks the question one last time, “Are you thinking of harming yourself?” If the answer is yes, then we are able to get them some help. We actually had this happen at the end of a long day. We succeeded in admitting the young person and prevented that suicide because, as we later learned, this person had a plan and was ready to go with it. But sometimes they fool us. I think they have become pretty savvy about being able to avoid answering that question now too.
Ms. Phipps: It is not until we develop a relationship with the kids that they feel comfortable being vulnerable about the pain of obesity. A multidisciplinary approach that establishes ongoing relationships and builds trust is one of the best ways to support these kids.
Ms. Barefoot: I think you are making a great point. We build a relationship with these children over time and therefore they are more likely to open up to us. I think it is important that every member of the multidisciplinary team be vigilant and continue to ask about suicidal ideation at each visit, because as these patients continue to come to appointments, they may open up more or things may even change for them at home or in school, making them more vulnerable.
Ms. Lynch: The feedback from several of my patients is that they feel safe discussing obesity with Dr. Zitsman, the adolescent bariatric surgeon, and me, as compared to even their outside therapist, who may lack familiarity with adolescent obesity sensitivities. Often, they express their feelings and thoughts regarding obesity. By providing education and sensitivity training to the healthcare members, teachers, families, students, and the people who most often influence them may create bias-free communication and understanding to the adolescent obesity population. Maintaining an open dialogue with the patient(s) by asking if they have been or are being victimized is important. Also, asking if they are a witness to other obese adolescents being victimized is equally important.
Ms. Dharia: I truly believe that we are in an amazing profession because we are actually able to influence the well-being of these kids. Lori [Lynch], to add to your point about open dialogue, I think it's key to remember that you may be the only individual inquiring about a child's mindset about eating or their feelings about their peers and school. It should not be assumed that “someone else”—the family doctor/pediatrician, teachers, or even the parents are having these conversations. It is imperative that as a healthcare provider we realize our importance in the lives of children.
Dr. McComiskey: I think this roundtable has provided a great dialogue not only about our passion for the population but also highlighting the tragedies that can occur. We have discussed our responsibility to educate each other, our staff, and the community about this vulnerable group of children and the devastating effects of weight stigma. I think at the end of the day that is what I take away from our conversation: my renewed responsibility to educate everyone I meet about what it must be like to be a child who lives with this kind of bias.
I would like to take the opportunity to thank you all for your time and for sharing your stories with our readership. This information will assist our readers to advocate for the children with renewed passion.
