The language around weight can be difficult to navigate. We want to encourage health to be the focus, but this can be difficult to do alongside weight stigma or bias. Learn more about how we can create conversations that are weight-neutral and body positive.
Host Dr. Sam Manger, talks with guest Dr. Kim Hurst about beating the bias. Dr. Kim Hurst is a Senior Psychologist & clinical lead at Robina Private Hospital’s Eating Disorder Service. Kim is passionate about eating disorder treatment and service delivery and has specialised in child, adolescent and young adult eating disorder treatment and research, working across a range of treatment settings for over 15 years.
The language around weight can be difficult to navigate. We want to encourage health to be the focus, but this can be difficult to do alongside weight stigma or bias. Learn more about how we can create conversations that are weight-neutral and body positive.
Host Dr. Sam Manger, talks with guest Dr. Kim Hurst about beating the bias. Dr. Kim Hurst is a Senior Psychologist & clinical lead at Robina Private Hospital’s Eating Disorder Service. Kim is passionate about eating disorder treatment and service delivery and has specialised in child, adolescent and young adult eating disorder treatment and research, working across a range of treatment settings for over 15 years.
Health and Wellbeing Queensland acknowledges the Yuggera and Turrbal people and the traditional custodians on the lands on which this podcast was recorded and the traditional custodians on the lands of borders on which you are listening. We pay our respects to the Aboriginal and Torres Strait Islander elders past and present, for they hold the memories of the traditions, cultures and aspirations of Australia's First Nations people.
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Dr Kim Hurst [speaking over music]: Unfortunately, in our privileged western society, the thin ideal has been promoted as being preferable, which of course it's not, and as a result we now live in a diet culture ridden society that equates weight to worth and that it tells us that higher body weight is a problem that needs to be fixed.
Sam: Welcome to the Clinician’s Guide to Healthy Kids, a podcast series for health professionals brought to you by Health and Wellbeing Queensland's Clinician’s Hub. I'm your host Dr Sam Manger and in this series, we'll be diving deep into the topics that matter most in childhood weight management. We'll be talking to Queensland experts across a variety of topics including sleep, disordered eating in higher weight children, prevention and healthy growth with healthy diets.
Let's get started.
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Today we are going to discuss how we can have empathetic discussions around unhealthy growth or higher weight. Research shows us that healthcare professionals do not feel confident to discuss weight, as they are worried they will damage the relationship with the patient or family or cause unintended harm. On the other side of the table, patient feedback tells us that they have been judged or discriminated against in the past because their weight and may avoid engaging with healthcare providers as a result.
To help us, we welcome guest Dr Kim Hurst. Kim is a Senior Psychologist and Clinical Lead at Robina Private Hospital’s Eating Disorder Service. Kim is passionate about eating disorder treatment and service delivery and has specialised in child, adolescent and young adult eating disorder treatment and research, working across a range of treatment settings for over 15 years. So, thank you so much for joining us, Kim.
Kim: Thank you for having me.
Sam: So, tell us a little bit about yourself and your why, Kim? What got you into this space? Why do you love it? Why do you keep doing it?
Kim: Originally, I was drawn to understand how people interact with their bodies because I had observed a lot of adolescents really kind of identifying body image as being a huge factor that bothers them and worries them. And so, it was the interrelationship between body image and how we manage our emotions, health and wellbeing that attracted me to become a psychologist and then to specialise in eating disorder treatment, because I also believe that eating disorder treatment over the years has not been effective and adequate because of the weight kind of focus. And also, I guess the glorification of appearance being related to our worth and value. So, I'm very much an advocate of trying to change those ideas.
Sam: Yes, absolutely. Changing the ideas and as you say the dialogue both internally and externally around this, the thoughts, the feelings, the ideas, a lot of that needs to be questioned and evolved. So, let's start at the beginning. What is weight bias and weight stigma? It's words you hear a lot but how do you define them?
Kim: Good question. So, when we think about weight bias, we're describing the negative attitudes and stereotypes surrounding and attached to larger bodies. And the weight stigma is the social rejection and devaluation that occurs directly to those people that are potentially not adhering to what would be socially accepted as an adequate body weight and shape.
So often weight stigma happens in quiet and subtle ways, and it may be invisible to those doing the stigmatising yet very hurtful and demoralising to those that are on the receiving end. So, some examples might be when you go into a clothing store and there's not a diverse range of size or the models that are displaying the clothes are only one kind of particular frame.
Restaurants and waiting rooms or public spaces without adequate chair sizes for those in larger bodies or predominantly a lot of people complimenting on appearance-based parameters, like wow, you've lost so much weight as if weight loss is a pinnacle of an achievement. So, it can be quite detrimental, and it can affect people in really horrible and terrible ways. And for me the main concern is that those that are discriminated against on weight, are roughly two-and-a-half times more likely to experience mood and anxiety disorders as a result of, you know, them being targeted.
Sam: And as you mentioned, it can be quite insidious. You know, it's not necessarily that obvious because a lot of these are cultural norms to some degree that we're sort of questioning here. And the impact of that perpetuating, as you say, other health concerns, anxiety, depression, which then can perpetuate health behaviours in the right or wrong direction. So, we're trying to interrupt that cycle and send it in a better direction. So, but given the pervasiveness of this, or potential pervasiveness of this, would you say most adults have an element of weight bias or stigma.
Kim: Absolutely. We've all been exposed to and influenced and shaped by, to some extent our social environment. Our parent’s attitudes towards food, eating and health, cultural influences. And unfortunately, in our privileged western society, the thin ideal has been promoted as being preferable, which of course it's not. And as a result, we now live in a diet culture ridden society that equates weight to worth, and that it tells us that higher body weight is a problem that needs to be fixed through restricted diet and exercise regimes. So, we really do need to reflect and consider our own attitudes: where they have stemmed from and are they needing to be challenged and reversed to be more inclusive and you know, raise our awareness of diversity?
Sam: So, given that, how can our listeners overcome or address some of this weight bias and stigma in their practice? How can or what are the ways we can shift that conversation to be more productive and valuable and useful?
Kim: That's a really important kind of learning for professionals. We really do need to reduce our internal weight bias and the way to do that is surround ourselves with diverse body types of all shapes and sizes, interact and learn from those who have been oppressed. We want to really reduce the attractiveness of the thin ideal so that it leads to a greater understanding and acceptance of diverse bodies. I guess when you think or when you notice that you're thinking negatively about people in larger bodies, you need to take a minute to unpack these thoughts and challenge them.
Remember that you cannot tell the health of someone just by their appearance, and that it is not your concern to judge their lifestyle habits. So, everyone, regardless of body weight and shape is worth dignity and respect. Probably, we also need to learn to appreciate and accept our own body. And it's important to remember the influence of social media and advertising, and the impact that that can have on shaping our opinions. And so, we can, I guess, in a way, be an advocate by avoiding those businesses that use or reinforce weight stigma or unhelpful like appearance, beauty, health or fitness stereotypes. There's lots of things we can do.
Sam: It's a really interesting one you mentioned there around it's not our job to judge people’s health behaviours, but in a way, it is our job too. So, this is where it's kind of difficult for health professionals, cause on one hand you're spot on we don't want to continue and perpetuate a pathology of an ideal stereotyped body weight that is normal. If you're not that, then there's something wrong. So that's clearly unhealthy for everyone. But at the same time, we also need to recognise that there are unhealthy health behaviours that need to be addressed. So, it's not necessarily attaching other generalisations or stereotypes to that, but there is a sort of element of clinical judgement you could say and a priority of people's health, so that can feel like a grey space or a difficult space to walk as a clinician sometimes. Do you find that?
Kim: Yes. I think though what we need to do is look at health on a continuum and weight or body shape is one component of that. And like you've raised; healthy behaviours and attitudes and the way we deal and manage with our lifestyle choices and what cultural influences we have. So, it is a fine line to walk between, you know, not wanting to over focus on health and weight being tied together. But of course, they are connected. So, it's kind of trying to just remove the hyper-focus just on one aspect and broaden it out to a whole range of factors that contribute and relate to health. Also, I think it's important to understand a person's individual perception of health. What does that look like for them? And in some cases, we need to educate ourselves as professionals on those issues, rather than just, you know, having a one-size-fits-all.
Sam: You're spot on, I agree. It’s a question of what will be effective and as we know and talking to the expert here, a psychologist. There are aspects like righting reflex, where you talk to someone and tell them what to do, especially if you're very specific about weight, people will often respond with their righting reflex to resist that and be defensive against that. I think we’ve all experienced that to some degree.
But if we focus on the whole person, you know the bio, psycho, social, cultural, spiritual elements of that person and personalise it, we end up perhaps not talking about weight a lot specifically and body image may come about as a direct, you know change, but it won't be what we primarily talk about. We’re talking about the whole person wellbeing, as you said, the attitudes, the thoughts and feelings of the environment and then we find that those old things snowball and sort of improve with time.
So, you know, I partly raise this as clinicians, we do fear talking about weight, especially in front of kids and adolescents, because we're worried about what that may perpetuate or stimulate or trigger. And we don't want people to start on fad or restricted diets because we are worried that might be a precursor to eating disorders. So how can we discuss weight and not increase this risk?
Kim: Yeah, being comfortable discussing weight and talking about a person's weight with them is a task that we have to be comfortable with. You know, we do need to have baseline weight, so we do need to be reflecting on weight trajectories, but we do that with an attitude of respect and dignity.
We have to keep coming back to the point that weight and body size does not determine the health of an individual. So, we need to frame health and wellbeing as being multifaceted. So, it's much more than just body weight, it's you know, like we've said already, a complete state of physical, mental, social wellbeing, not merely just the absence of disease. So, if we shift away from solely focusing on the number on the scale or the person’s BMI and look at broader factors. You know, like we've already mentioned, individual characteristics and genetics and behaviours, social and economic environment and physical environment. And we actually encompass the conversation about weight in amongst all of these things. That it's not, you know, segregated off to the side, but it's a part of, and we want to use language that doesn't imply blame to the individual relating to their body weight or shape.
Sam: I've got in mind when I'm hearing and when we're talking around the context and the time restrictions and just the pressure that a lot of our listeners will be under, especially those in general practice where there are you know, I can speak from personal experience, as well as teaching experience, that because of those pressures sometimes things don't come out of your mouth as you intended. And you've got to sort of, and you go oh, I wish I haven't used that word like that because I can see the persons tensed up just as we talk about it.
And so, one thing you mentioned about respect and dignity, I suppose, you could call it a clinical tip or a pearl, I do think that sometimes actually just using those words, I mean this with respect and dignity, it's a tricky question, but I'm curious about [patient], is that you can just sort of make it clear that no matter how the rest of this sentence comes out, I mean this with respect and dignity and then that sort of softens the conversation a little bit and at least you're on an even playing field. I wonder, you know, along those lines or anything else you can think of, you know, what are the important things that we as healthcare professionals can bring to the room when discussing these, especially in family contexts as well?
Kim: Yes, they're very good questions. And you're right, the way that you set up a question either allows a person to feel heard and understood, and we would want to be curious around their attitudes, their beliefs, their thoughts rather than, you know, dictating or kind of dominating the conversation with our opinions. And we want be using kind of person-centred questions. You know, what how do you feel about this? This is putting the person in the room.
I also think what's really important, when we actually have to weigh a person, is we do it in a way that's not, you know, anxiety provoking for us like: Is it okay if I weigh you, that is going to create a judgement and a view from the patient. We just want to say: Would it be okay if I just take your height and weight today please, just so that I've got a baseline.
And I guess the idea of making things more relevant to the person, you know, what concerns have you got about your health rather than saying, you know, how do you feel about your weight, directly? You know, we kind of try and keep using an encompassing kind of framework. And interest in maybe asking about factors that are affecting their health so that we're not pre-empting or judging that weight is the problem. You know, it might be a whole range of other things. They may be going through a really stressful and emotional period in their life. And food has become a comfort to them. And if we don't understand those components, we're moving straight towards your body is not acceptable. You need to do something about it. But really the problem is something very, very different.
Sam: Yes, absolutely. Those open-ended questions are just a good clinical skill. You know, really full stop. And as you said, there's person-centred questions. How do you feel? How do you feel about your health or how do you feel about XYZ? Because you see where the person responds and then you can sort of get a sense reasonably quickly where there is fertile ground to dig a bit deeper and follow that thread, as it were, into the conversation that will be, will not have the same resistance as if you are enforcing a certain type of conversation. So, it's based on what they're clearly more keen to talk about and if you follow that thread, it can be really good.
We'll be back after this short message.
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Sam: And now back to the show.
So, you mentioned there around in a way normalising taking a biometrics of body metrics. You know we're going to do blood pressure today. They always like do that. Do your heart rate, today. I'm thinking there is a GP obvious bias here but and then let's do your weight and height. It's just a normal everyday run-of-the-mill sort of activity. So, that makes me think about, so we've obviously got our one-to-one skills, but if we zoom out a little bit and then look at the whole consultation room or even the clinic or whatever setting they're working in, how can we make consultation rooms more comfortable for people with a higher weight.
Kim: I think the first thing is that we've got to have adequate seating and adequate furniture to accommodate all bodies and all shapes, and also considering if people have disabilities, you know, we need to make accommodation around those things. We also want to include diverse images on our walls. So, if we've got artwork, we want it to be reflective, not just, you know, one size fits all. It is super important that our clinical staff, our reception staff, our people that interact at every point of contact when a person attends either a clinic or a hospital are actually trained in weight neutral attitudes and are able to have respect for people and not be judgemental. So, there's just a couple of ideas.
Sam: And do you ever feel uncomfortable? You been doing this for quite a while now? So do you ever feel uncomfortable still discussing this or is this just so run-of-the-mill for you now.
Kim: I don't think that I've ever had major concerns, you know, discussing weight or weight related issues with patients. But as you've mentioned, I have had a lot of experience. I've undertaken a lot of training.
I'm also consistently seeking feedback from my patients and those with lived experience around how do they want the issue of weight and health addressed? You know what approach is best for them? Do they want me to be direct or do they want a more kind of collaborative problem-solving approach. So, you know, we've got to kind of think the individual approach and kind of setting up our treatment with that in mind is so important. And I think that if you've got that respect for patients, they will give you feedback and asking them constantly for that, is so important.
Sam: I can't say I personally feel that uncomfortable about it anymore either. Like to me, I just see it as just health. You know, I don't really see it any other way. So, I'm just there to improve your health. As you said, personalised approach is always what matters. And yes, sometimes weight does fall into [conversation] and you know sometimes it doesn't. So, it's just something that we do.
So now you mentioned around feedback. So, getting feedback from patients can be really important. And that is certainly one of the, as far as I'm understanding, sort of coaching of the psychology world, that can actually be really important to get feedback on either services or how do you feel today's consult went etcetera. So, what would you say if the parent or the carer responds with something negative with regards to the idea of being weighed or the results, like you know, the results of say their child being weighed, you know, are you saying my child's overweight or something, even though we may not actually say that?
Kim: Yes, I would directly raise that with the parent there and then and you know, let them know that it wasn't my intention to give the impression that I was focusing on their child's weight as being a determinant of health. But I would explore the parent’s beliefs around, you know, their view. I'd reiterate that weight is only one aspect, obviously, of the child's health. But I would also take the opportunity to educate the parents on the negative impact of using weight stigmatising language like, you know, my child is overweight or obese or chubby. I'd kind of try and help them understand that they're judgemental words that have really significant impacts on a person's sense of self and wellbeing. And we would probably need to think about other ways of trying to explore, you know, body weight and shape conversations.
Sam: And so, what if the parent doesn't feel there's a problem though. So, there's perhaps an element of denial, and often again in my experience, and this is anecdotal, but it can be because in a way we're judging them directly. Rather, you know, it's saying, well, you know, you're parenting with the environment that is potentially a problem and people get very defensive about that.
Kim: Look, if a parent was either minimising or demonstrating a sense of denial around the problem, I would kind of take again a curious questioning approach and ask them what they consider the problem is, or the issue is. I guess in my experience, sometimes there's been misinformation presented to the parents and I would be keen to understand if this is the case. Like you said, if they've been judged or criticised or even, you know, put in a position of blame.
I suspect if they're presenting to my clinic in particular, you know, it specialises in eating disorders. I would hazard a guess that the parent feels like there is some issue. So, I again be really curious around what the parent wants out of the consultation or the interaction or the intervention. And try and align our goals towards that. Again, I would not ever expect, you know me to be directing that. You're coming to me for something that's not quite right in your life, that you're not managing. You need to be the author of that kind of story, so that then I can arm you with whatever you need to kind of either improve that or feel better about yourself. So yeah, I kind of think a lot of the time the denial is related to feeling subject to criticism and blame. So, I'd want to debunk that as soon as I can.
Sam: Yeah, you could offset it to some degree with what we mentioned before around disclaimers around respect and dignity. You can usually offset that it will reduce the likelihood of that sort of response. And you mentioned before around acknowledging, I think any clinician can get a sense when there's a shift in the room, you know, and things suddenly got a little more tense, a little bit more uncomfortable, you know, something just happened. Either what I said, or some part of the process here just didn't match with that person. And in a way, the temptation is to stick your head in the ground and just keep going with the consult. But it is better and I've certainly [learnt], this is absolutely true from my experience, just stop for a second, and say: Okay, something just shifted. Did I say something wrong or did something happen? It's better just to get it out there and then, it's my experience to then just say: So, is there something that was said? Just, I'm curious with what's going on. And then people say, well, I didn't like this, or I'd like this, or this triggered me when you said this. I [respond] okay, I'm really sorry. That wasn't my intent. My intent is, as you say, is to empower you. It’s your health. It’s the family's health. And my opinion on this is XY and Z.
And sort of flipping back that curiosity always helps. So now my mind goes to various scenarios. So, we talk there around, if there's a case of denial. And I think that as we said, sort of cautious curiosity there can really help to explore what's going on in the parent’s life and their conditioning and history that may be impacting that. And what about when the parent lays blame on the child and their choices?
Kim: Again, I would explore how the parents have come to this conclusion. So maybe by saying: So, what do you think your child does or has done that tells you that they're to blame for this current situation? Alongside of that, it's important to understand the parent’s attitudes and perceptions around food and choices.
Then I'd want to explore with the parents how they might be able to assist their child. So, if you know, parents are kind of saying, well, they should be making good choices. I would say: Okay, what as a parent, could you do to help them make those choices? Would it be access to more variety of foods? We would make sure that we're not removing foods or restricting foods because often times that can also be a trigger, for particularly children and adolescents, when they're not able to have access to preferred foods and whatever, there might be a tendency for them to sneak food or to kind of get it in a way that their parents aren't observing. So, we want to make sure that, you know, there is adequate nutritional information for the parents so that they understand what foods will optimise health.
We don't want to demonise food, though. Food is not on a continuum of good and bad, it just is food. It's just energy. It’s what we need to fill our bodies and if parents are really struggling with maybe their knowledge and understanding of these things, I'd certainly encourage them to seek out dietetic input, nutrition input. You know, again, it's about a whole range of professionals contributing to try and help and resolve the whatever the issue is. It's not just a one thing. It's not just the food that we put in our mouth, but that's one component that might need to be addressed.
Sam: Yeah, the point you say there around, there’s not good or bad food. I feel that deserves digging into a little bit because that that opens up to me a conversation around mindful eating and in the essence around non-judgement. And so, what we, well please correct me if I'm wrong, but my understanding is it's not labelling food good or bad, but it's still acknowledging there is healthier and unhealthier foods cause that's undeniable. But in the sense of when we are labelling things as bad, then: ‘that's bad and therefore I'm bad for engaging in it’.
Then that spirals the shame, the guilt, typically then restrictive eating, then that makes us want to eat more because you put the body under stress and now it just wants to comfort itself through whatever means it can. I guess the concern from some people, maybe that we're trying to soften the conversation so much as to not challenge people. And, so if people still need to be challenged, but what we're talking about, and again, I hope I'm getting this right, what we're trying to do is challenge people in the most supportive environment. Sort of like post challenge growth, as opposed to post challenge stress, you know and so we if we can challenge them with the right language in the right environment, then that challenge can be a growth experience.
So, we're not trying to say: Oh, there's no such thing as good and bad, don't worry about it, to say anything. No, there are clearly healthy and unhealthy. But what we're looking to do, is not necessarily instantly judge because we don't want you spiralling into that. We want to spiral in the right direction where you actually feel supported: ‘Okay, I've made a healthy choice. That's great. If I haven't, that's fine. I’m just going to enjoy it for now, but I'll move on.’ Is that a fair synopsis?
Kim: Yeah. I think what we need to think about when we're talking about food is more around nutrition. Like we want to say: There are certain types of foods that offer optimal nutrition and others are preferred foods that offer us, like you said, comfort or enjoyment, but they're all on the table. Potentially we have a larger portion of these kind of more nutritious type.
I sometimes avoid using healthy and unhealthy as well. Just because it can also be a judgement. Like I might have used [these terms] about what I consider healthy and not healthy, but sometimes these might be skewed. Sometimes I avoid the unhealthy versus healthy and talk more around optimising nutrition or even thinking about the interplay with our bodies. So, you know what foods are rich in iron or proteins, what calcium dense foods can we be having? So, I kind of try and look at food in a more nutrition-based way. Maybe it's because I secretly also want to be a dietician. I don't know.
Sam: No, I think that's right. I mean I see it in the sense of impact on the rest of your physiology and psychology as well. But, you know, whether it's the hormonal cascade or the microbiome or the inflammatory cascades, these are foods that are anti-inflammatory, they’re good for your gut microbiome, good for your mental health. And then there are foods that may be detrimental to those things. And we know that from the research. And so, again removing their labels of good and bad in that sense, but just actually, and this is a good, I think general principle, for all of health and medicine is to, we mentioned a principle about being curious. And then, not the flip of it, but the other side of that is demonstrating our clinical reasoning. So, it’s the: How did I? Why am I saying this right now? And I may say the wrong word for ‘healthy versus healthy for that person’. But if I explain my reasoning as to why I think that people go: ‘Okay, I understand what you're saying.’ You don't get lost in translation and that can be a real risk with this.
We'll be back after this short break.
[Community message: narrated by a male] Unhealthy weight is one of our greatest public health challenges. Two in three Queensland adults and one in four children live with overweight or obesity. We need to shift the dial. That's why Health and Wellbeing Queensland has created Clinicians Hub for you, our clinical workforce. Clinicians Hub is a digital ecosystem of initiatives, resources and tools, including this podcast series for multidisciplinary health professionals to support best practise prevention, identification, treatment and management of overweight or obesity. It offers a variety of clinical tools and training to help you transform health for children, adults and families. Find out how Clinician’s Hub can help you at hw.qld.gov.au/hub
Sam: And now back to the show.
Now the last scenario, to ask you about, is where the parent then lays the blame on themselves for what's going on, so then you’ve got, as we talked about before, the potential for quite a negative sort of spiral.
Kim: Yeah. I suspect when a parent is concerned about their child's health, they will tend to take responsibility for this and blaming guilt sometimes follows that along. But I would try and empathise and understand how they've come to this conclusion. Like, why do they believe that they've had this impact or why are they blaming themselves? I guess in my experience, parents may hold some inaccurate perceptions, and these themselves may have been kind of emulated by health professionals who are directly blaming and shaming.
So, of course, then you're going to internalise that. But again, I would take the opportunity to debunk immediately and again provide education to help them understand, you know, biological factors, survival drives, the reason that we sometimes mismanage our emotional response through food or you know, I would kind of try and take a real bigger picture approach, rather than it's your fault because you've done this, it's not going to be helpful and it's going to not empower them to take action if need be.
It's going to actually demoralise them and maybe inadvertently prevent them from seeking the help that they need. So that one's a really hard one and I think lots of parents, particularly parents of children with eating disorders, they come and they feel such immense guilt and their so tortured themselves by the impact, potentially, that they might have had. But again, we know that it's not one factor. So, the fact that they're bringing their child to seek help for me is really a key thing that I want to kind of, you know, amplify and praise them. You know, you obviously care so much about your child. How can that be, you know, congruent with blame. That doesn't match up to me.
Sam: Yeah. Herein lies your whole profession of psychology, that is, dealing with the nuance of human beings. And, because most things are shaded grey, things are rarely black or white. So, it's a case that it's extremely unlikely that the parent is responsible for what's going on, you know, because as you said, there's social, cultural factors involved here, and we know what an impact they have on a child and that lessons mental wellbeing and perceptions of themselves.
But there are always places that we can improve, you know, as individuals, as parents, that sort of stuff. And that is also true. So, this is not a case of blame, but it is a case of where we can go from here, you know, that really helps. And so along those lines then, what about if the parents are living with a higher weight themselves? I imagine you take a whole family approach to that.
Kim: Yes. I guess when we think about health, it exists on a spectrum of body sizes, including those in larger bodies and a person's health and eating and exercise behaviour should not be assumed just based on looking at them or their appearance. I would only address with the parents around their body and their weight issues, if they have any. If they bring it up as a problem I would not automatically assume just because they're in a larger body that the parents require intervention.
You know, we do have to consider that you can be healthy at a larger body weight. If they are worried about the impact that that is having or potentially how that translates to them helping their child, I would raise it only in that context, but I would not just assume that they need intervention themselves. So, I would put the child, if they're bringing the child, the child is the centre of the intervention not the parents. I would not be educating the parents directly if that makes sense.
Sam: Yeah. So, does that sometimes feel like there's a lot of weight then on the child?
Kim: Oh. Okay, so maybe I haven't explained it properly. What I guess I'm meaning is we would get the parents to devise and come up with problem solving strategies around how to help the child with whatever the problem is. But I guess what I'm saying I wouldn't say to the parent: ‘You also have a weight issue, and we need to address that.’ So, that is I guess what I'm trying to separate out.
But, of course, the parents do need to be involved in either decision making or the goals of treatment or you know the parameters of health that need attention. So, yeah, I guess I just wouldn't then automatically assume that I have to, you know, manage the parent’s weight or weight related issues.
Sam: Yeah, sure. Okay, avoiding those automatic assumptions. Yeah, not going down the path of blame. And just think about what can be done and what's the best path forward, which usually requires a whole family or a whole person approach. And then sometimes, depending on the culture, a whole of community approach can be really important too. And let's say that a parent is living with a higher weight themselves and they have raised it as a factor that worries them, that may be related. So, I imagine you would not necessarily go down in that consult, but you could refer or arrange or consider how to support that whole family or is that something you do within your services?
Kim: If a parent directly raises it there and then, that they feel like they've had a negative relationship with food themselves and they're worried that this has kind of directly led to their child having problems, then I would actually, you know, ask specifically: Do you worry that your relationship with food has somehow affected the way that your child interacts with food? You know, in what ways do you think that has been a problem? In what ways would you like it to be different? So yeah, I certainly will raise it if they raise it, but again, I'm not going to assume that just because potentially a parent’s in a larger body that they have a problem themselves.
Sam: And now the perhaps one of the more particularly sensitive points is what would you say to healthcare professionals who are worried to discuss weight because they themselves may have a higher weight?
Kim: That's really actually a really good question because we have to be comfortable and confident in our own skin and our own body to actually be able to address it with someone else. So, if we're holding views and judgements around ourselves that certainly is going to seep out through the consult, into the room. So, I would be wanting to talk to my staff, you know? Are there worries that you have about your own body? What are the ways that you can come to an acceptance? How are you going to not allow these opinions and thoughts about yourself to affect your patient? And, in some cases, I would encourage them to do more professional development or seek supervision around their own experience, and their own thoughts and feelings about weight and shape. You know we really do need to be very cognisant of how we present our attitudes, inadvertently or overtly. So, you know, that's a really good question for professionals to consider and keep reflecting on.
Sam: Yeah. The transference question, the counter transference is one of those very interesting dynamics in a consult. And, I don't think that, you know, for want of a better word, perhaps awkwardness, or a sense of discomfort, in a consult that can happen. The last question I raised is if the health thresholds are a higher body weight themselves, but even, then it doesn't have to be the case. If you've got a, you know, within normal – in inverted commas – ‘BMI weight’, then they can still feel like I'm going to raise this conversation, but I don't want people to think I'm judging them because I'm this BMI and you're that BMI, you know. So, regardless of the health professional’s weight, it can be a dynamic that we have to be very conscious of and I think a lot of what we've discussed today does help improve the outcomes and the likelihood of outcomes on that. So, what would be your top tip then for building rapport for children and adolescents?
Kim: Since we are trying to be as human and kind of down to earth as possible, I also think it's really important to put their kind of anxiety and kind of worries at ease as soon as they walk in. Kind of like, you know, I imagine the conversation that we're going to have today might be a little difficult and challenging, the more vulnerable and open you can be with me, the more able I am and more armed I am to help you.
I often say to teenagers., in particular, ‘Look nothing you say will shock me and I'm not here to judge you. I'm here to understand.’ So, showing that unconditional positive regard, empathy, compassion. I also like to name what's going on in the room. So, if I can see an adolescent is squirming or kind of, you know, feeling uncomfortable, I'll raise that: I can see that you kind of were a bit uncomfortable with that question. Can you let me know what's going on for you or what was it about the question that made you not feel okay? Would you like me to ask it in a different way? You know, so it's that constant kind of checking in with what's happening in the room with the person.
Sam: Yeah. There are some really good pearls there, which I'll just highlight. So, acknowledging that this may be a difficult conversation for some, it may not be for others, but: I just want to have an open [conversation], the more open we can be the more we'll get out of it. I think it's a really nice way to put it, but there's nothing that you could say that will shock me, it's certainly true. As a GP, we see absolutely everything. That, you know, there's no judgment, that I'm here to respect, and I'm just curious. You know that word we've used frequently throughout this podcast around ‘curiosity’; it is such a great principle to sort of come back to and I'm learning. I mean, as in professional development, I mean I can think of numerous times over my career where I've interacted with adolescents in a less than ideal manner and just in the sense of always practising developing our own communication skills. So, I've been at the end of the consult that didn't go as well as it could of, and I think, ‘Okay how, next time do I do this? How could I do this a little bit differently? Some of the points you raised, I think I'll be taking home and practising because there's some really great pearls there. So, thank you so much for your time and expertise and knowledge today, Kim. I'm sure the listeners have benefitted enormously.
Kim: Thank you so much. It's been a privilege.
[Today we've been talking to Dr Kim Hurst from Robina Private Hospital. For more information on today's topics, visit the Health and Wellbeing Queensland website at www.hw.qld.gov.au. We'll see you next time on the Clinician’s Guide to Healthy Kids.]