Should doctors tell obese kids they're obese?

[Grimmlok]

Seems like a no-brainer to me.. if you're fat, then you're fat.

CHICAGO (AP) - Is it OK for doctors and parents to tell children and teens they're fat?

That seems to be at the heart of a debate over whether to replace the fuzzy language favored by the U.S. government with the painful truth - telling kids if they're obese or overweight.

Labeling a child obese might "run the risk of making them angry, making the family angry," but it addresses a serious issue head-on, said Dr. Reginald Washington, a Denver pediatrician and co-chair of an American Academy of Pediatrics obesity task force.

"If that same person came into your office and had cancer, or was anemic, or had an ear infection, would we be having the same conversation? There are a thousand reasons why this obesity epidemic is so out of control, and one of them is no one wants to talk about it."

The diplomatic approach adopted by the federal Centers for Disease Control and Prevention and used by many doctors avoids the word "obese" because of the stigma. The CDC also calls overweight kids "at risk of overweight."

Those favoring a change say the current terms encourage denial of a problem affecting increasing numbers of U.S. youngsters.

Under a proposal studied by a committee of the American Medical Association, the CDC and others, fat children would get the same labels as adults - overweight or obese.

The change "would certainly make sense. It would bring the U.S. in line with the rest of the world," said Tim Cole, a professor of medical statistics at the University College London's Institute of Child Health.

The existing categories are convoluted and "rather ironic, since the U.S. leads the world in terms of obesity," Cole said. "There must be an element of political correctness."

The debate illustrates just how touchy the nation is about its weight problem.

Obese "sounds mean. It doesn't sound good," said Trisha Leu, 17, who thinks the proposed change is a bad idea.

The Wheeling, Ill., teen has lost 60 pounds since March as part of an adolescent obesity surgery study at the University of Illinois at Chicago.

"When you're young, you don't understand what obese means," Leu said. "I still don't understand it."

The CDC adopted the current terms in 1998, using weight-to-height ratios and growth charts from a generation of children much slimmer than today's.

Children are said to be "at risk for overweight" if their body-mass index is between the 85th and 94th percentiles. They're "overweight" if their body-mass index is in the 95th percentile or higher - or greater than at least 95 percent of youngsters the same age and gender.

Many pediatricians understand the first category to mean "overweight" and the second one to mean "obese," said the CDC's Dr. William Dietz. He said the word "obese" was purposely avoided because of negative connotations but conceded that many pediatricians find the current language confusing.

Adding to the confusion is the fact that about 17 percent of U.S. children are in the highest category, and that almost 34 percent are in the second-highest category. That sounds like a mathematical impossibility, but it's because the percentiles are based on growth charts from the 1960s and 1970s, when far fewer kids were too fat.

In children, determining excess weight is tricky, partly because of rapid growth - especially in adolescence - that can sometimes temporarily result in a high body-mass index.

For children in at least the 95th percentile, high BMI "is almost invariably excess fat," Dietz said. But there's less certainty about those in the second-highest category. So to avoid mislabeling and "traumatizing" kids, the CDC chose to be diplomatic, Dietz said.

The committee, set up by the American Medical Association, involves obesity experts from 14 professional organizations including the American Academy of Pediatrics. Their mission is to update recommendations for prevention, diagnosis and management of obesity in children.

Final recommendations are expected in September, and the participating groups will decide individually whether to adopt them.

Dr. Ronald Davis, the AMA's president-elect, said it's unclear whether the expert committee can develop a consensus on the obesity terms.

"There are seemingly legitimate arguments on both sides," said Davis, a preventive medicine specialist with Henry Ford Health Systems in Detroit.

Maria Bailey of Pompano Beach, Fla., whose 12-year-old daughter, Madison, is self-consciously overweight, opposes the proposed change. She said their pediatrician has told her daughter to exercise more and see a nutritionist, but "hasn't told her that she's in a (weight) category."

"We're already raising a generation of teenagers who have eating disorders," Bailey said. "I think it would just perpetuate that."

Paola Fernandez Rana of Fort Lauderdale, Fla., has a 9-year old daughter who at 40 pounds overweight is considered obese. Rana said doctors "refer to it as the 'o-word'" in front of her daughter "in an effort not to upset her."

"They very clearly told me she was obese," Rana said. But she said she agreed with the term and thinks that at some point it should be used with her daughter, too.

"Obviously I don't want my daughter to be overweight, but ... in order to change the situation, she is ultimately going to need to hear it," Rana said.

Dr. Michael Wasserman, a pediatrician with the Ochsner Clinic in Metairie, La., agreed. Using the term "at risk for overweight" is misleading, creating the perception "that I'm only at risk for it now, so I don't have to deal with it now," said Wasserman, who is not on the committee.

"There's a tremendous amount of denial by parents and children," he said.

Chicago pediatrician Rebecca Unger, also not a committee member, said she likes using the term "at risk for overweight" because it gives patients hope that "we can do something about it."

http://apnews.myway.com/article/20060702/D8IK12IO0.html

[MrsDark]

Yes. Are people really so incredibly delicate these days that they can't handle the truth? It's outrageous and irresponsible to me that a doc wouldn't address this with a patient, especially a child.

[Icepik]

I'm sure most kids know they if they are chubbier than other kids - just as I'm sure other kids have pointed it out to the chubbier kids.

Doctor's certainly should make mention of this. A doctor mentioning this would probably get the kid into the mindset that changes obviously need to occur.

[MrsDark]

IMO This whole "it's okay/normal to be fat" (and how dare you even think about mentioning it because it might make me feel bad about myself) mindset is at least partially responsible for the steadily increasing obesity rate.

[equallydivided]

OK, can someone just slap their parents? This is absolutely CRAZY! How about telling the parents YOURE KILLING YOUR KIDS. Stop going through the McDonalds drive-through and cook something NUTRITIOUS at home!!!!

This really pisses me off, let's concentrate on the problem, instead of the symptom. How about we tell the parents the truth, that THEY are doing this to their CHILDREN.

My daughter would eat candy and junk food all day if I let her. BUT I DON'T. Quit tiptoe-ing around the issue...that's the reason there is a problem in the first place. Parents don't want to somehow 'hurt their kids' feelings' by telling them no in the first place.

[KD]

Originally Posted by equallydivided

OK, can someone just slap their parents? This is absolutely CRAZY! How about telling the parents YOURE KILLING YOUR KIDS. Stop going through the McDonalds drive-through and cook something NUTRITIOUS at home!!!!

This really pisses me off, let's concentrate on the problem, instead of the symptom. How about we tell the parents the truth, that THEY are doing this to their CHILDREN.

My daughter would eat candy and junk food all day if I let her. BUT I DON'T. Quit tiptoe-ing around the issue...that's the reason there is a problem in the first place. Parents don't want to somehow 'hurt their kids' feelings' by telling them no in the first place.

Excellant post, ITA. Also to the parents: Turn the TV off, make the children play outside, ride bikes whatever.

[darksithbunny]

My doc had no problem telling one of my kids he was a little chunky. I agreed. He is fine now. I know he had a growth spurt. My 2 oldest were the same. They would get a little heavy and then bam. They would grow about 1 or 2 inches taller. Amazing how that works.

[suede]

A 9 year old doesn't become 40lbs overweight on their own beyond real genetic problems that would cause her to be so it is not only the child it's the parent(s) that need to be rattled.

Beyond "vanity" it's also health reasons that obesity in children is a serious matter.

[MrsMarsters]

rarely is there some disease that is causing the kid to gain weight..but most of their parents are plus sized..and too damn lazy to watch what the child eats.

[KD]

^^^And using the TV as a babysitter.

[DeChayz]

If a kid's fat, they fucking KNOW they're fat, whether it's purely self-awareness, or - more likely - other kids TELLING them they're fat. It's not like he doc's gonna whip out the "o-word" and the kid's gonna go "ummm...okaaayy... wow, that's, uh, that's news to me". I highly doubt they'll go into shock after hearing it; it's the parents that are probably in denial and defensive over their parenting skills and don't want to be told the way they're raising their kids is killing them...

[A*O]

Wow - we all seem to be in total agreement on this one. Kids get fat because their parents (also usually fat) feed them junk and don't make them exercise. I actually DO feel sorry for younger kids who are being overfed because they don't have much choice in the matter. If mommy only knows how to order in pizza or go to McDonalds then it's no use saying "hey Mom, please can I have a tuna salad today?". I also think that some parents deliberately enable their kids to overeat and get fat as some kind of weird control/attention seeking thing but bleat about 'hormone imbalance' or 'slow metabolism' or some other non-existant 'medical condition' to explain their 300lb 7yr old.

[Grimmlok]

When's the last time you saw kids playing outside in the neighborhood? I go back to my suburb, and there are NO kids outside. None. It's fucking eerie. I used to go bombing around in my bike every day, play capture the flag, run around in the creeks and forests...

Now all kids do is sit on their asses and play videogames.

[DirtyPool]

If the kid is packin 200 lbs of donut oil, someone needs to let them know.

[Lobelia]

Originally Posted by MrsDark

IMO This whole "it's okay/normal to be fat" (and how dare you even think about mentioning it because it might make me feel bad about myself) mindset is at least partially responsible for the steadily increasing obesity rate.

This is one of my favorite rants. It's yet more delicious fallout from America's asshat preoccupation with feeling good about ourselves with absolutely no corresponding effort or accomplishment. We're special, just the way we are. We can do anything we put our minds to - IQ & physical ability are equal in us all. We all deserve trophies & medals. There are no winners or losers because we all tried hard!

You can't tell kids they're fat because you might hurt their (my all-time most despised & loathed words in the English language when placed together) *shudder* "self-esteem."