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Few parents recall doctor saying child overweight

Posted December 5, 2011
Updated December 6, 2011

— Pediatricians are supposed to track if youngsters are putting on too many pounds — but a new study found less than a quarter of parents of overweight children recall the doctor ever saying there was a problem.

Does that mean doctors aren't screening enough kids, or aren't frank enough in these tough conversations? Or is the real story parent denial? The research published Monday can't tell, but makes it clear the message too often isn't getting through.

"It's tricky to say, and it's tricky to hear," says lead researcher Dr. Eliana Perrin of the University of North Carolina. She analyzed government health surveys that included nearly 5,000 parents of overweight children from 1999 to 2008.

Parents tend not to realize when a weight problem is creeping up on their children. When almost a third of U.S. children are at least overweight, and about 17 percent are obese, it's harder to notice that there's anything unusual about their own families. Plus, children change as they grow older.

The new study suggests when parents do recall a doctor noting the problem, it's been going on for a while.

About 30 percent of the parents of overweight 12- to 15-year-olds said a doctor had alerted them, compared with just 12 percent of the parents of overweight preschoolers. Even among the parents of very obese children, only 58 percent recalled a doctor discussing it, says the report published Monday by the journal Archives of Pediatrics & Adolescent Medicine.

"Many pediatricians don't worry until children are very overweight, or until they're much older," says Perrin, whose team has created stoplight-colored growth charts to help doctors explain when a problem's brewing. "If we can notice a concerning trend early, we're more likely to be able to do something about it."

That means taking a family approach, says Dr. Nazrat Mirza, medical director of an obesity clinic at Children's National Medical Center in Washington. Important changes — such as switching to low-fat milk and water instead of sugary sodas and juice, or cutting back on fast food — should be viewed as making the whole family healthier, not depriving everyone because Johnny needs to lose weight.

"You do not want to single out one individual in the family. That's enough to cause a lot of friction," says Mirza, who wasn't involved with the new study.

Doctors have long tracked children's height and weight during yearly checkups, but more recent guidelines urge them to calculate a youngster's body mass index, or BMI, to screen for developing obesity. Unlike with adults, one measurement alone doesn't necessarily mean children are overweight — they might be about to shoot up an inch.

UNC study looks at overweight children UNC study looks at overweight children

The next step is plotting that BMI on a growth chart. Youngsters are considered overweight if their BMIs track in the 85th to 95th percentile for children their same age and gender, a range that just a few years ago was termed merely "at risk." Above the 95th percentile is considered obese.

"It's a lot easier to work on things when children are younger, when their lifestyles are not quite so entrenched," Perrin said.

To tackle lack of awareness, Children's National has begun calculating BMIs for every child age 2 or older who is admitted for any reason. Mirza calls it "a teachable moment."

Perrin's analysis shows more parents of overweight kids are starting to get the message. Overall, 22 percent of parents reported a health professional telling them their child was overweight. But that rose to 29 percent in 2008, the latest year of the survey data and about the time guidelines changed.

So what should parents, and overweight children themselves, be told?

Perrin focuses on health, not fat. She tells them the child is at an unhealthy weight that puts them at risk for later problems — and that she can help families learn to eat better and get more active. That's where her color-coded BMI charts (www.eatsmartmovemorenc.com) come in. Parents can tell at a glance if their child is in the overweight yellow zone or the obese red zone, and over time if they're moving closer to the green zone. Perrin calls the charts especially useful between ages 3 and 8, when children are growing so fast it's particularly hard to tell if they're a healthy size.

Portion size is key, too. Nutritionists define the right size as about 1 tablespoon of each food type for every year of age. Perrin's easier measure is that a serving is about the size of a child's palm, which will grow as the child gets older.

Pre-teens and teens are more independent and have to be on board, adds Mirza. Teens, for example, start to stay up late, eating more at night and skipping breakfast, not a healthy pattern. The kid who never exercises will tune out all weight advice if told to hit the gym but might agree to walk around the block. The athlete might be sabotaging physical activity with 600-calorie snacks.

The good news: As kids grow older and taller, "they can grow into a healthier weight," Perrin says. And "we know that parents with an accurate assessment of their child's weight are more likely to make weight-related changes."

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Online:

Journal: http://archpedi.ama-assn.org/

BMI charts: www.eatsmartmovemorenc.com

47 Comments

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  • HowManyOunces Dec 16, 2011

    My oldest child was always overweight according to the growth charts. The doctor would say "cut out sugary drinks and snacks". We didn't feed him any sugary snacks and he only drank water and milk. In fact, he breastfed exclusively until he was 7 months old and continued to breastfeed until he was 14 months. When he hit 4 years old, the "extra" fat melted off. My other 2 boys have never been overweight on the charts and my husband and I are both "normal" on BMI charts.

  • IMHO05 Dec 9, 2011

    Nurse 101, I am currently in nursing school and we just discussed BMI. You are so right BMI is way outdated in my opinion. When they say the likes of Will Smith are considered obese by their BMI there is a problem. No wonder so many teenagers have a distorted image of themselves.

  • gopack10 Dec 8, 2011

    I agree the BMI is just a mean number! When I was in nursing school they were discussing the fact that BMI was fading by the wayside but I think when they figured out the money that life insurance companies, health insurance companies and physicians could bring in based of this data it became the end all be all measurement used. It does not take into consideration frame and muscle mass. I have seen many instances where a patient's BMI is in the obese range but the individual is at a healthy weight. But with that said...our children are becoming more and more overweight and less active. It is really sad and we need to be proactive to ensure that this generation can be as healthy as possible by modeling and teaching good habits.

  • Statick Dec 8, 2011

    "Ir also depends on what criteria a doctor uses. If they go only by BMI and the child has dense bones or is very muscular, they are going to be considered overweight when in reality they aren't. We were told at one time that my son was overweight by a physiatrist (physical rehab doctor) , but his pedriatrician said look at the way he is built. He is large boned, large feet, etc. She said he was fine. He still is, although he is going to be a very tall man, as he is just 13 and is 6'1" with size 14 feet!"

    The BMI is so outdated. All people aren't built the same.

  • IMHO05 Dec 8, 2011

    Thank goodness my pediatricians are very thorough and weight and body fat is discussed during my children's visits. Luckily they do not have a problem, but all parents should be aware of their child's BMI not just their height and weight.

  • bcde Dec 7, 2011

    Ir also depends on what criteria a doctor uses. If they go only by BMI and the child has dense bones or is very muscular, they are going to be considered overweight when in reality they aren't. We were told at one time that my son was overweight by a physiatrist (physical rehab doctor) , but his pedriatrician said look at the way he is built. He is large boned, large feet, etc. She said he was fine. He still is, although he is going to be a very tall man, as he is just 13 and is 6'1" with size 14 feet!

    A large part of the problem now with true childhood obesity is that kids don't go outside and play like they did when I was a child. It either isn't safe to just send the kids out to play or they are inside playing video games. Kids do need to play more outside, and if they did so, I think of lot of the obesity problems would subside.

  • question_why Dec 7, 2011

    I think the size of the clothes they purchase for the kids should be a pretty good indication. A doctor shouldn't have to state the obvious and a lot of people would probably not have a nice response to the doctors concerns.

  • OGE Dec 7, 2011

    Considering how parents always feel their children are angels in school and are blind to their action or non-action. It's not much of a stretch to believe they would blank out the conversation where their Johnny or Susie are obese.

  • baracus Dec 7, 2011

    "BINGO. Fat kids can only go to thin physicians for parents to listen? Parents are often the problem, ask any medical professional who treats kids."

    Well, not too thin otherwise they will be sitting on their skinny pedestals in judgment of our fat kids.

  • Viewer Dec 7, 2011

    I was outraged! If I'm going to hear that I or my daughters need to lose weight - it doesn't need to come from someone more overweight than me! AWakeMom

    BINGO. Fat kids can only go to thin physicians for parents to listen? Parents are often the problem, ask any medical professional who treats kids.

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