Experts Debate Labeling Children Obese
Yes you need to control your kids eating. Or they will be popping pills at a early age. Being fat is not cute. That why my fat butt is going to get in shape.
CHICAGO (July 3) - 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.
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
Those favoring a change say the current terms encourage
denial of a problem affecting increasing numbers of U.S. youngsters.
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
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.
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
The debate illustrates just how touchy the nation is about its
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
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,
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.
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."
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."