June 15, 2007

Childhood Obesity: Is Honesty the Best Policy?

So yet another strange headline caught Crabby's attention the other day: "Expert panel says to call kids obese.'"

Really? It seemed odd advice, even from Experts. Crabby should just walk up to an extremely overweight child and say "Hey kid, you're obese?"

Well, no. This was more about changing the language in the guidelines the Center for Disease Control uses in defining childhood obesity. The Experts aren't really recommending we walk up to kids and start calling them names.

(Actually, you may want to take a look at the article itself, because with her tiny Crab brain, it was hard for Crabby to understand what they meant by all this. She wasn't entirely clear on who the experts were, what the guidelines do, and how this would impact actual doctor/patient/family conversations). But apparently the guidelines "refer to children many would consider too fat as being 'at risk for overweight,' and use 'overweight' for those others would consider obese."

This sounds like a difficult issue for pediatricians, and Crabby doesn't envy them the alternatives: spare the family's feelings and the kid's self esteem by normalizing excessive weight gain? Or be more blunt and possibly alienate the family and make the fat kid feel like crap?

And what if it's one of those families where there's a strong genetic component to the obesity? How do you handle the issue if the family feels they're already doing what they can to encourage healthy eating?

Crabby has no kids herself, and she's never had to deal with the social stigma or the health risks of obesity. She's all questions here, not answers.

What do you folks think about this? Should pediatricians be more honest with kids and families about obesity?

UPDATE: This is one of those posts where all the insightful observations and great suggestions are happening down in the Comments section. If you don't usually click on the Comments to these posts, today is a good day to find out what goes on down there! Crabby is off for a bit this afternoon, but she shall return later to see what other sensible and/or brilliant things you folks have written. She's way impressed so far.


  1. On one hand, I think avoiding the term "obese" for kids is silly at best and misleading at worst, since the usage seems to be contrary to what we're all used to as adults.

    On the other hand, kids are still growing, and what with height spurts and puberty and everything, it doesn't necessarily follow that a kid who seems to be packing a few "extra" pounds is actually overweight. So, leeway needs to be given, and I suspect that's why they don't call kids "obese" currently.

    But back on the first hand again, the number of kids who clearly do weigh too much and aren't just gearing up for a spurt is going up, and pussy-footing around that doesn't help anyone. Shaming the kids doesn't help either, of course.

    In a perfect world, I'd deal with this by nuking all the McD's, giving kids healthy food for lunch, and totally restructuring PE programs so that they (a) exist and (b) actually result in all of the kids being more active and enjoying it, instead of just being a 45 minute torture ritual for the fat kids. (OMFG I hated gym, and to this day I can't stand team sports. I could go on and on, but I've already gone on enough for one comment.)

  2. if you have a smart pediatrician, he/she would tailor their advice based on the situation. Obesity has such a negative connotation, that i think if someone were to diagnose the patient so bluntly, they should probably spin it into "it's so easy to fix, and it doesn't reflect badly on your character. it is just a symptom of ignorance, or a higher disease, and we will treat it as such." Maybe saying "you didn't have a chance to be healthy before, but now you do" might help?

  3. I think that they need to be more honest with parents. The parent is at fault. It is a family problem, not the individual kids problem.
    Too often, I have seen people tell their kids they are fat and make them feel bad and then do nothing but, expect the child to do it. It makes me mad.

    Telling a parent their kid is obese is important but, give them GOOD tools to help them fix it.They are probably over weight or obese themselves.

  4. Where to begin? We've messed up the meanings of these words to begin with so calling a child "obese" can mean anything from dangerously fat to being up a few pounds.

    That said, tell the truth to the child and give the parents what for while you're at it. Saying "at risk" can give a false sense to parents that there is no problem even when there clearly is.

    I'm with Chicken Girl. Obliterate fast food. Further, give us real food in the stores and teach everyone how to prepare it. Have you tried to find ingredients for scratch cooking? Bit of a hunt.

    And I'm with Chicken Girl again on the phys. ed front. Punt team sports where the kids pick the teams and let them run around and play or exercise like they want.

    Oh, and de-emphasize the painfully skinny look while we're at it.
    Kids too fat, grown-ups too thin.

    Okay, I've gone on a bit too much but really. Let's get good, proper real information about weight, couple it with real, healthy food, and learn to take care of ourselves.

  5. I think the real problem of so many overweight children needs to have several real solutions. In the past there were many individual reasons for childhood obesity, some of which include childhood depression, poverty and trauma due to sexual assault.

    But today we have wide-ranging social problems which include fear of letting kids play outside (predator fear), the computer age (jobs and recreation both) and the age of labor-saving devices. Children couldn't pack on the pounds before this generation. Now it's a miracle if they don't.

    By the way, Crabby, I've tagged you for a Recycle meme!

  6. Having been a fat kid myself, I think there can be lots of reasons why a kid is overweight. I was always on the high end of the weight and height charts, and I spent most afternoons and weekends running around with my friends. I will say that we probably could have eaten healthier as a family.

    I really started going from "big-boned" to just plain "fat" when I was about 9 years old and really depressed for the first time. I remember wearing size 11 shorts.

    Luckily, puberty did a great deal to put be back on the normal side.

  7. I think you should all go take a hike. Literally. And I'll go with you. Let's bring the kids along, too. It strikes me as curious that today, when environmental concerns are FINALLY leading to productive actions, we seem to be more and more divorced from the natural world. Yes, computer addiction and all of our technological gadgets are a main factor. One day, no one will ever have to leave their home -- we'll be telecommuting to work, having video chats with our friends, and turning on a switch for on-call entertainment.

    There's an old Ray Bradbury story set in the near future in which a man goes for an evening stroll through his neighborhood. He enjoys the night air, the sound of the breeze in the foliage, and his own thoughts. He meets no one else, but passes by houses all with flickering lights in the windows from TV sets. Finally, a police cruiser stops and he's arrested as a suspicious person. It's a prescient story.

    My point (and I do have one): kids need to be introduced to nature early. Get out of the city, get out of the tamed environment of the suburbs, and take a walk in the woods or along the shore or hike up a mountain. Or explore a city park. Or hell, just jog around the block. Grow some windowsill herbs or keep a fish tank. That might go a long way to instilling an appreciation for the natural world and a lifelong desire to visit the great outdoors -- and a stronger will to channel tax dollars to maintenance of our deteriorating national parks.

    As for this terminology flap, we might make some progress if we could just say "fat" without freaking out. Let's remove the shame from the concept of obesity and tackle its resolution in a frank, straightforward manner, without imposing an emotional burden. The best-adjusted fat people I know have no problem referring to themselves as fat. Of course, they don't seem to be getting slimmer. It's undoubtedly healthier not to be fat, but it's possible for fat people to maximize their health when they make the effort.

    Would it cloud the issue if we destigmatized the word "fat"? Would that make it "okay" to be fat? I doubt it. We'll continue to swing on that schizophrenic pendulum typified by our love-hate of anorexically thin fashion models and fear of fat.

  8. I'm a blunt person and all for calling a cat a cat. Now, I'd rather be of the mind to use the 'obese' words with the parents, rather than the kids themselves. There's no need to shoot down a child's self-esteem even more with blunt words; on the other hand, since the parents are the first providers of food (or pocket money to stealth-buy food--I'm sure a lot of us have done that when they were in their teens >.<), a doctor should shoot down the potential sense of denial about " that's only baby fat" and "s/he'll soon grow up more and it'll be all gone".

    And there should be clear guidelines of what to do, too. Not every parent has all the keys in hand to properly feed a family (i.e. I figure out that if there are some of us who didn't and had to learn all that stuff through WW, the web, etc., parents or not, then others human beings may need such advice too!). I remember a friend of mine, when we were teenagers, who was put on the infamous 'Mayo diet' by her mother. How is that healthy and useful for a child/teenager to lose weight?

    Of course, this implies that the child is really overweight or obese. No need to fret out over an adolescent not perfectly corresponding to the awfully thin criteria in the media. *rolls her eyes*

  9. As one who was an obese/overweight child, I believe the whole labeling issue is irrelevant. You don't need to tell a fat kid, he/she is fat. All the other kids do that enough.

    You don't need to tell a kid to exercise, you need to invite the kid to have some fun, like playing frisbee, riding bikes, or rollerblading. Kids should play, not exercise.

    You should not tell a kid to diet. Parents need to cook healthy foods, empty the house of junk food, and make things the kids will enjoy like sugar free Jello.

    Parents need to be parents. Don't stigmatize the kid for his/her weight. Instead, treat the problem. Playtime, healthy mealtime, healthy snack time. Even if the kid whines and complains, cries and screams, be the parent!!!! The parent needs to grow up and be adults. It's no coincidence that many obese children have obese parents.

  10. Just found your blog from strollerderby (http://babble.com/CS/blogs/strollerderby/archive/2007/06/15/strollerderby-playdate-attack-of-the-fitness-blogs-part-deux.aspx) and have loved reading back a few days! you crack me up.

    Anyway, maybe times have changed significantly, but when I was a kid, I *knew* I was fat. My dr's never addressed it, but I didn't need a label to take it seriously. What I could have used was an in-depth discussion about what was causing me to overeat and how it was affecting my life. Too often, my well-meaning parents signed me up for some fitness program or diet plan without addressing the root causes of the problem. Dr's, parents, counselors etc. can't be afraid to face the issue, or the child will be too!

    I second (or 10th whatever) all the suggestions here - we have both an individual responsibility as parents and a larger community responsibility to foster health and activity in our children.

    On a related note, I was truly shocked when I recently plugged my #s into a BMI calc, and found out I was again labeled "obese" - 30.9. Granted, I have a 5-month old, so I'm not at my slimmest, but no WAY am I that far off the chart. Since then, I lost 5 lbs, am at the upper end of "overweight." These labels are truly made by the insurance companies.

  11. Kate: I think part of the problem with the word "obese" is that nobody can seem to decide whether it means "grossly, hideously fat" or just "truly, honestly fat" (as opposed to "could stand to lose five pounds, maybe").

    BMI 30 is clearly the latter, but when people talk about "obesity", they frequently mean the former. And then when those people bring BMI into the discussion and start lumping both of them together and howling about how 1/3 of the population is OBESE OMGOMGOMG, shit starts to really get weird.

  12. I don't have children so won't give advice to parents but it does seem to me that children who are overweight will already be painfully aware of that. They don't need anyone to tell them.

    Get rid of the fast foods and bring back family dinner times. And I know the situation is way more complex than that, but that's what I think.

  13. I don't think a word will change it. Fat. Obese. Large. When you're overweight you *know* you are...I was lumpy growing up, and didn't lose weight until I became an adult and learned how to eat better and exercise. I think obese should be reserved for when you are so, and keep the overweight terms there as well. While I was overweight I was never obese, and I don't know if calling me so would've helped or hurt me.
    Without some sort of guidance in how to be healthy, kids don't know where to begin - I mean I wonder where I'd be if I hadn't worked it out for myself. My parents never really took the time to teach me the hows and WHYs of being healthy. They'd comment on weight (my Mom is a nurse), but never led by example, so I didn't know how to eat smaller portions and live an active life until I just figured it out on my own as an adult. I just got told what diets were and that I needed one. Both my parents worked a lot and I had to feed my self more often than not...not a good way to learn healthy eating.

    There needs to be a way to teach kids how to be better...and to now have crappy food everywhere tempting them. Having healthy food, a family that went outside and didn't watch TV or play video games all evening combined with actual PE programs would be good too...it would've helped me to be outside doing things and eating healthy food. It's somethign that shockingly few kids get very often...it's sad.

  14. A doctor should tell the parents that their kid is obese. There it is. No beating around bushes. Then docs should break it down. Diabetes. Heart disease. Cancer. High blood pressure.

    If a kid is obese it is the parents' fault. Too much food freedom. Don't allow crap food into the house. Instead of docs prescribing this med or that med or surgery for obesity or it's related complications, prescribe healthy, clean food, which is the best medicine. Sports activities. Not too much TV or 'net time. The parents most likely are obese themselves. Docs should point out that kids live as their parents.

    Of course it would also help if McD's, Hardees, Burger King, ... would all self destruct.

  15. I'm with those who are pointing out that fat kids know they're fat. And their parents know it, too.

    It's better to stay in the solution. Work on educating the parents. Help them understand the difference between baby fat and potentially dangerous fat. Teach them ways to be healthier as a family.

    At the same time, everyone needs to understand that it's better to be big but healthy and strong, than skinny but flabby and unhealthy. Being thin isn't evidence of good health, any more than being big is evidence of poor habits. I've seen some pretty hefty marathoners cross the finish line, and unlike some skinny supermodels, they're alive!

    We're not all supposed to look the same. Be healthy, and the rest will fall into place. This is what should be taught, not big=bad and skinny=good.

  16. Wow.

    I sneak off for half a day and return to find so many great comments! I really feel like I learn so much from you guys. Each one of these is a great educational opinion piece that should be published somewhere; I don't how I got so lucky to have you all down here.

    Rather than try to go comment by comment and say something lame in appreciation for each one, I'm just going to have let them speak for themselves. There are an overwhelming number of good points and nuanced observations.

    (You should also know that readership at Cranky Fitness is creeping up, thanks to you all, and so hundreds of people each day are reading your words. You all deserve more like thousands and thousands though, so Crabby will keep working on that).

    Thanks so much everyone, and keep 'em coming!

  17. I'm tired and was going to comment. But Half Man said what I think perfectly. So, I'll just say, good job Half Man and "I was here" like Kilroy and leave it at that.

  18. I was a fat kid, and I agree that no one needs to tell these kids they're fat. Their charming little friends will take care of that. But a kid -- who has very little power in our society -- can't take care of this problem on her own. If one kid in the family is fat, the parents and other kids are probably either fat or otherwise unhealthy, and there may well be emotional dynamics at work that are triggering the fat kid's overeating.

    I would suggest that the doctors in these cases refer the families for short-term family therapy centered around health goals. A good therapist may be able to get at some of the emotional issues and find out what's going on that the parents aren't talking about. For instance, is the kid home alone all afternoon with nothing to do but eat? Is there an abuse issue?

  19. There were such great comments on this post; sorry I didn't have time to respond individually. In addition to all the wonderful "regulars," it was great to meet some cool new folks!

    Welcome musical mushroom, julia, lisa, kate, and jane! You all had such great things to say & usually I'm not quite such a slacker.

  20. I'm new to this blog and wow! did this issue catch my attention. As a formally morbidly obese woman this hits home. Like many girls, I began to gain weight around puberty. My parents were concerned, and spoke with my doctor who told them not to worry. He told them, peer pressure would take off the weight. Well, peer pressure ruined my self-esteem, but surprise, surprise, it did not take off the weight.

    I topped out at 264 lbs at the age of 29, a miserably unhappy, unhealthy woman, completely out-of-control. I attribute my weight struggles to genetics, low self-esteem, poor eating habits and an unrealistic view of self. Like many, the heavier I became, the more unahppy I was, so the more I ate. Also, the heavier I became, the more difficult it was to excercise, or be active. So, more withdrawn from social situations. More depression, more food, less excercise, health concerns due to weight... And on and on. A horrible downward spiral.

    As a special education teacher and child advocate, I work with children who are emotionally distrubed and are medically fragile. Weight is a key issue! No professional who interacts with children can ignore obesity. It is a legitimate health concern, and a quality of life issue. We must do all we can to support and enable children to learn healthy habits and address underlying medical concerns BEFORE they become obese adults with long term health problems and unmanageable life styles.

    On a personal note, I am now down to 148 lbs, but I did not do it alone! And, though on a logical level (and according to my doctor) I know that I am no longer obese, I think it will take me years to internalize that. I still think I'm fat. Living in NY doesn't help, where it seems like everyone is a size 4.

  21. Thanks Ellie,
    Wow, you make some great points and your story is so inspiring!

    Interesting that you still think of yourself as fat... but NYC, you're right, is not exactly representative of average body size.

    Thanks so much for stopping by!

  22. At a basic level, it seems that good habits are easier to keep if we enjoy them and find them fulfilling. As adults, we know how hard it is to maintain a workout and healthy eating schedule if we're only doing activities and eating foods we think we should, but not that we enjoy. It seems like it should be similar for kids. Find the one(s) that they enjoy. When I become a parent, I'll test this out and see if it makes sense!

    Appleton might be interested: I recently stumbled upon a book by Richard Louv called "Last Child in the Woods: Saving Our Children from Nature Deficit-Disorder". I haven't read it yet, so I can't comment on his theories, but the premise sounds pretty valid even from a non-clinical, common-sense point of view.

  23. Hi norabarnacle,
    Thanks! And the book sounds like something Appleton might well be interested in--I'll try to catch his attention the next time he stops in.

  24. Wow, I just found this post, and I just HAD to add my 2 cents. I'm 21, so it hasn't been that long since I was in school. I was (and still am) clinically obese. Everytime I went to my doctor it was the same thing... you need to eat lean meats, veggies, exercise, blah blah blah... I never heard a word he said, seriously. And my mom turned into such a, "ohmigod we need to only eat low fat foods" health-nut that I just didn't care. Rebellion, maybe? I dunno exactly. When I did finally get my act together and lost 50+ pounds, it was because I had a HUUUGE support system. I worked out 7+ times per week, some with my mom, gym with a friend, gym class at school, after school workouts with NJROTC... it was endless. (before that point I NEVER worked out) Plus... I did a lower carb-higher protein diet. (notice I said lower.. not totally restricted. Moderation in everything is fine) Anyway, if everyone around you is eating cheeseburgers and sipping on milkshakes, you're going to do it too.

    Which leads me to my rant. SCHOOL CAFETERIAS! Oh, my, goodness. If I could pick a place that had less nutritional value than McDonalds, it would DEFINITELY be a high school cafeteria. Some of the healthiest selections included a cheeseburger, oven fries, or maybe some chicken fingers complete with fried breading. Why is no one concerned with the total lack of healthy options in school cafeterias? This is what children are eating 5 days per week!! It's a HUGE part of their diet, but the parent's don't see it, so it's out of mind. Oh, and the soda machines in the schools? The one at my school wouldn't allow you to buy soda during the school day, but you could get plenty of sugar-filled juices. Pass me a water, please.

  25. Jessica,
    That's a great point about the school cafeterias. I think in some places (like where I live) they're finally starting to take a look at it, but other places it's still impossible to get anything remotely healthy. How screwed up is that!


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