Expert panel gives very heavy children a new label -- obese

Children whose size puts them at or above the 95th percentile on the pediatric growth charts or who have a body mass index higher than 30 should be classified by physicians as obese. Those who are between the 85th and 95th percentile should be considered overweight, say recommendations from the Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity released June 6.

"The rest of the world uses that terminology already," said Reginald Washington, MD, panel spokesman and medical director of Rocky Mountain Pediatric Cardiology in Denver. "It's not necessary to address the child or family in these terms, but as far as medical terms, a child above the 95th percentile is obese."

The committee was first convened in 2005 by the American Medical Association, the Health Resources and Service Administration and the Centers for Disease Control and Prevention, to figure out solutions for the growing number of children who are severely overweight. It included representatives from 15 medical societies such as the American Academy of Pediatrics and the National Medical Assn.

"Childhood obesity is a major public health problem," said Cecil B. Wilson, MD, outgoing chair of the AMA Board of Trustees. "The Expert Committee studied this issue intently, and we thank them for their hard work and recommendations."

Previously, the word "obese" was avoided with regard to children because of concerns about stigma. Those whose size categorized them higher than the 95th percentile were referred to as overweight while those between the 85th and 95th percentile were referred to as "at risk for overweight."

Since the release of this document, Dr. Washington has received numerous abusive e-mails, but many physicians praised the linguistic shift. The authors' intent is for medical personnel to use it as a diagnosis with family members in an appropriate and culturally sensitive way to make it more likely that a child's excess poundage will be treated as a serious chronic disease. Some physicians said it would aid their attempts to help children lose weight.

"I'm in favor of it. I think you have to be honest with people," said Michael Wasserman, MD, a general pediatrician at Ochsner Health System in New Orleans. "You have to alert parents that their child has a significant health problem now and significant health risks in the future."

The panel also recommended that all children receive at least an annual assessment of their weight, dietary habits and physical activity levels. Problematic issues such as frequent restaurant dining, the drinking of large amounts of sugar-sweetened drinks and excessive time screen viewing should be addressed. Children who are overweight should have their blood pressure, pulse and lipids measured. Those who are obese should also have their liver and kidney functions tested.

Using the recommendations

Physicians who treat children said it was possible to integrate much of this advice into their practices, and some of it already was a part of the repertoire. The laboratory values also could be used to reinforce further the idea that a child's excess weight is causing damage.

"These are regularly part of my ammunition to convince parents to improve their behaviors," said James Cunnar, MD, a family physician in Naperville, Ill.

But physicians said that although assessment might fit into practice, getting families to carry out recommendations that could lead to a child slimming down is not easy. Parents might not have the time to provide home-cooked meals, and some live in areas not conducive to healthy eating or levels of physical activity.

"In certain communities, nutritional food choices are not as readily available, or there may not be safe parks or community centers," said Winston Price, MD, who represented the National Medical Assn. on the panel and is a pediatrician in Brooklyn, N.Y.

These recommendations were published on the AMA Web site, and publication of four papers more fully outlining how to implement them is expected in a scientific journal within a year.