Doctors reluctant to tell parents their child is overweight

The author of a new study suggests starting the conversation with sensitive language and color-coded charts.

By Christine S. Moyer — Posted Dec. 19, 2011

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Early intervention by physicians can reduce overweight children's risk of developing serious health conditions, such as cardiovascular disease and diabetes, later in life. Yet only 22% of parents whose child has a high body mass index said a health professional told them their child was overweight, according to a study published online Dec. 5 in Archives of Pediatrics & Adolescent Medicine.

Lead study author Eliana M. Perrin, MD, MPH, was surprised by the finding, because it comes as the medical community and legislators are pushing to resolve the nation's child obesity epidemic.

"As health care providers, it's our job to screen for overweight and obesity, and communicate those screening results in sensitive ways," said Dr. Perrin, associate professor in the Division of General Pediatrics and Adolescent Medicine in the Dept. of Pediatrics at the University of North Carolina at Chapel Hill School of Medicine. "And we are clearly either not doing it or not doing it in a way that families can hear or remember."

She encourages physicians to use sensitive language when talking to parents about a child's weight. She recommends the terms "overweight" and "unhealthy weight" rather than "fat" or "obese."

Parents consider the terms "weight" and "unhealthy weight" the most desirable words to describe youths' excess body weight, said a Sept. 26 Pediatrics study that surveyed 445 parents. Respondents rated the terms "fat," "obese" and "extremely obese" as the most undesirable words and the least motivating.

Color-coding BMI charts is helpful so a child's unhealthy weight is more clear, said Dr. Perrin, a pediatrician at North Carolina Children's Hospital in Chapel Hill. For example, the hospital where she works uses red to denote a BMI above the 95th percentile. Yellow is for levels between the 85th and 95th percentiles, and green signifies a BMI between the fifth and 85th percentiles.

About 17% of U.S. children and adolescents age 2 to 19 (12.5 million) are obese, according to the Centers for Disease Control and Prevention. Since 1980, the prevalence of obesity in this age group has nearly tripled.

Researchers in the Archives study examined data on children 2 to 15 who participated in the National Health and Nutrition Examination Survey from 1999 to 2008. Participants had a BMI at or above the 85th percentile for their age and gender.

Overweight children were described as having a BMI between the 85th and 95th percentiles. Obese was defined as a BMI between the 95th and 99th percentiles, and the severely obese had levels at or above the 99th percentile.

Most parents were asked if a doctor or other health professional ever told them their child was overweight. A slightly different question was posed to parents of children 12 to 15 from 1999 to 2004: Has a doctor or other health professional ever told your child that he or she was overweight?

Weight discussions are important

Researchers found that the percentage of parents who were told their child was overweight increased from 19% in 1999 to 29% in 2007-08. But among parents of severely obese children, only 58% recall a physician telling them their child was overweight.

The higher a patient's BMI, the more likely a parent was told about the child's unhealthy weight. Such discussions also were more common with parents of older children and Hispanic children.

"These conversations might be difficult for physicians to have with parents, but they're worthwhile and important, and they usually go better" than doctors expect, Dr. Perrin said.

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Parents not told their child is overweight

From 1999 through 2008, an average of only 22% of parents whose child has a high body mass index said a health professional told them their child was overweight. But the percentage of parents who reported being told that their child had a weight problem varied depending on the level of obesity.

Year Very obese Obese Overweight All
1999-2000 46% 28% 6% 19%
2001-02 52% 26% 6% 20%
2003-04 63% 30% 9% 23%
2005-06 55% 26% 6% 20%
2007-08 69% 31% 16% 29%

Source: "Parental Recall of Doctor Communication of Weight Status," Archives of Pediatrics & Adolescent Medicine, Dec. 5 (link)

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External links

"Parental Recall of Doctor Communication of Weight Status," Archives of Pediatrics & Adolescent Medicine, Dec. 5 (link)

Centers for Disease Control and Prevention's overweight and obesity page (link)

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