Few parents recall doctor saying child overweight

LAURAN NEERGAARD

AP Med­ical Writer

WASHINGTON — 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.

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.

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.”

Posted by AP News on Dec 5 2011. You can follow any responses to this entry through the RSS Feed. Comments can be made below.