Are parents and pediatricians turning a blind eye to their kids’ weight gain?

By Dr. Ananya Mandal, MDDec 7 2011

Childhood obesity is fast becoming a major problem in the United States. However a new study shows that parents, pediatricians and even nursery schools or kindergartens have not really paid the attention the problem needs.

The study showed that parents of heavy kids could not recall anyone mentioning their kid's overweight problem. This occurred in more than three quarters of the population studied. And though the study couldn't specifically identify the reason why, it did indicate that there was little if any solid, persistent and forceful communication to them about their kids' weight issues.

According to lead researcher, Dr. Eliana Perrin of the University of North Carolina, who analyzed government health surveys of nearly 5,000 parents of heavy kids from 1999 to 2008 surmised that parents neither acknowledge nor notice when their kid is gaining weight.

The study also noted that though doctors did inform them, oftentimes, the damage had been done. The numbers are abysmally low for the population surveyed: doctors didn't discuss the problem with 88 % of overweight preschoolers' parents and 70% of overweight teens' parents. And even among very obese children, only 58 percent of the parents remembered a doctor talking to them about their kids' weight, as reported by the Journal Archives of Pediatrics and Adolescent Medicine, on Monday.

“Many pediatricians don't worry until children are very overweight, or until they're much older. If we can notice a concerning trend early, we're more likely to be able to do something about it,” said Perrin who has created charts to help doctors.

Doctors have 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.

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.

Dr. Nazrat Mirza, medical director of an obesity clinic at Children's National Medical Center in Washington confirmed that families must revamp old food selection habits, switching to low-fat milk. And instead of having sugary sodas and juice in the fridge, they should just buy bottled water. Snacking food habits must be eliminated.

Enforced weight loss is one of the worst ways to approach changing familial eating routines. “You do not want to single out one individual in the family. That's enough to cause a lot of friction,” said Mirza.

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 is that 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.”