Is it OK for doctors to tell kids they're fat?

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Avoiding negative connotations
Many pediatricians understand the first category to mean “overweight” and the second one to mean “obese,” said the CDC’s Dr. William Dietz. He said the word “obese” was purposely avoided because of negative connotations but conceded that many pediatricians find the current language confusing.

Adding to the confusion is the fact that about 17 percent of U.S. children are in the highest category, and that almost 34 percent are in the second-highest category. That sounds like a mathematical impossibility, but it’s because the percentiles are based on growth charts from the 1960s and 1970s, when far fewer kids were too fat.

In children, determining excess weight is tricky, partly because of rapid growth — especially in adolescence — that can sometimes temporarily result in a high body-mass index.

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For children in at least the 95th percentile, high BMI “is almost invariably excess fat,” Dietz said. But there’s less certainty about those in the second-highest category. So to avoid mislabeling and “traumatizing” kids, the CDC chose to be diplomatic, Dietz said.

The committee, set up by the American Medical Association, involves obesity experts from 14 professional organizations including the American Academy of Pediatrics. Their mission is to update recommendations for prevention, diagnosis and management of obesity in children.

Final recommendations are expected in September, and the participating groups will decide individually whether to adopt them.

Dr. Ronald Davis, the AMA’s president-elect, said it’s unclear whether the expert committee can develop a consensus on the obesity terms.

“There are seemingly legitimate arguments on both sides,” said Davis, a preventive medicine specialist with Henry Ford Health System in Detroit.

Maria Bailey of Pompano Beach, Fla., whose 12-year-old daughter, Madison, is self-consciously overweight, opposes the proposed change. She said their pediatrician has told her daughter to exercise more and see a nutritionist, but “hasn’t told her that she’s in a (weight) category.”

“We’re already raising a generation of teenagers who have eating disorders,” Bailey said. “I think it would just perpetuate that.”

Getting around the 'o-word'
Paola Fernandez Rana of Fort Lauderdale, Fla., has a 9-year old daughter who at 40 pounds overweight is considered obese. Rana said doctors “refer to it as the 'o-word’ “ in front of her daughter “in an effort not to upset her.”

“They very clearly told me she was obese,” Rana said. But she said she agreed with the term and thinks that at some point it should be used with her daughter, too.

“Obviously I don’t want my daughter to be overweight, but ... in order to change the situation, she is ultimately going to need to hear it,” Rana said.

Dr. Michael Wasserman, a pediatrician with the Ochsner Clinic in Metairie, La., agreed. Using the term “at risk for overweight” is misleading, creating the perception “that I’m only at risk for it now, so I don’t have to deal with it now,” said Wasserman, who is not on the committee.

“There’s a tremendous amount of denial by parents and children,” he said.

Chicago pediatrician Rebecca Unger, also not a committee member, said she likes using the term “at risk for overweight” because it gives patients hope that “we can do something about it.”

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