Desani Marshall was never really overweight, but she was always a
little big for her age. During a checkup at age 4, her doctor pointed
out to her mother that Desani was gaining weight more rapidly than he
thought was normal. Six months later, she was still putting on pounds at
a rapid pace -- a strong predictor of future obesity.
"I didn't
take it seriously; I didn't think it was that bad," says Desani's
mother, Caryl Marshall, of New York City. "But then he showed me the
growth chart. At the rate she was gaining, what really made me take it
more seriously was what the future could be."
Now 7, Desani is
gaining weight at a normal pace, thanks in part to dietary changes, such
as cutting out soda, that Marshall has implemented. "Everybody would
look at her and say, 'She's so skinny. Why?'" Marshall says of her
daughter's regimen.
In some ways, Desani's success story is an
exception. Across the country, childhood obesity has only gotten worse.
More than 20 years after it was first described as an epidemic, 17
percent of American children and adolescents are obese, triple the rate
in 1980, and nearly one-third are overweight, according to the latest
government data.
Alarming statistics such as these have prompted
government agencies, schools, and nonprofit organizations to launch a
barrage of anti-obesity programs in recent years.
Their
sense of urgency is not shared by all parents, however. In fact,
studies have consistently shown that parents tend to underestimate their
child's weight and the health risks associated with being too heavy.
In
a 2006 study that surveyed the parents of obese children, only one-half
recognized that their child was overweight, and less than one-third
said they were "worried" about their child's weight. In another survey,
only 38 percent of parents had taken steps, or were planning to take
them, to help their obese child lose weight.
Several
factors may be contributing to this indifference among parents, experts
say. Some parents believe their child's excess weight is just "baby
fat," for instance, and some may simply be in denial. Or it could be
that parents have concluded their kid is normal after eyeballing his or
her overweight peers.
"Because so many children are overweight
and obese ... they don't stand out as much as they would have 20 or 30
years ago," says nutritionist Elisa Zied, a registered dietitian and
spokesperson for the American Dietetic Association. "I almost see a lack
of concern with some parents."
Parents
should be concerned. Although some overweight kids do outgrow their
baby fat, roughly two out of three are likely to grow up to be obese
adults, according to a 2009 study by the U.S. Centers for Disease
Control and Prevention (CDC). Childhood obesity, moreover, is associated
with a slew of serious health problems, including diabetes, asthma,
heart disease, and depression.
How do you know if your child's
chubbiness is baby fat or a serious health problem? You can't always
tell just by looking, and you can't always count on pediatricians to
broach the subject. But you can take matters into your own hands and
adopt habits that will keep your child as healthy as possible.
You can't trust your eyes
Most
parents probably feel pretty confident that they know whether their
child is overweight or not. The research tells a different story: A
large proportion of the parents of overweight children -- and especially
mothers, who are surveyed more often -- do not perceive their children
as overweight. In some studies, the percentage of parents who don't
realize (or won't admit) that their child is overweight has been
reported to be as high as 80 percent to 90 percent.
It's not
entirely clear what accounts for this disconnect. For starters, many
parents define obesity differently than health professionals do, and
distrust the growth charts used by pediatricians.
In a focus
group discussion that was excerpted in the journal Pediatrics in 2001,
one mother of a preschooler defined an obese person as someone who "can
barely walk." Other mothers denied that their children were fat or
overweight, and instead used words like "big-boned," "chunky," and
"solid" to describe them.
Susan Carnell, Ph.D., a research fellow
and childhood obesity expert at the New York Obesity Research Center,
attributes the failure of parents to accurately assess their child's
weight to changing social norms. Not only are kids heavier than ever
before, but roughly two-thirds of adults are also overweight, and
parents who are overweight themselves are less likely to identify their
children as overweight, Carnell notes.
"We gain many of our
perceptions from comparison with peers," she says. "So if we compare a
healthy-weight child with their overweight classmates, we may even think
they are too skinny and try to feed them up."
Social values and
beliefs may also distort a parent's perception. Parents are more likely
to overestimate the weight of their daughters, for instance, perhaps
because they feel it is less acceptable for girls to be heavy.
Similarly, some studies suggest that parents of different ethnicities
and cultural backgrounds have different conceptions of body type and
overweight.
The doctor may not bring it up
If
you're waiting for your child's pediatrician to tell you that your child
is a bit heavy, don't hold your breath. In spite of the myriad health
risks associated with childhood obesity, pediatricians often fail to
screen for it during annual checkups and office visits.
In a
recently published survey of its members conducted by the American
Academy of Pediatrics (AAP), virtually every pediatrician said they
measured height and weight during checkups.
But just 52 percent
use those figures to calculate body mass index (BMI), a simple ratio of
height-to-weight that provides a rough yet useful snapshot of whether a
child is overweight for his or her age. (The CDC defines overweight as a
BMI in the 85th percentile or above, and obesity as the 95th percentile
or above.)
Even if they do feel that a child is overweight, many
pediatricians are hesitant to say so, perhaps because they think it's a
touchy subject. In the AAP survey, only 59 percent of pediatricians
said they believe that families want to discuss weight.
"I think
some doctors are reluctant to bring up weight because they are not
trained to deal with it sensitively," says Carnell. Discussing a child's
weight with parents in the wrong way -- by implying that they are to
blame, for instance -- can make parents "feel guilty and defensive," she
adds.
Doctors may also adopt a hands-off approach to weight
because they feel there's little they can do. Less than one-quarter of
the pediatricians in the AAP survey believed that there are effective
treatment strategies for overweight and obesity.
"We all have
strategies we use that can make a difference with a certain proportion
of kids," says Eugene Dinkevich, MD, the division chief of general
pediatrics at SUNY Downstate Medical School, in Brooklyn. "But it's not
like an ear infection where you can give someone an antibiotic and
they're better."
Pediatricians only set aside about 15 minutes
for a regular checkup, Dr. Dinkevich says, and they have to pick and
choose which topics to discuss with parents in that time. Doctors must
ask themselves, "What am I competent to talk about, and if I talk about
it, will it make a difference?" he says. For far too many doctors, he
adds, obesity treatment and prevention don't fall into that category.
New
guidelines for childhood obesity screening might help reassure
pediatricians. In January, the U.S. Preventive Services Task Force, an
independent panel of experts that advises the federal government on
preventive care, released new guidelines that urge doctors to routinely
calculate the BMI of children between the ages of 6 and 18. The
guidelines also say that children who qualify as obese should be
referred to various interventions, such as nutritional counseling or
physical activity programs.
"In 2005, we said you can screen
kids, but we had insufficient evidence of any effective therapy for
weight loss," says task force chairman Ned Calonge, MD, referring to the
previous guidelines. "Now we have evidence that shows you can get
modest weight loss through these intensive programs."
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