A reader writes:
I am an emergency room pediatrician, and your post about reluctance to tell a patient he or she is fat struck home. Overweight and obese children, aside from the well-publicized risks of diabetes, hypertension, and heart disease later in life, are at increased risk for things like injury (because when they fall their weight makes them more likely to be seriously hurt) and delayed diagnosis of appendicitis (because it is much harder to rely on an exam of an obese child, and radiology exams like ultrasound are much less reliable in overweight children.) The same mind-set that says “every kid deserves a trophy” is at work here. Doctors, and perhaps more so parents, are so afraid of harming a child’s self confidence that we refrain from telling the truth.
In addition, remember, most of us work in practices where we are judged on “patient satisfaction,” meaning we have to avoid saying or doing things that might upset parents. I have been cursed at by parents for even suggesting that weight loss might improve there child’s health.
Along the same lines, I’ve had parents walk out of the emergency room when I told them that the biggest risk to their asthmatic child’s health was the parent’s smoking. In some states, mentioning gun safety and risk (gunshot wound being the most likely cause of death after a car accident for most of the pediatric population) can land you in jail. Under Obamacare, hospitals and physicians can be docked pay if their patients aren’t satisfied enough.
Society has come to a place where hard truths are the last thing many want to hear. Most physicians, most of the time, would rather not buck that trend.
Your post struck such a chord for me. I’m the father of two young-adult daughters who are morbidly obese. They were above-average on the height/weight charts pretty much from birth, and compulsive overeating runs through both sides of our family. Our pediatrician was a wonderful person, yet it was clear that she had no training in or comfort level with addictive eating disorders as they relate to children. This is somewhat understandable since research on the psycho/bio-chemical triggers for overeating is still pretty new. But even when we quizzed our pediatrician about the issue and urged her to look into it more, she found that there just isn’t much info out there that will give doctors the comfort level they want before broaching such a volatile subject.
I feel like my wife and I failed our daughters. We couldn’t figure out how to balance being too restrictive with being supportive. We talked with both our daughters about it a lot and made them aware of the issues. But both daughters are morbidly overweight.
Yes; personal choices by the parents and the child matter in childhood obesity, but there are built-in societal causes (high-fructose corn syrup anyone?) and hereditary factors (addiction) that drive these negative outcomes for those with the predisposition. I only hope that pediatric practice will continue to improve its knowledge of this subject so that effective and compassionate interventions can someday become the norm.