Who Wants To Tell A Kid He’s Fat? Ctd

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.

Another reader:

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.

Who Wants To Tell A Kid He’s Fat?

Not pediatricians, according to Russell Saunders, who admits, “I absolutely hate talking to patients about being overweight”:

Reading the results of a new study from the Centers for Disease Control (PDF), I couldn’t help but wonder if other medical providers are even more reluctant to talk about weight with their patients than I am. Using survey data collected from children ages 8-15 from 2005-2012, the study finds that roughly a third of children and adolescents misperceive their body status. Only 23 percent of overweight children knew they were heavier than was healthy, and 41 percent of obese respondents thought their weight was about right. …

When overweight children are roughly similar in appearance to many of their peers, it takes someone telling them their weight is unhealthy for them to realize it. Though the study does not report on the reasons for the rate of body status misperception among overweight children, I strongly suspect it’s that those conversations simply aren’t happening. Further, I suspect they’re not happening because they are so challenging. Trying to tell little girls and boys that their weight is too high without making them feel bad about themselves or their appearance is a daunting task. It’s relatively easy to give across-the-board recommendations about what comprises a healthy diet and getting enough physical activity. Discussing what changes a specific child might need to make to get back into a healthy weight range is trickier, and clearly isn’t happening nearly as often as it needs to be.

As important as fostering self-esteem in children is, medical providers cannot be so afraid of damaging it that they sidestep sensitive but clear conversations with patients and their parents when the child’s weight is unhealthily high.

One medical provider who doesn’t have such qualms: