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% 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% 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.”
Next page: What parents can do