WASHINGTON - Pediatricians are supposed to track if youngsters are putting on too many pounds - but a new study found that less than a quarter of parents of overweight children recall the doctor ever saying there was a problem.
Does that mean doctors aren’t screening enough children, or aren’t frank enough in these tough conversations? Or is the real story parent denial? The research published yesterday can’t tell, but makes it clear that the message too often isn’t getting through.
“It’s tricky to say, and it’s tricky to hear,’’ said lead researcher Dr. Eliana Perrin of the University of North Carolina. She analyzed government health surveys that included nearly 5,000 parents of overweight children from 1999 to 2008.
Parents tend not to realize when a weight problem is creeping up on their children. When almost a third of US children are at least overweight, and about 17 percent are obese, it is harder to notice that there is anything unusual about their own families. Plus, children change as they grow older.
The new study suggests that when parents do recall a doctor noting the problem, it has been going on for a while. The report was published by the journal Archives of Pediatrics & Adolescent Medicine.
About 30 percent of the parents of overweight 12- to 15-year-olds said a doctor had alerted them, compared with 12 percent of the parents of overweight preschoolers. Even among the parents of very obese children, only 58 percent recalled a doctor discussing it, according to the report.
“Many pediatricians don’t worry until children are very overweight, or until they’re much older,’’ says Perrin, whose team has created stoplight-colored growth charts to help doctors explain when a problem is brewing. “If we can notice a concerning trend early, we’re more likely to be able to do something about it.’’
That means taking a family approach, says Dr. Nazrat Mirza, medical director of an obesity clinic at Children’s National Medical Center in Washington. Important changes, such as switching to low-fat milk and water instead of sugary sodas and juice, or cutting back on fast food, should be viewed as making the whole family healthier, not depriving everyone because Johnny needs to lose weight.
“You do not want to single out one individual in the family. That’s enough to cause a lot of friction,’’ said Mirza, who wasn’t involved with the new study.
Doctors have long tracked children’s height and weight during yearly checkups, but more recent guidelines urge them to calculate a youngster’s body mass index, or BMI, to screen for developing obesity. Unlike with adults, one measurement alone doesn’t necessarily mean children are overweight - they might be about to grow an inch.
The next step is plotting that BMI on a growth chart. Youngsters are considered overweight if their BMIs track in the 85th to 95th percentile for children their same age and gender, a range that just a few years ago was termed merely “at risk.’’ Above the 95th percentile is considered obese.
To tackle lack of awareness, Children’s National has begun calculating BMIs for every child age 2 or older who is admitted for any reason. Mirza calls it “a teachable moment.’’