Misguided Diplomacy: Getting Past the "Fear" of Telling a Child They Are Overweight or Obese
Not long ago, Wellspring Academies, a boarding school for overweight and obese teens, received an e-mail from a parent that said:
My child has a BMI at the 92% for her height and age. While this is technically labeled as "at risk for being overweight," I am very concerned about her happiness and self-image. I am exploring many options currently and would like more information about your program. Thank you.
Why would a child with a BMI at the 92nd percentile for her height and age be called only "at risk for being overweight"?
As a preliminary matter, it's important to decide the correct terms to describe children who are at an above-normal weight.
Overweight and obesity are defined differently for children than for adults. Although definitions for both kids and adults use the Body Mass Index (BMI = your weight in kilograms divided by the square of your height in meters), there is a double standard here, and one that we think is actually contributing to the problem.
In one sense, we can't measure overweight the same way in kids as we do in adults: age needs to be taken into account because children are still growing. An 11-year-old girl who is 4'11 and 140 lbs should be viewed differently from a 50-year-old woman of the same height and weight. As a result, while the test for whether adults are overweight or obese is absolute (BMI over 25 is overweight, BMI over 30 is obese), kids need to be looked at in terms of their BMI percentile for their age and gender (to take in account differences in body fat between boys and girls). As a result, the benchmarks for kids are BMI percentage - over 95% BMI for age and gender is defined as "overweight," and 85-95% BMI is defined as "at risk of overweight."
According to this definition, there is no such thing as an obese kid. But isn't it appropriate to apply the term "obese" to the heaviest kids, in the same way we do for adults? What about the 300-pound 17-year-old boy whose doctor says is "overweight." When he turns 18, does he become "obese" without gaining one more pound?
The rest of the world is ahead of the U.S. in this regard: doctors outside the U.S. use the terms "obese" and "overweight" for kids just as they do for adults. Unfortunately, in the U.S., doctors have not been comfortable with the idea of telling kids they are obese. They see the term as judgmental and harsh and possibly leading to confrontations with upset parents. The 2002 National Health and Nutrition Examination Survey revealed that only 36.7% of overweight kids had actually been told by a doctor or other health care professional that they were overweight.
In our view, this is an example of misguided diplomacy. Kids hear much worse than "obese" in the schoolyard. Hearing from a doctor that they are obese could play an important role in establishing a foundation for change.
As is typically the case, if we're going to solve a problem, we need to start by being honest about it. As practitioners treating childhood obesity, we must be willing to use the terms "overweight" and "obese" when they apply to a child.
Dr. Daniel Kirschenbaum is the clinical director of the nation's leading weight loss programs for children and teens, Wellspring Academies, weight loss camps, and retreats. He is a licensed clinical psychologist in Illinois and California, Professor of Psychiatry & Behavioral Sciences at Northwestern University Medical School, Fellow and Diplomate in Clinical Health Psychology of the American Psychological Association and former president of its Division of Exercise and Sport Psychology.
