Experts Urge Blunt Terms For Kids' Obesity

CHICAGO – Doctors ought to quit using fuzzy terms to define children's weight problems and instead refer to truly fat kids as overweight or obese, a committee of medical experts recommended.

Less blunt terms used by the government and many doctors diplomatically avoid the term "obese." Instead, they refer to children many would consider too fat as being "at risk for overweight," and "overweight" for those others would consider obese.

Those categories don't adequately define the hefty problem, according to the group, which was convened by the American Medical Association and funded by federal health officials including the Centers for Disease Control and Prevention.

The nonbinding recommendations are designed as guidelines for pediatricians and other medical professionals who work with children. The CDC will consider whether to adopt the recommendations; the AMA has no plans to endorse them.

Dr. Reginald Washington, a committee spokesman and member of the American Academy of Pediatrics, said Tuesday that some doctors have avoided the blunt terms for "fear that we're going to stigmatize children, we're going to take away their self-esteem, we're going to label them."

The recommended terms cut to the chase, at least medically, but don't mean that doctors should be insensitive or use the label in front of every patient, he said

"We need to describe this in medical terms, which is 'obesity.' When we talk to an individual family, we can be a little more cognizant of their feelings and more gentle, but that doesn't mean we can't discuss it," Washington said. "The evidence is clear that we need to bring it up."

About 17 percent of U.S. children are obese and one-third are overweight, using the committee's recommended definitions. Those numbers are rising, putting children at risk for diabetes, high blood pressure, cholesterol problems and other ailments more commonly found in adults.

The overweight category -- the CDC's "at risk" -- refers to children with a body-mass index between the 85th and 94th percentiles. The obese category -- the CDC's "overweight" -- is kids with a BMI in the 95th percentile or higher -- or greater than at least 95 percent of youngsters the same age and gender.

With current obesity rates, that sounds mathematically impossible, but the percentiles are based on growth charts from the 1960s and 1970s, when far fewer kids were too fat.

To some extent, the fuzzier labels let pediatricians "off the hook," allowing them to avoid counseling patients who clearly need to lose weight, said Dr. Peter Belamarich, a pediatrician with Children's Hospital at Montefiore in New York City.

The blunter terms make sense if they motivate doctors to work with more kids who need help, "but you have to be real careful about labeling or saying it in front of a child," Belamarich said.

"I've had mothers ask me not to use the (obese) label," he said. "Sometimes you can see it in the child's face. They're ashamed."

The change in terms is among several recommendations the committee, comprising 15 medical organizations, is promoting to help doctors prevent, diagnose and treat obesity in children. Other recommendations include assessing weight and body mass index at least yearly; and evaluating eating habits and activity levels at all well-child visits.

"The substance of these recommendations is great," but expecting pediatricians to implement them thoroughly at already overburdened well-child visits is unrealistic, Belamarich said.

The change in obesity terms is the most controversial recommendation and Dr. William Dietz, director of the CDC's division of nutrition and physical activity, said the agency will discuss whether to adopt the new terms.

The recommendations were posted on the AMA's Web site last week. They have been endorsed by most of the organizations on the committee, including the American Academy of Pediatrics, the American Dietetic Association, the American Academy of Child and Adolescent Psychiatry and the American College of Preventive Medicine, an AMA spokesperson said.