By Elizabeth M. Ward, MS, RD
The family of five crowded into my small office, a cheerful lot who didn’t seem to mind the tight squeeze.
They were there to improve their eating habits as a group, but the initial reason for the visit was that one of the children was overweight, and his pediatrician had referred him to a registered dietitian for counseling.
I secretly applauded the parents for involving the entire family in making healthy eating changes, and for not singling out the child as the only one with habits worth improving.
The visit went well, and the family left with a manageable list of lifestyle changes to try at home that everyone agreed upon. It was a productive, and memorable, session.
If only all conversations concerning overweight children went as well.
More often than not, it’s uncomfortable to discuss a child’s weight problem, even when it’s your job. A recent study in the Archives of Pediatrics & Adolescent Medicine suggests that pediatricians may be shying away from initiating conversations that could lead to positive lifestyle changes.
Researchers found that just 25% of parents of overweight kids said they were told by a doctor that their child weighed too much. That means, according to this one study, that
75% of parents of overweight kids said they had never discussed their child’s issue with the pediatrician. Of course, it’s also possible that parents didn’t remember speaking with the doctor about their child’s weight.
“While I’m sure that not all doctors are discussing this topic, I also have found, and fairly often, that parents and patients don’t recall things that I definitely discussed with them - even when I thought I’d been very clear,” says Laura Jana, MD, a pediatrician in Omaha and co-author of Food Fights: Winning the Nutritional Challenges of Parenthood Armed with Insight, Humor & a Bottle of Ketchup.
Weight control and healthy eating should be hot topics for parents and pediatricians. After all, an estimated one in three children in the U.S. is overweight, and many more are undernourished as they miss out on key nutrients including calcium, vitamin D, potassium, and fiber.
It’s not as easy as it looks to talk about children being overweight, however.
“Sometimes I hesitate because I know that I need to find a way to communicate how important this topic is and to motivate behavior change, rather than embarrass, offend, or make parents and children feel guilty,” Jana says.
“Parents often look forward to pediatrician visits,” says Alanna Levine, MD, a pediatrician at Orangetown Pediatrics in Tappan, NY. “They like to hear how wonderfully their child has developed, to boast about their accomplishments, and to see how much they’ve grown.”
It’s much more pleasant for pediatricians, and other health professionals, to discuss all of the wonderful things about a child rather than the behaviors they would like the child to change.
Yet, overweight is a fact of life, and you could even say it’s a safety issue, although talking about it is certainly not the same as discussing why kids should wear safety helmets, mouth guards, and avoid drugs and alcohol.
I don’t think anyone knows for sure why pediatricians and parents aren’t talking about childhood overweight more often. Perhaps pediatricians fear alienating parents and patients. Maybe parents are put off by the idea that the doctor thinks they aren’t feeding their kids right.
“There is an art to delivering the message about weight, and it’s not an easy discussion which is why so many doctors may shy away from it,” Levine says. “Pediatricians have to be careful with their choice of language and the way they deliver their message in order for it to be effective.”
Levine and Jana don’t avoid talking about weight issues, but they do tread lightly when approaching parents and patients. Levine typically begins the conversation by asking about a child’s habits, the foods they like to eat, their beverage choices, and how they get their exercise.
“Then I ask them how they feel about their weight. For me, it’s a non-judgmental way to start the conversation rather than saying, ‘Hey, we have a problem here, you are overweight.’”
Involving everyone present at the appointment in coming up with solutions for healthier eating helps promote success, too.
“We all have to work hard at being healthy, no matter what the scale says,” Levine notes.