Child obesity: The issue no one wants to raise

21:39, Sep 01 2014
IGNORING THE ISSUE: It's not only parents who underestimate their child's weight - doctors tend to under-diagnose it too.

With more and more parents unable to recognise their kids are overweight, healthcare professionals may need to step into the breach.

News last week that fewer American parents can even tell that their kids are overweight was no surprise to New Zealand researchers, who say up to 80% of parents with young children can't see it. The problem's compounded by the fact GPs tend to underdiagnose overweight and obese kids, and avoid raising the issue with parents.

"A significant number of GPs avoid having the conversation," says dean of the Dunedin School of Medicine, Professor Barry Taylor. They find it difficult for fear of damaging the relationship with the family.

Part of the problem is that parents won't believe their GP, often comparing their children to others around them in a society that's increasingly getting larger.

"You think what is normal is what's around you," says Taylor, so parents can hardly be blamed.

But these skewed perceptions are doing kids a disservice, and silence from GPs and other health professionals can exacerbate the problem.


Boyd Swinburn, professor of population nutrition and global health at the University of Auckland, says whether it's acted on or not, a message from the GP carries importance. "And if the GP says nothing, that also carries importance. So silence is also a message."

Growth charts are key

Taylor believes kids should be routinely weighed and measured when they visit a GP or any healthcare professional they see regularly - including Well Child services and dental clinics - so their BMI can be measured and the weight discussed objectively.

The responsibility shouldn't lie with GPs only, but healthcare professionals broadly.

"Dental providers, for example, are seeing 'well' children all the time, and the children we're talking about are well. They're not going to the GP unless they're considered unwell."

Growth charting is supposed to happen at GP clinics up to the age of 18 years. "That should be standard, but it doesn't happen very much or as often as it should," says Taylor.

When trialled by University of Otago researchers, growth charts using a traffic light system of green, amber and red zones to depict weight, were well accepted by parents and helpful in showing them how their child was tracking.

Swinburn agrees growth charting should be a routine part of doctor's visits.

Parents inherently have a positive view of their kids, he says. And any weight gain might not be obvious until it's actually plotted on a growth chart.

Blame the environment, not parents

The growth trajectory you might expect in kids has now changed, says Swinburn. That 'puppy fat' parents assume will melt away, doesn't disappear like it used to in the old days.

That's because the packaged snacks and junk food that appear early in children's lives, don't disappear. By the time kids get to school they're heavily exposed to them, and by the time they're adolescents they're making a lot of food choices for themselves.

"And in this obesogenic environment, it does get tougher and tougher as kids grow up to be able to resist these highly-packaged, cheap, ultra-palatable junk foods."

While parents have the biggest impact on their children's eating habits and weight, they're just creatures of their environment too, says Swinburn.

It's an environment where supermarket aisles are lined with processed, packaged foods, fast foods are marketed to kids and there's no cost-incentive on healthy foods.

If it's normal practice at the child's school to pack a lunch box full of packaged snacks, then that becomes acceptable. We need to get to the point where that's seen as inappropriate and unacceptable, he says. "A bit like it used to be quite acceptable to smoke indoors and in offices and then that became unacceptable, we need to go through the same kind of transition in relation to children and junk food."

Elaine Rush, professor of nutrition at the Auckland University of Technology, adds busy parents have a lot on their plate so weight issues 'just creep up' on them. They're busy making sure their child is fed and housed, that they're doing well at school, and that as parents they're spending enough time with them.

Reach kids through their communities

Rush says reaching children in schools is key to instilling better eating habits in future. She points to great developments such as Fonterra milk for schools, the fruit in schools programme, and better food in pre-schools.

Programmes like Project Energize, now running in almost 280 schools in Waikato, Franklin and Northland, involves sending 'Energizers' to schools to work with teachers and parents to implement health and fitness programmes and give nutrition advice.

In answer to how we instill those habits at home, Rush says, "These children are going to be parents one day."

Swinburn agrees there's a host of interventions needed at the community and policy level, but says talking to kids sensibly about weight is also okay.

"It is a sensitive issue, but nevertheless almost all studies show even primary school kids are actually aware of body image."

He likens our silence on it to where we were "30 years ago in talking about sex education".

"If we accept the fact kids are thinking about it anyway, then getting alongside them and talking about it could be helpful. We need to be much more engaged than we currently are, rather than standing off and saying 'I'm worried it's going to trigger off an eating disorder' or something."

What remains critical, he says, is parental role-modelling - as well as what's in the fridge at home.

"Parents should be tracking their children's growth and providing a healthy home environment - that's the first thing that should happen."