- The Washington Times - Sunday, July 2, 2006

CHICAGO (AP) — Is it OK for doctors and parents to tell children and teens they’re fat?

That seems to be at the heart of a debate over whether to replace the fuzzy language favored by the U.S. government with the painful truth: telling children whether they are obese or overweight.

Labeling a child obese might “run the risk of making them angry, making the family angry,” but it addresses a serious issue head-on, said Dr. Reginald Washington, a Denver pediatrician and co-chairman of an American Academy of Pediatrics obesity task force.

“If that same person came into your office and had cancer, or was anemic, or had an ear infection, would we be having the same conversation? There are a thousand reasons why this obesity epidemic is so out of control, and one of them is no one wants to talk about it.”

The diplomatic approach adopted by the federal Centers for Disease Control and Prevention (CDC) and used by many doctors avoids the word “obese” because of the stigma. The CDC also calls overweight children “at risk of overweight.”

Those favoring a change say the current terms encourage denial of a problem affecting increasing numbers of U.S. youngsters. Under a proposal studied by a panel of the American Medical Association, the CDC and others, fat children would get the same labels as adults: overweight or obese.

The debate illustrates just how touchy the nation is about its weight problem.

Obese “sounds mean. It doesn’t sound good,” said Trisha Leu, 17, who thinks the proposed change is a bad idea.

The Wheeling, Ill., teen has lost 60 pounds since March as part of an adolescent obesity surgery study at the University of Illinois at Chicago.

“When you’re young, you don’t understand what obese means,” Miss Leu said. “I still don’t understand it.”

The CDC adopted the current terms in 1998, using weight-to-height ratios and growth charts from a generation of children much slimmer than today’s.

Children are said to be “at risk for overweight” if their body-mass index is between the 85th and 94th percentiles. They are “overweight” if their body-mass index is in the 95th percentile or higher, or greater than at least 95 percent of youngsters the same age and sex.

Many pediatricians understand the first category to mean “overweight” and the second one to mean “obese,” said the CDC’s Dr. William Dietz. He said the word “obese” was purposely avoided because of negative connotations but conceded that many pediatricians find the current language confusing.

Adding to the confusion is the fact that about 17 percent of U.S. children are in the highest category, and that almost 34 percent are in the second-highest category. That sounds like a mathematical impossibility, but it’s because the percentiles are based on growth charts from the 1960s and 1970s, when far fewer children were fat.

The committee, set up by the American Medical Association, involves obesity specialists from 14 professional organizations, including the American Academy of Pediatrics. Their mission is to update recommendations for prevention, diagnosis and management of obesity in children. Final recommendations are expected in September, and the participating groups will decide individually whether to adopt them.

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