By Angela, Registered Dietitian
For anyone who is new to Dr. Ann’s blog, let me introduce myself. My name is Angela Bilbrey and I am a registered dietitian, an avid runner, a community advocate for healthier schools and most importantly, a mom to two lovely children. I am well aware of the obesity crisis that our nation is facing and the impact obesity has on our children. That awareness didn’t prepare me for my son’s obesity diagnosis or the awkward and confusing dialog that followed with our doctor and his staff. My hope is that by sharing our story we can help other parents avoid the helplessness and frustration we felt that day in the doctor’s office.
We had gone to our pediatrician’s office for a routine checkup when my son was six-years old. I knew that he had grown a lot over the year as he had skipped an entire clothing size. The physician who saw us that day didn’t mince words. He simply said that our son had gained too much weight over the past year and had jumped from the middle of the BMI (Body Mass Index) percentile range to the 95th percentile. My heart sank as he added, “We are really concerned that your son could be prediabetic or diabetic and he also may have abnormal cholesterol levels and liver function.”
Up to that point, I had considered my son’s weight gain and growth to be normal, as he looks exactly like the other children in our family did at his age. I never thought his rapid growth might be a sign of underlying disease until those words came out of the doctor’s mouth. It was at that moment that a bit of panic began to weave its way into my heart. My mind was overwhelmed with the thought that my son was sick with a serious illness and I was completely unaware.
I would like to point out that the pediatrician we saw that day was not our usual pediatrician, and perhaps the conversation between the doctor and myself would have been a bit different had it been a provider that knew our family. Instead, our exchange was extremely uncomfortable and strange, as the doctor stumbled over his words regarding my son’s diagnosis. I knew that due to concerns over promoting negative body image and eating disorders the American Academy of Pediatrics (AAP) had issued a clinical report in August 2016 regarding how pediatricians are to speak to children and parents about obesity. It was clear to me that the doctor was trying to avoid saying my son was obese, but had absolutely no other words to draw from to identify what he was diagnosing him with. At the time, the AAP was working on a resource to help guide this very delicate conversation and now it is available for physicians to use, click here. In the future, I am hopeful that the information and role-play scenarios located on the site will help to make the obesity conversation easier between physicians and families.
In addition to our conversation being limited by the reluctance of the doctor to say the word “obese,” it was plagued by what I felt was a serious lack of listening to the answers I provided about my son’s eating and activity patterns. As I stated before, I am a dietitian and I watch what my children eat. My son in particular dislikes juice and only drinks milk or water – but the doctor insisted that couldn’t be the case. The doctor also was insistent that my son must be sedentary and likely had too much screen time even though I told him repeatedly that my son plays several sports and is active all year. It was extremely frustrating to have the doctor and his nurse insist that our family must have done something they considered “wrong” that had caused his weight gain. In 2017 the AAP issued a policy on weight stigma that would have been helpful for the pediatrician and his staff to utilize during our appointment. Stigma in healthcare unfortunately does exist, and in our case the doctor’s stigma towards obesity in children derailed our appointment.
Although our experience wasn’t ideal, I am thankful that the doctor followed AAP protocol and raised an alarm in regards to my son’s weight gain. The AAP policy regarding childhood obesity states “BMI (Body Mass Index) between 85th and 95th percentile for age and sex is considered at risk of overweight, and BMI at or above the 95th percentile is considered overweight or obese”. My son certainly met the criteria to be diagnosed as obese, and without a regular checkup and evaluation I would have been unaware. In order to rule out obesity related illnesses, I agreed to bloodwork to test for diabetes, and to check my son’s liver function and cholesterol levels. Thankfully, all of the lab tests came back normal and my son’s weight has stabilized since our appointment.
I want to take a moment to review why BMI is used to evaluate children. BMI is a calculation that uses weight and height in order to screen for possible weight issues that can lead to future health problems. BMI provides pediatricians with another reference to monitor children’s growth. In addition, a child’s BMI measurement is consistent with an adult’s BMI measurement, and it can be used throughout a person’s life, unlike growth charts. I am providing this resource from the CDC that explains the use of BMI and also provides information on how BMI is calculated, click here. Research has shown that that an elevated BMI in children tracks to an elevated BMI for adults. Click here to read more about the research and the very serious consequences of carrying extra weight.
It’s important that the conversation parents have with their child’s doctor regarding their child’s weight is productive and not confusing and frustrating like mine was. One way to help facilitate this conversation is to be aware of how obesity is diagnosed, which I’ve covered in this blog post. In my next post, I will provide information and links to help you manage the obesity conversation with your doctor and also provide reference materials to help you manage your child’s weight at home. Thank you for joining me on this journey!