Wednesday, July 1, 2015

Parents’ Denial Fuels Childhood Obesity Epidemic

Not only was the 16-year-old boy 60 pounds overweight, but a blood test showed he might have fatty liver disease. At last, his mother took him to a pediatric weight management clinic in New Haven. But she did not at all like the dietitian’s advice.

“I can’t believe you’re telling me I can’t buy Chips Ahoy! cookies,” said the mother, herself a nurse.

This was hardly the first time that Mary Savoye, the exasperated dietitian who recalled this exchange, had counseled parents who seem unable to acknowledge the harsh truth about their child’s weight.

“Often they don’t want to accept it because change means a lot of work for everyone, including themselves,” Ms. Savoye said.

Despite widespread publicity about the obesity epidemic, parents increasingly seem to be turning a blind eye as their children put on pounds. In a recent study in Childhood Obesity,more than three-quarters of parents of pre-school-age obese sons and nearly 70 percent of parents of obese daughters described their children as “about the right weight.”

The researchers also compared these 2012 survey results with those from a similar survey in 1994. Not only were the children in the recent survey significantly heavier, but the likelihood that parents could identify their child’s weight accurately had declined about 30 percent.

Dr. David L. Katz, the director of Yale’s Prevention Research Center, has coined a word for the problem: “oblivobesity.”

“Parents cannot ignore the threat of obesity to our children and still hope to fix it,” he wrote in an editorial accompanying the new study.

One reason parents may have difficulty perceiving their child’s weight is because of the “new normal”: Throughout the developed world and even in some developing countries, children are generally becoming heavier.

But in an interview, Dr. Katz also cited parents for “willful, genuine denial.”

Once a parent acknowledges the child has a problem, he said, “You have to deal with it.”

“ ‘Do I become the food police? Do I have to change my diet and walk the walk?’ ” he added. “So, often, it’s easier to pretend the problem’s not there.”

Other experts counter that the problem can be complicated and subtle, the result of family dynamics. Perhaps the parents are resigned to being overweight. Perhaps there are slender siblings, and the parents cannot figure out a diet that fits all.

“Denial can be a coping mechanism,” said Arnaldo Perez, a doctoral candidate at the University of Alberta who researches what motivates families to seek help for their overweight children. Before judging them outright, providers should explore parents’ possible feelings of guilt and failure, he said.

Denial may also be a form of wishful thinking.

It is “natural for a parent to want to think optimistically about their child,” Dr. Thomas N. Robinson, a professor of pediatrics and director of the Center for Healthy Weight at Stanford and Lucile Packard Children’s Hospital Stanford, wrote in an email.

“I have parents tell me that they waited to address it because they thought their child would ‘grow out’ of their extra weight,” he added.

It is only now, as Bonnie Ryan of Bridgeport, Conn., looks at old photographs of her grandson, 12, that she sees how the weight accumulated over the years. At 7, he was “chunky,” she remembers thinking. And at 8, chunkier still.

But his father grew to 6 feet 4 inches tall and about 220 pounds. She hoped her grandson would stretch out, too. The boy’s parents separated. Lonely, he kept eating.

Shortly after her grandson’s checkup at 11, she and her son met with the pediatrician. Her grandson, the doctor said, was 5-foot-1, 200 pounds and had pre-diabetes.

“You think he’s a little overweight and then suddenly, ‘Oh my God,’ ” she said. They could no longer look away.

She has enrolled the boy in Bright Bodies, a healthy lifestyle program in New Haven, sponsored by Yale.

A child’s weight problem may escape notice for any number of reasons. Many clothing styles obscure shape, for instance, particularly for boys.

“When they take their loosefitting shirts and pants off in the exam room, you see just how a tremendous amount of body fat can be hidden,” Dr. Robinson said.

And when parents believe their children are active, they are more likely to consider their child’s weight to be normal, studies have shown. But parents often overestimate their children’s physical activity.

Other confounding factors include immigrant status and socioeconomic standing.

Dr. Francine R. Kaufman, a pediatrics professor at the Keck School of Medicine at the University of Southern California, said that among new immigrants from countries where starvation is a reality, “Even the 3-, 5- and 7-year-old can’t be heavy enough for abuela. Nourishing and nurturing children is often the same.”

Studies do show that as adolescence approaches, more parents pay attention to their children’s weight problems, because social exclusion and sliding self-esteem become more pressing. But Dr. Kaufman said that in her experience, those parents tended to be middle and upper-middle class.

“Eating healthy costs more,” said Dr. Kaufman, the author of “Diabesity.” “It’s harder for someone with a fixed income who relies on school lunches than someone who can get the kid a personal trainer and buy their groceries at Whole Foods.”

Other researchers blame the rise in “oblivobesity” on imperfect communication between parents and pediatricians.

A 2011 study in Pediatrics found that parents preferred that physicians use terms like “weight problem” and “unhealthy weight,” rather than “fat,” “obese,” and “extremely obese.” Doctors may feel awkward about using blunt language, for fear of pushing away patients and losing the opportunity to discuss behavioral change.

Parents and physicians may have conflicting ideas about appropriate weight. Research shows that some low-income mothers distrust growth and weight charts.

Of course, a body mass index score or a number on a scale is one factor among many that indicate a child’s overall health. “But weight is the canary in the coal mine of chronic disease,” Dr. Katz said.

Dr. Katz and others said that a first step in helping parents help their children was to set aside the shame that might be their biggest impediment.

“It has to be about love,” he said. “Families have to approach this together. This is not just about the child.”

Indeed, children may be more aware than their parents that they are overweight. They are barraged with ambient news media messages, and their peers are not likely to be stingy with cutting comments.

But children may not know how to change their eating habits.

The other night at Bright Bodies, the New Haven program, Ms. Savoye facilitated a discussion in a weight-management group for teenagers. One girl, 15, had lost 30 pounds and had about 40 more to go.

“I wish my parents had done something about my weight earlier,” the girl said.


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