By whose definition?

Among the efforts to convince us all of a childhood obesity epidemic are expressions of dismay that parents are failing to recognize that their children are “overweight.”

This has been a real thorn in the side for those trying to advance anti-obesity programs and anti-fat sentiment. For years the medical journals and media have lamented this “troublesome” problem because, as they've noted repeatedly, getting parents to recognize and accept childhood obesity as a health risk is vital before anti-obesity initiatives can be successful. Parents have been accused of being in denial, being “blind to the realities of childhood fat,” being “guilty of overlooking the obvious,” and failing to appreciate the problem and dangers childhood obesity.

A member of Australia’s National Health and Medical Research Centre working panel on obesity told the Australian News on February 22, 2005, that “so often parents interpret children who look well-covered as being healthy, rather than interpreting that they are at risk of becoming obese and having a range of diseases.” Earlier this month, UK health authorities launched their Health Living Initiative targeting parents, beginning with those of lower socioeconomic status, who “often have no idea their child is overweight and know little about the damage that could do to their health.”

A 2003 issue of Obesity Research, the journal for the North American Association for the Study of Obesity, a trade association for obesity researchers, reported that only 10.5% of parents of “overweight” children understand that their child is too fat. The pediatricians concluded: “Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.”

Another survey of 99 mothers of “overweight” children published in the Pediatric Nursing Journal, found that 79% failed to identify their children as too fat. And a survey of 277 “overweight” children, aged 7-8 years old, published in the British Medical Journal reported 75% of parents didn’t realize their children were fat. This report, led by a senior research nurse at Derriford Hospital in Plymouth, did debunk what many incorrectly believe, however, that parents who are fat, uneducated or poor are less aware of childhood obesity. They found no difference in parents’ ability to recognize “overweight” in their children based on social class, education or weight status. But their conclusions do give us better insight into what the real issue here is:

The layperson’s perception of average weight, however, now conflicts with the clinical definition of normal weight, and a label of overweight from a health professional may be insufficient motivation for a change in lifestyle. The apparent lack of parental concern about their child being overweight probably stems from a lack of awareness. Until this is resolved, we are missing critical partners in our efforts to stem an impending health crisis.

While it has become popular to indict parents of “overweight” children for being irresponsible and to hype a "crisis of childhood obesity," those eagerly doing so are often the ones who don’t understand childhood obesity. Perhaps, many have come to believe the media hype and marketing, and actually think that those extreme examples being trotted out on television are representative of “the problem.”

As a Cleveland, Ohio columnist wrote this morning while talking about the 500-pound teen being profiled in Al Roker’s “Childhood Obesity: Danger Zone” for Food TV, it’s a “sobering look at what is shaping up to be a real national crisis. His story mirrors the childhood obesity story for the 12.5 million kids in America who are considered overweight or obese.”

This exemplifies the difference between what vested interests are trying to convince us is “childhood obesity” and the reality — that "conflict" mentioned by the British researchers.

So let’s start with a few basics. Body weight and size is nothing more than a description of a body characteristic. Obesity, including childhood obesity, is not a disease like polio or something you catch like strep throat. It is no different than trying to say that ear lobe creases or balding are diseases simply because some may find them unattractive or because they are associated with some chronic disease, and hence a “risk factor.”

What many don’t realize is that the definition for what is “too big” — “overweight” and “obese”— is a totally arbitrary thing, with various cultures and historical times seeing it very differently. We’ve already looked at some of the ways childhood obesity has been redefined over the years to include more children. Also popularly misunderstood is that the prevalence of overweight and obesity being used to define the "crisis" merely describes the numbers who have crossed the line of these arbitrary cut-offs for the labels of “overweight” or “obese.”

When we hear scary statistics that, for instance, childhood obesity among children aged 2-5 years has soared from 5% in 1971 to 13.9% in 2004, that doesn’t mean that children’s weights have ballooned by nearly 9% over the past 33 years. Nor does it mean that 13.9% of children today weigh 500 pounds. It means that 9% more children today have crossed that arbitrary threshold to receive the clinical label of being “overweight.”

A recent Voices of America article reported on the “alarming number of obese children worldwide at risk for heart disease” and the “disturbing global trend.” To illustrate the “20 million children under the age of five considered ‘too fat,’” they showed this adorable little girl:

We’ll look more at the creation of an epidemic of childhood obesity Monday, but for our discussion today, we are trying to get a more realistic picture of what “childhood obesity” and this supposed epidemic looks like. For our illustration, we’ll even use the CDC’s latest BMI growth charts and calculator for the cutoffs for “overweight” and “obesity” in children. Remember, children who are at or above the 85th percentile on the new BMI-based growth charts are considered clinically “at risk for overweight” (or “overweight” by the term popularized in the media). And at the 95th percentile, they become “overweight” (or “obese” in popular terms).

If we have a 6-year old girl who is 3 foot, 9 inches tall she would be considered to be a “healthy, normal weight" at 49 1/4 pounds (BMI 17.1).

If she gained 1/4 pound more, however, she becomes “overweight” at 49 1/2 pounds. For untold numbers of children classified as “overweight” they are within a fraction of a pound or few pounds of “normal.”

However, if this little girl grew a mere 1/8 inch, she would be considered to be a “healthy, normal weight” again!

At 54 1/2 pounds (BMI 18.9) she crosses the 95th percentile cut-off and is now labeled “obese.” A very different picture of childhood obesity than the mainstream media is portraying.

However, if this little girl was a mere 1/8 inch taller, at 3-9 1/8 inches tall, she would be merely “overweight” again.

So, for a 6-year old girl who theoretically isn’t growing taller, around a mere 5 pounds makes the difference between being labeled as a “normal” weight or all the way to being “obese.”

It’s no wonder that most parents aren’t readily able or willing to “recognize” that their child is overweight or obese.

And it’s no wonder that parents aren’t readily accepting the notion that this is a health crisis.

It also appears that parents have more common sense and wisdom than many experts and journalists in understanding the genetic component to the natural diversity of sizes that’s always been evident among children. They see that their children take after the other members of the family, aren’t eating or behaving any differently than the other kids, and are just as healthy. Increasing numbers of parents are not readily buying into the belief of a need to medicalize their healthy, active children based on such a spurious label.

© 2007 Sandy Szwarc

[The wonderful opening photo is courtesy of Deb Lemire of Queen Bee Productions.]