Pointing out that a child is fat is not cruel
When I first entered medical school I planned to complete my training and spend the rest of my career working in hospitals. I really enjoyed most specialities that I rotated through but had a particular interest in cardiology and oncology.
One would think that these two specialities are quite far apart, but as time went on I realised it wasn't the curing of these diseases that really interested me but rather the reasons they occurred and their prevention.
There comes a point in post-graduate training where you have to decide what speciality you wish to pursue and when I finally sat down to think about this I realised that if I really wanted to help prevent disease then the community – not hospitals – was the place to be.
So I hung up my white coat and undertook a post-graduate scheme in General Practice.
As a doctor dedicated to preventive health I actively seek to assess potential health risks of all patients who visit me.
I weigh and measure pretty much every new patient who comes through my door from babies through to the elderly. It isn't always easy to raise the issue of weight with a patient especially if they have attended for another reason. I have been accused of being insensitive or distracted and off point.
In my experience the most difficult consultation is when I find myself faced with a child who is visibly overweight in the company of a parent who clearly doesn't seem to think this is a problem or issue.
The difficulty in this consultation lies in the fact that society today still sees obesity as a cosmetic, not a medical issue.
Historically, to be "fat" is to be unattractive.
Most women's magazines have some form of diet in their pages. Many TV shows that address obesity ultimately end up with a "made over" person who has new hair, wardrobe and make-up and can be perceived as attractive.
It is very hard as a doctor to try and convince parents that when you raise the issue of weight you are not describing the physical appearance of the child in front of you, but rather a medical condition that is a serious risk to health and life.
Parents often take the conversation quite personally and feel they are somehow being told they are failing in the care of their child. I have heard all the excuses. One that is often mentioned is the genetic predisposition to weight gain "we are all fat in our family".
Another popular one is that the child gets most of their food elsewhere. "It's the grandparents feeding him/her or "they buy junk on the way to/from school".
In my experience most of the children are well aware that they are overweight.
Many children have been bullied at school or feel down in themselves because they can't keep up with their thinner of fitter friends.
Children and teenagers are usually quite willing to discuss their diets and activity but parents are often in denial or so afraid the child will become upset that they try to shut the conversation about weight down before it has even started. This needs to change.
If a patient attended a doctor with a visible swelling that could potentially be life threatening it would be considered malpractice for the doctor not to examine or review this. Obesity significantly increases the risk of many diseases including diabetes, heart disease, arthritis, various cancers and also reduces life expectancy.
It should be seen as the life-threatening condition that it is and addressed as such.
It is also important to remember that a child doesn't become obese all by themselves. Younger children don't buy their own food or make their own choices, so in most cases where there is an overweight or obese child the whole family needs to review and address their eating habits.
Healthy eating in a family needs to be for all – not just those who are considered overweight. We know now more than ever that intervening in childhood is essential.
What the mother eats in pregnancy can affect the child's risk of obesity down the road and overweight or obese children are more likely to become overweight or obese adults.
It is very hard for obese adults to lose significant weight and keep it off but the good news is research shows that addressing the issue of obesity in childhood can lead to significant weight loss that may be sustained.
So the message to parents is clear – it isn't cruel for your doctor to talk about food and diet to your child. It is in fact a conversation to be encouraged – as their best chance of getting to a healthy weight and staying there is doing it while they are still young.