Should youngsters be called obese?

CHICAGO -- 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 government with the painful truth -- telling kids if they're 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-chair 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 and used by many doctors avoids the word "obese" because of the stigma. The CDC also calls overweight kids "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 committee of the American Medical Association, the CDC and others, fat children would get the same labels as adults -- overweight or obese.

The change "would certainly make sense. It would bring the U.S. in line with the rest of the world," said Tim Cole, a professor of medical statistics at the University College London's Institute of Child Health.

The existing categories are convoluted and "rather ironic, since the U.S. leads the world in terms of obesity," Cole said. "There must be an element of political correctness."

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," Leu said. "I still don't understand it."

Paola Fernandez Rana of Fort Lauderdale, Fla., has a 9-year-old daughter who at 40 pounds overweight is considered obese. Rana said doctors "refer to it as the 'o-word'" in front of her daughter "in an effort not to upset her.

"Obviously I don't want my daughter to be overweight, but ... in order to change the situation, she is ultimately going to need to hear it," Rana said.

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're "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 gender.

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 kids were too fat.

In children, determining excess weight is tricky, partly because of rapid growth -- especially in adolescence -- that can sometimes temporarily result in a high body-mass index.

For children in at least the 95th percentile, high BMI "is almost invariably excess fat," Dietz said. But there's less certainty about those in the second-highest category. So to avoid mislabeling and "traumatizing" kids, the CDC chose to be diplomatic, Dietz said.

The committee, set up by the American Medical Association, involves obesity experts 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.

Dr. Ronald Davis, the AMA's president-elect, said it's unclear whether the expert committee can develop a consensus on the obesity terms.

"There are seemingly legitimate arguments on both sides," said Davis, a preventive medicine specialist with Henry Ford Health System in Detroit.

Maria Bailey of Pompano Beach, Fla., whose 12-year-old daughter, Madison, is self-consciously overweight, opposes the proposed change. She said their pediatrician has told her daughter to exercise more and see a nutritionist, but "hasn't told her that she's in a (weight) category."

"We're already raising a generation of teenagers who have eating disorders," Bailey said. "I think it would just perpetuate that."

"They very clearly told me she was obese," Rana said. But she said she agreed with the term and thinks that at some point it should be used with her daughter, too.

Dr. Michael Wasserman, a pediatrician with the Ochsner Clinic in Metairie, La., agreed. Using the term "at risk for overweight" is misleading, creating the perception "that I'm only at risk for it now, so I don't have to deal with it now," said Wasserman, who is not on the committee.

Chicago pediatrician Rebecca Unger, also not a committee member, said she likes using the term "at risk for overweight" because it gives patients hope that "we can do something about it."

It would be kinder to tell them that they have a disease, lardassosis!

Thanks. I will let my 13 year old with genetic obesity know.

Jerk!

Read this:Chewing the fat: New theories on world's obesity pandemic
Jul 01 11:33 PM US/Eastern
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Fatty hamburgers, sugar-laden sodas and a couch-potato lifestyle: these are the familiar villains in the crisis of obesity sweeping developed countries.

But what if they had been convicted without fair trial?

What if the global fat explosion had other causes?

What, for instance, if air conditioning or lack of sleep helped make you fat? Or what if obesity were caused by a microbe -- what if, bang, you caught an unlucky sneeze and this made you chub out?

These ideas challenge the mainstream view that the bulging waistlines of an advancing society can be overwhelmingly pinned to diet and lifestyle.

The World Health Organisation (WHO) last September warned that a billion people were overweight and obese, and the toll could rise to 1.5 billion by 2015, driven by low- and middle-income countries.

The WHO accepted there were "a number of factors" for this increase, but especially blamed "a global shift in diet towards increased energy, fat, salt and sugar intake, and a trend towards decreased physical activity due to the sedentary nature of modern work and transportation, and increasing urbanisation."

Some worry that this view is dangerously monolithic.

Writing on Tuesday in the International Journal of Obesity, a team of US public-health experts caution against focussing obsessively on the "Big Two" -- a slower lifestyle and modern food marketing.

"This has created a hegemony whereby the importance of the Big Two is accepted as established and other putative factors are not seriously explored," they say. "The result may be well-intentioned but ill-founded proposals for reducing obesity rates."

They contend the evidence against junk food, supersize-me portions and high-calorie corn syrup is "equivocal and largely circumstantial" and offer some intriguing ideas of their own for other drivers of the obesity tsunami.

Among them:

-- Industrial chemicals called endocrine disruptors that disturb metabolism, encouraging the formation of fat.

-- Giving up smoking: people who give up cigarettes very often gain weight.

-- Air conditioning, which establishes a comfortable temperature zone. In temperatures above this zone, people eat less. The rise in number of air-conditioned homes in the United States virtually mirrors the increase in the US obesity rate.

-- Fat people marry other fat people. These individuals may be genetically vulnerable to obesity, a trait that could handed on to their children.

Another hypothesis is that lack of sleep jolts the metabolic system into demanding doses of instant energy.

University of Chicago researcher Esra Tasali notes that waistlines in modern societies started to expand when people started to sleep less. Today, the "sleep deficit" is about two hours per night compared with 40 years ago.

In work unveiled at an obesity conference last October, Tasali recruited a group of healthy young adults and divided them into three groups. One group had eight hours' sleep; another had their sleep regime extended to 12 hours; and the third was limited to only four hours.

The sleep-deprived group swiftly developed cravings for high-calorie sweets, and their metabolisms were akin to those of diabetics.

Meanwhile, Nikhil Dhurandhar of the Pennington Biomedical Research Center at Louisiana State University believes obesity could be caused by a bug.

At least 10 different pathogens are known to cause obesity in animals, causing dramatic changes to the metabolic system so that more energy gets converted into fat.

Dhurandhar believes that something similar may happen among humans exposed to cousins of the common cold.

He tested the stored blood of 500 Americans and found that 30 percent of obese people had antibodies for Ad-36, an adenovirus which causes coughing, sneezing and cold-like symptoms. Only 11 percent of people of normal body weight had this telltale of Ad-36 infection.

Dhurandhar stresses, though, that infection is likely to be only of a bouquet of causes for obesity.

"In 10 years, people may be able to walk into a clinic and be told that their obesity is due to X cause, such as genes, the endocrine system or pathogens. That may have a more productive outcome than a blanket treatment right now, (which) is not very successful."

Neville Rigby, of the European Association for the Study of Obesity, says that such unconventional views usually get a good hearing among scientists, for no one claims to have a monopoly of wisdom when it comes to this fast-growing disease.

"It's a very complex story, it's not a single issue," said Rigby. "But the overarching question is how much we consume and how much we burn."

"A fat woman sloshed into the shoe store today. Said she was retaining water. I told her not to worry the dam of cellulite should keep us all safe for the next few years!"

"A fat woman clip-clops into the shoestore today and says "I want something I can feel comfortable in." so I said "Try Wyoming!"."

Fat Lady: I want my money back. I've worn these shoes only once and they split at the sides.
Al: Let me explain. Just like an elevator, there's a 2 ton weight limit. How about I just nail the soles to the bottom of your feet to give you added traction while you're pulling the ice wagon.
Fat Lady: You'll be hearing from my attorney.
Al: Is that the law firm of Haagen & Dazs?

"A fat woman walked into the shoe store today. She was so fat, she had three smaller women orbiting around her."

"A woman comes into the shoestore today, so huge she's protected by GreenPeace. She asked for a pair of sixe 4 so I asked if she'd eat them here or take them home. Then she has the nerver to complain about my performnce!"

"A fat woman godzillas into the shoe store today, she asks for something she could wear to walk in the woods. Jokingly I suggest she wear a sign that says "Don't shoot! From the front I look human!"."

“A fat woman came into the shoe store today. Wanted a pair of shoes for a Christmas party. I told her to stand on her hands, put a star in her butt and go as the world’s largest, ugliest tree!”

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