Experts Reconsider Labels for Childhood Obesity

The Centers for Disease Control and major U.S. medical groups are considering changing the way obese children are labeled. Currently, obese children are called "overweight" or "at risk of overweight." Those labels affect how children are treated by doctors, nutritionists, teachers and parents.

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ALEX CHADWICK, host:

In public health terms, the worst of the E. coli outbreak could be an excuse for kids to reject more green vegetables. Obesity among kids is a major problem and better eating habits is a key answer.

MADELEINE BRAND, host:

Here's a complication: language. How do you persuade a kid to exercise and eat wisely without actually using a word like obese, or worse, fat?

CHADWICK: As NPR's Alex Cohen reports, there's a meeting in Washington tomorrow, a panel of physicians working with the Centers for Disease Control devoted just to this subject, because it is so difficult and important.

ALEX COHEN: Here's the language Whitney Hawthorne(ph) uses to describe herself.

Ms. WHITNEY HAWTHORN (Student): I'm - I wouldn't say fat, but I'm not the skinniest person.

COHEN: Whitney is five foot three and weighs 170 pounds. She's 12 years old. If she were an adult, she'd be classified as obese, a word Whitney says that hurts.

Ms. HAWTHORN: I'm fat, that's what I hear.

COHEN: And as tears start to well up in her eyes, Whitney says that's not really something she wants to hear, but at school she often does.

Ms. HAWTHORN: They will like make rude remarks, like one girl, when I walk she would say, like, blubber blubber blubber. She wouldn't actually say you're fat, but she would like tell me stuff that makes me feel like I am. When it happens, I get mad, but I don't want to start a fight or anything, so I start to cry.

COHEN: So how do you talk to Whitney about her weight? It's an issue her mom, Tommy(ph), struggles with. Tommy, who was also heavy as a child, says adults need to choose their words carefully. She doesn't want Whitney to develop an eating disorder.

Ms. TOMMY HAWTHORN: I think if they use words like obese and stuff, a lot of times a child will be more ashamed, and sometimes that leads to more eating. I went through a lot of that when I was younger.

COHEN: For the most part, the medical community agrees that words like obese are too harsh to use with kids and teenagers. The Centers for Disease Control and Prevention recommends softer language. It uses these two categories for anyone under the age of 20: at risk for overweight, and overweight.

But what exactly does at risk for overweight mean?

Ms. CYNTHIA HAINES (Dietician): It seems a little confusing to me. It sounds like, well, you're not overweight right now but you might get that way. And it's pretty obvious that the kid is overweight now, but we just don't define it in any way.

COHEN: That's dietician Cynthia Haines. Though she doesn't like the phrase at risk for overweight, she says she understands why many healthcare professionals use it.

Ms. HAINES: I think parents don't want to hear that their children are overweight. I run into that a lot. A parent may feel personally responsible for that child being overweight.

COHEN: To make both parents and kids feel comfortable, Haines's solution was to come up with her own terminology. She usually opts for these two words: weight problem.

Ms. HAINES: A problem is something you can get your mind around and do something about. Obesity is a state of being. I don't like for people to be labeled as having this state.

COHEN: But when a child weighs 50, 60, 70 pounds more than they should, that's more than just a problem, says Reggie Washington. Washington is co-chair of the American Academy on Pediatrics Taskforce on Obesity. He says the debate over semantics always stirs up controversy among doctors. But to him, the solution is clear: be frank. Washington says he regularly uses the term obese with kids.

Dr. REGGIE WASHINGTON (American Academy of Pediatrics Taskforce on Obesity): I try to be as sensitive as one possibly can be when bringing that up, but I think they need to hear those terms.

COHEN: Washington is part of an expert panel which will convene tomorrow to discuss whether the current terminology used by the CDC needs updating. He thinks it does and that the words used to describe kids should be the exact same ones used for adults. Doctors shouldn't candy coat their words when talking about disease, Washington says, even when dealing with children.

Dr. WASHINGTON: We don't do that if the child had a brain tumor. We don't do that if the child had congenital heart disease. And this is ever much as important of a health issue.

COHEN: Washington says it's unlikely that healthcare professionals will ever agree to use one set of words, but that may be okay. After all, he adds, the language adults choose to describe a kid's weight problem is important, but not nearly as important as the language they choose to talk about the solution.

Alex Cohen, NPR News.

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