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March 8, 2006 -- Parents often don't recognize that their children are overweight or aren't concerned about those extra pounds, a new study shows.
The study, published in Pediatrics, included 223 children. Nearly 40% of the kids were overweight or at risk of becoming overweight.
"Few parents of overweight and at-risk-of-overweight children recognized their child as overweight or were worried," write Kathryn Eckstein, MD, and colleagues, noting that past studies have had similar results.
Eckstein's team wants that pattern to change, since recognizing a weight issue is the first step toward treatment. So they came up with several ways parents can take control of the touchy topic of kids' weight.
Getting Visual
Eckstein worked on the study while at the University of Tennessee's medical school. She's now in Boston at the Harvard Longwood Psychiatry Residency Training Program.
Eckstein's team asked parents if their kids were "overweight" or "a little overweight." Few agreed, even if those descriptions were accurate.
Parents were better at picking sketches that looked like their child's body. The drawings showed kids of various shapes, ranging from very thin to several times larger.
In short, parents knew their kids' bodies. But they didn't always know when kids crossed the line from "normal" to "overweight."
"Sketches might be useful as a research tool," Eckstein tells WebMD.
About a quarter (26%) of those with overweight or nearly overweight kids voiced concern about their kids' weight, the researchers report.
Talking About It
Parents were more likely to recognize their child's weight problem and be concerned about it if a doctor had mentioned it, the study shows.
"I think that was actually an important and kind of encouraging finding, that if the physicians have indicated concerns, that that may heighten the parents' level of concern," Nancy Krebs, MD, MS, tells WebMD.
Krebs co-chairs the American Academy of Pediatrics' Task Force on Obesity. She's also a pediatrics professor at the University of Colorado's medical school.
Parents can ask doctors if their child's weight is keeping pace with growth. Waiting for a doctor to broach the topic isn't necessary.
In Eckstein's study, most parents of overweight or nearly overweight children said they didn't recall a doctor mentioning their child's weight problem. Those reports weren't confirmed.
Taboo Topic
When it comes to discussing kids' weights with parents, "so many docs don't want to go there," Krebs says. "They don't want to talk about this."
She sees several reasons for that reluctance. "One is that there's a perception that you can't do anything about it, and ... that parents don't want to change, they don't want to talk about it."
"It's considered a sensitive topic," Krebs continues. She adds that some doctors may get frustrated when they bring up the topic and then see no changes in their patients.
"These are huge issues. They're not easy," Krebs says, talking about behavior changes -- like eating more healthfully and boosting physical activity -- that can lead back to a normal weight.
Lagging Behind, Lingering 'Baby Fat'
Parents were more concerned about their kids' extra pounds if their kids were less active or slower than their peers, the study shows.
Evaluating kids' fitness could help flag the problem, Eckstein notes.
Ideally, parents would recognize weight problems before kids start lagging behind, Krebs says. "By the time they're to that point, it's already pretty far along," she explains.
Will kids outgrow their baby fat? Some people think so, and "some children do," says Eckstein.
But others stay heavy into adulthood. "Unfortunately, in our current environment, I don't think it's as high a likelihood as it used to be that they will outgrow it," says Krebs.
Being overweight is associated with health problems, some of which start in childhood, Krebs says. But not all overweight people have health problems, and slenderness doesn't guarantee health.
Banish the Guilt
Parents aren't solely responsible for kids' weight issues, Krebs notes.
"This is a very wide-ranging issue," she says. "It involves schools; it involves advertising; it involves our communities and how they're set up ... it's very broad-based," she says. "It's not a matter of just what the parents are offering for food.
"But at the core, the parents need to be involved," she continues. "It's a society problem, but there are things that the individual family can do."
She suggests well-known steps such as eating healthfully, not going on temporary diets, limiting couch potato time, eating breakfast, keeping TVs out of kids' bedrooms, and getting outside for physical activity.
The point isn't to go overboard or make kids feel badly about their bodies but to promote healthy habits that last a lifetime.
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Comparing your child with other kids might not be helpful.
Many more kids -- and adults -- are overweight than in the past. About 16% of U.S. kids aged 6-19 years were overweight in 1999-2002, says the CDC. That's a 45% increase since the late 1980s and early 1990s.
"We have gotten kind of a distorted view of what's normal," Krebs says. "Because it's so common now to be overweight, children that are actually normal weight may appear to be thin."
She adds that it's often tough to tell whether a child is slightly overweight based on looks alone. Growth charts and BMI charts can show whether a child is on track, says Krebs.
Serving as Role Models
Many parents in Eckstein's study admitted that they hadn't met their own goals for physical activity.
Did parents' weight influence views of their kids? "That certainly may be related, but we did not measure that," Eckstein says in her email.
She offers this advice to parents:
"Your children are watching you and will follow what you do," Eckstein writes.
SOURCES: Eckstein, K. Pediatrics, March 2006; vol 117: pp 681-690. Kathryn Eckstein, MD, Harvard Longwood Psychiatry Residency Training Program. Nancy Krebs, MD, MS, co-chair, American Academy of Pediatrics' Task Force on Obesity, pediatrics professor, University of Colorado School of Medicine.