Raising Awareness Of Weight As A Health Issue

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It is critically important that parents view childhood obesity as a health issue and realize that obesity can have a deleterious impact on physical as well as mental health, both during childhood and later in life. Yet parents of overweight or obese children do not always recognize their child's weight status and many are not fully aware of its adverse consequences (Young-Hyman et al., 2000; Etelson et al., 2003; Maynard et al., 2003).

Because children often exhibit idiosyncratic growth patterns, it is important to evaluate a child within the context of his or her own particular growth history as well as relative to a healthy and appropriate reference population. For individuals under 20 years of age, BMI is a complex concept; not only do weight and height change as the body grows, but body-fat content and muscular development are also changing, and there are significant gender differences in the pattern of change. Thus it is important to use gender- and age-specific BMI percentiles to determine whether a particular child has excess weight.

During infancy, parents tend to be well aware of their child's weight and height, and it is not unusual for them to know where his or her measurements fall on the health-care provider's growth curves, which are derived from reference populations of healthy children of the same age and sex. However, as children grow, and particularly in the late elementary and middle- and high school years, this information often is not familiar to parents—unless they think their child is failing to grow, which may sensitize them to the need for careful monitoring and tracking. Parents may also notice particular periods of height change, as when the child rapidly outgrows his or her clothes. Because of the variable timing of growth spurts, and the sometimes dramatic changes in body composition with age, continued monitoring of growth on an annual basis is warranted; if concerns arise about the child's growth trajectory, parents should then discuss these issues with a qualified health-care professional.

Routine determination of children's BMI percentile, and regular communication between parents and health-care providers regarding their child's BMI-percentile history and current status, are crucial to increasing the knowledge base of parents regarding their child's growth pattern and weight status. Parents also need to be aware of the strong connection between good nutrition and physical activity to the child's weight—and to his or her health. If excessive weight gain is observed, it is important for parents to discuss follow-up steps and behavior changes with their child's health-care provider (see Chapter 6). These discussions should be sensitive to parental concerns about the stigma of obesity and its potential impact on the child's self-esteem and should take care to allay concerns about eating disorders (Borra et al., 2003).

Just as vaccination schedules require parental intervention during childhood, parents should be discussing the prevention of obesity with their health-care providers to make sure that the child is on a healthy growth track. Parents should consider the weight of their children to be a critically important indicator of health. They should ensure that a trained professional routinely (at least once a year) measures their child's height and weight in order to track his or her age- and gender-specific BMI percentile.

But given that many families do not have the health insurance to cover preventive services, and these types of health-care visits may therefore impose a financial burden, the committee also recommends (in Chapter 7)

that schools conduct periodic assessments of students' weight status and provide the resulting information to parents—and to the children themselves, as age-appropriate.

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