I walked into the exam room to meet my 14-year-old patient for the first time only to find a very angry mother. Arms crossed and mouth twisted into a frown, her answers to my questions were short and blunt. After just a few questions, I felt the need to break character from the formal pediatric specialist I usually play.
I pulled my chair closer to mom and daughter, hunched towards them and casually asked, “So, let’s take a break … what’s up today? It seems like you’re very mad, and I’d like to help if I can.”
“Well, I’m a little offended by the language the staff used when we got here today,” she replied. I had a moment of internal panic and embarrassment over what she could possibly be referring to in our kind and happy pediatric office.
“Can you tell me what the language was that offended you?” I asked while bracing for her response.
“They keep referring to my daughter with ‘the o word,’” she almost mouthed without sound. “You know, about her weight. We prefer to say that she’s ‘a little heavy’ or ‘chubby’ — but ‘the o word’ is just insensitive.”
As a pediatric endocrinologist, I specialize in treating children with hormonal conditions, including “the o word” — obesity — which is, in fact, a medical condition. In this role, I have seen countless toddlers, children and teens who meet this medical definition of “obese,” and it wasn’t until this visit that someone had taken such offense to the terminology before.
It is important for patients and their families to understand that “obesity” is a body measurement just like blood pressure or liver function. The term is used for physicians to predict the risk a patient has for future health outcomes based on how much fat or adiposity is deposited in their body. Since we can’t easily measure fat percentage in the doctor’s office, we rely on a calculation involving height and weight to give us an estimate. This estimate is expressed as Body Mass Index or BMI which above certain thresholds will confer the most amount of risk for weight-related medical issues.
In children, since height and weight are supposed to increase as age increases, we rely on percentages rather than threshold numbers and compare each child’s measurements to other children of the same age and sex. If a child’s BMI is greater than 85 percent of kids their age, they are considered “overweight” and if greater than 95 percent, they are considered “obese.”
As a physician, I know that a toddler who is obese has a four times greater chance of becoming an obese teenager. I also know that 4 percent of children and teens who come to see me for obesity will already have type 2 diabetes and not even know it yet. Knowing these associations allow me to individualize a plan to care for each child based on their level of risk. For instance, I know to screen for hypertension and high cholesterol in obese children so we can prevent the heart disease they are five times more likely to die from than other children their age. For me, “obesity” is a tool just like any other instrument that might be inside my black doctor’s bag.
I explained to my patient and her mother that a number calculated by weight and height should never feel like a judgment. It is not a grade of how well a parent is raising a child or of what a wonderful person a child is becoming. It gets listed on medical forms right in line with asthma, influenza or eczema. Obesity does not describe who a person is. People are diagnosed with cancer; people are not cancer. Just as children are diagnosed with obesity, they are not obesity. And as their pediatric endocrinologist, I reassured this patient that I will be here to help them fight the battle against this disease — to keep their insides healthy and safe from harm; because after all, it’s what’s on the inside that truly counts.
Dr. Laura C. Young, MD, Pediatric Endocrinologist – Mercy Children’s Hospital