• How deep can we get our heads underground?

    Here’s a study* that makes me want to cry:

    Objective: To examine time trends in parental reports of health professional notification of childhood overweight over the last decade and to determine the characteristics most associated with such notification.

    Design: Secondary data analysis using 2 tests to examine the relationships between multiple factors on the reports of parents and/or caregivers (hereinafter “parents”) and logistic regression for multivariate analysis.

    Setting: National Health and Nutrition Examination Survey, 1999 through 2008.

    Participants: Parents of 4985 children aged 2 to 15 years with body mass index (BMI) in the 85th percentile or higher based on measured height and weight.

    Main Outcome Measures: Affirmative answer to the following question: “Has a doctor or health professional ever told you that your child is overweight?”

    This study couldn’t be simpler. The parents of nearly 5000 children who were over the 85th percentile for BMI were asked if they had been told their child was overweight (they were). Know how many said yes? 22%.

    Only 22%! There are times I despair. Only about one in five parents whose child was overweight reported that they had been told so by their physician. I don’t know whether this is because their doctors actually didn’t tell them, or because they didn’t hear. Either way, it’s depressing. There is a serious obesity problem in the US, and we’re having trouble even admitting it exists.


    *Full disclosure: I know the authors quite well, and would call them friends.

    • Hey Aaron,
      Its not exactly like these parents don’t know their children are overweight. The problem is that parents can’t identify correctly the number of calories that their kids should be having. That is a much larger issue that I’m not sure has been under investigation enough.

      • I disagree. I think there is evidence that parents actually underestimate their children’s weight to a shocking degree. I’ll see what I can find.

    • There’s a spectrum of conclusions that one can draw from this study, but it’s not clear that they are equally plausible and well founded. The most narrow conclusion is that doctors who treat overweight children aren’t telling parents that their kids are fat. The broadest conclusion is that people with extremely overweight kids don’t know they are obese and can’t possibly make that determination on their own without a physician telling them so.

      The narrow conclusion is the most plausible and useful, inasmuch as it might prod physicians to overcome their reluctance to broach an uncomfortable issue that parents are likely (painfully) aware of but have been/are unable or unwilling to address and/or attempt to remedy. Variations of the broader claim (parents know that their children are heavier than average but don’t have an accurate understanding of the health consequences, are aware that their kids are overweight but aren’t willing to make the kind of concrete admission to an authority figure like a doctor, or to a survey question that would force them to acknowledge that they have a serious deficiency as parents, etc) are plausible.

      The notion that parents are oblivious to everything from the what they see with their own eyes to the taunts and slights that their kids endure amongst other children is wildly implausible. It’s also worth noting that not everything that shapes behavior, attitudes, etc or occurs in society can be accurately captured in a survey. I can vividely remember a woman who’d been reared in a virtually all white East coast prep school telling me that a destructive racial dynamic that I’d observed in my much more diverse and downmarket high school didn’t actually happen “because their were studies” that said so.

      • I’m not disagreeing with you. This study was about doctors’ actions, and that is what I was commenting on.

        Separately, I also think that parents also have their heads in the sand, but let me look for some data on that before I blog on it.

    • Edit “can’t be”

    • I remember this study from last year:

      “20 percent of parents with overweight or obese kids actually chose an image that was smaller than the healthy weight image to indicate their own child’s size.”


    • See this study about parents’ misperceptions of their children’s obesity:

    • I can see that happening in a clinical setting – but if the parents of the same kids were at the beach and their was standing next to an underweight kid of the same sex, race, height, and age wearing the same swimsuit right next to them and they were positioned such that from the parents’ perspective both of their were obscured by a sign – they’d be able to pick out which kid was theirs.

      Or take the original study and tell them they’ll get $10,000 if they pick the image that correctly correlates with their children size and the odds are high that the parent’s will be right on target.

      Admitting that there’s something potentially wrong (even a relatively benign and highly correctable health issue) with a child is immensely painful, and doubly so when doing so is tantamount to admitting that the way you’re raising them is to blame is doubly or triply so. The odds are high that the parents are also obese and throw in confronting their own issue into the mix and you’ve got a lot of defense mechanisms in play that can easily confound study results unless there’s an upside that can more than compensate for the emotional pain that accompanies explicityly acknowledging painful realities.

      There probably are parents who have willingly, or unwittingly duped themselves into believing that their obese children are vastly less heavy than they are – but I suspect that the number is smaller than the results from clinical and survey data suggest. Call it the bariatric equivalent of the Lake Wobegone effect.

    • Edit “both of their heads were obscured by a sign”