Two toddlers graced my exam room last month - fraternal twins, one screaming nonstop for the duration of the visit, the other looking around pleasantly, throwing a winsome grin to anyone making eye contact.
Both ate the same foods and kept to the same schedule. But the weight of the protester was considerably less than the mellow sibling's. Did you know that crying burns calories? (Good tip to keep on file.) The twins showcase the important role that personality and metabolism play in body type.
The news shouts to us every day: American children are fat and getting fatter. By some estimates 25 to 30 percent of American children have excess body weight, and there has been a 2.3- to 3.3-fold increase in childhood obesity over the last 25 years.
As panic over these trends escalates, we need to make sure our time and effort spent fighting the epidemic are not wasted. Weight is a very complex issue, and overzealous efforts to control it can lead to eating disorders, self-image problems, and ultimately, ineffective results.
Increasingly, pediatricians are being asked to solve this problem, and while they play an important role in identifying weight issues in their small patients, the solution needs to involve everyone.
Children watch too much television and play too many video games. Streets are unsafe. Parents are too busy for family dinners and are gaining weight themselves. Restaurants supersize portions. Schools cut back on recess. The heavier a child gets, the less likely he or she is to participate in sports, exacerbating the vicious cycle of more eating and less exercise.
One misguided attempt to curtail this pattern is to measure pediatricians' performance in managing overweight children. One quality measure recently proposed by insurers was to have each overweight child sent to a nutritionist. The pediatrician would receive a passing grade only if the visit actually took place; the referral alone was inadequate.
Another proposed "quality" measurement for pediatricians would be documented weight loss in an overweight child. Coming next: your friendly pediatrician making house visits to see if you have Twinkies in your cupboard.
Pediatricians would love to be able to solve the obesity problem. But we're also busy addressing literally 299 other public health issues from seat belts to sunblock use. And there's little evidence that what we do - counseling heavy children to eat better and exercise more - is actually effective.
While understanding nutrients is an important part of a general education, research has not demonstrated that sending children to nutritionists leads to weight loss. Any weight-conscious adult understands that just knowing that a carrot has fewer calories than a brownie is hardly the road to sustained, lifelong good health. Similarly, simply telling a child to get an hour of active exercise a day is unlikely to stick.
Pediatricians are told to address obesity straight on with parents. But that's tricky - we mostly see parents when their children are in the exam room, and a pointed comment about being "fat" or "chubby" can lay the groundwork for a later eating disorder or crisis in self-image.
A recent uncomfortable exchange with a mother of three adorable girls I care for highlights the rocky shoals of weight discussions. All three girls were adorable and slightly chubby, but it was obvious that their mom did not want the girls to hear of weight concerns. At each visit we discussed healthy foods, exercise, and their growth charts.
One of the girls had seen one of my colleagues on a weekend, and the doctor had brought up the weight issue quite directly. The mom was furious, although the doctor was doing exactly what the pediatric pundits suggested.
It's helpful when a parent will contact me in advance of an appointment to discuss concerns about body weight, which some do. But a parent in denial about a child's weight problem won't call.
A startling new poll from the University of Michigan's C.S. Mott Children's Hospital revealed that of 2,000 children ages 6 to 11, 25 percent were found to be overweight or obese. But only 13 percent of the parents described their child as having a weight problem.
The rise of childhood obesity is real and serious. Future problems in overweight youth include high blood pressure, increased cholesterol, insulin resistance leading to Type II diabetes, bone and joint problems, disordered sleep, depression, social alienation, and early sexual maturation.
Pediatricians are trying to reverse the trend, but every citizen has a role to play in this epidemic.
Dr. Victoria Rogers McEvoy is chief of pediatrics of the Mass. General West Medical Group and assistant professor at Harvard Medical School.
