Is your child too fat? Your doctor may be the only one brave enough to tell you.
With childhood obesity reaching epidemic levels in North America, doctors in the United States are being urged by the American Medical Association to talk to parents in stronger terms about their children's weight and to use the medical terms obese and overweight in more cases.
This sort of tough-love approach is increasingly being promoted by obesity and diabetes researchers across North America.
At the American Diabetes Association conference ending today in Chicago, International Diabetes Federation researchers proposed adding waist measurement to regular checkups to monitor children more closely for obesity.
The norm for measuring appropriate weight is currently the popular Body Mass Index measure, modified for age and gender.
At a Toronto conference this week on physical activity and obesity in children, researchers are presenting their findings on the role of exercise in countering obesity.
Some front-line medical experts are uncomfortable with the new approach.
Doctors have long avoided the blunt medical terminology - including words such as obese - for fear that "we're going to stigmatize children, we're going to take away their self-esteem, we're going to label them," said AMA spokesman Dr. Reginald Washington in a statement last week.
"I don't like the word obesity; I think it has a very negative sound to it," says Randy Calvert, who treats overweight and obese kids as manager of the Children's Exercise and Nutrition Centre at McMaster Children's Hospital in Hamilton.
"If we are trying to combat the epidemic of obesity we need to try and do that in a very positive way."
While stigmatization remains a concern, doctors say they need to offer parents more detailed measurements, including waist circumference data.
Parents often don't want to hear the message that their child is overweight, says diabetes expert and paper author Dr. Paul Zimmet of Monash University in Australia on the phone from Chicago, where he is attending the diabetes conference.
Faced with more objective measures in the hands of doctors, though, it could be harder for parents to escape the serious health message about the dangers of obesity.
"Waist circumference is the big topic in obesity and diabetes right now," says Dr. Zimmet, whose work is published in this week's edition of the Lancet. Integrating the measure into children's health assessments is the next step.
In Canada, the childhood obesity rate has tripled over the past 15 years, says one of Canada's top researchers in the field, David Lau. Dr. Lau, a professor of medicine, biochemistry and molecular biology and chair of the Diabetes and Endocrine Research Group at the University of Calgary, is also attending the Chicago conference.
"The current generation of teenagers may well have a shorter life expectancy than their parents," he says.
"The whole idea is talking about, in more ways than one, preventing obesity to prevent diabetes. We're all looking for answers and for new information to see what we can do to combat the obesity epidemic."
While the medical community is busy rethinking the doctor's visit, persuading parents of the seriousness of childhood obesity remains a challenge. To make such diagnoses more palatable, experts such as Dr. Calvert at McMaster suggest that doctors put a positive spin on telling parents how to alter their kids' behaviour.
"Rather than telling someone to stop eating something, we ask them to try something else."
Before that discussion can take place, though, many parents have to be persuaded their kids are actually overweight, says Dr. Lau.
"For the longest time, a little bit of baby fat was okay," he says.
"Some parents don't know how much to feed their kids. If their kids are hungry, they just keep feeding them."