How Should NP's Address Weight With Children?

As a nurse practitioner, there are times you really should tell a parent their child is fat.  I am in favor of being upfront and honest, but beginning a routine child physical by calling a kid "fat" doesn't usually lead to open discussion with parents.  It pretty much ends the conversation.  So how do you address the issue of overweight children with parents in a manner that is direct and honest but allows for discussion?

In her blog, Sizable Issues, Dr. Rebecca Puhl reviews a study she published in Pediatrics examining how parents respond to discussions about their child's weight.  Parent's were asked how they felt when their child's doctor used the words "extremely obese", "high BMI", "weight problem", "unhealthy weight", "heavy", "obese", "overweight", "chubby" and "fat".  Parents rated these terms as either stigmatizing, undesirable, blaming or motivating. 

Dr. Puhl’s study found that parents perceived the terms “weight” and “unhealthy weight” as the most desirable and the terms “unhealthy weight” and “weight problem” as the most motivating to lose weight.  The  terms “fat”, “obese” and “extremely obese” were regarded as stigmatizing and blaming. 

Although a conversation about a child’s weight can be uncomfortable for the parent, child and healthcare provider involved, these conversations are important.  Discussing weight with parents and children can ultimately lead to a healthier lifestyle and is crucial in preventing future health problems.  Based on this study, maybe we should begin to use the term “unhealthy weight” rather than “obese” with our pediatric patients.