Child obesity: Who are you calling fat?
Child obesity can be a taboo subject.
Doctors can struggle to talk to parents who feel they are being accused of poor parenting, which is why healthcare professionals may need guidance in tackling the problem, especially when parents cannot see there is one.
From Turkey Twizzlers to MPs suggesting a correlation between a child's weight and their social background, obesity is a hot topic and an ever-growing public health issue.
The reality can be devastating for families with children taken into care for being obese, or suffering long-term health problems.
Children unable to lose weight as they grow older may develop chronic and life-threatening diseases such as Type 2 diabetes and heart disease.
Obesity is also a huge cost to the public purse, and experts predict that it will result in the health service paying out £6.3bn by 2015.
So how should doctors intervene?
While friends and family may be afraid to comment on a child's physique or put the excess weight down to "puppy fat", a doctor should not ignore tackling the issue openly with parents who may be in denial.
Studies have suggested that parents' judgement is poor regarding weight, with 75% underestimating the size of an overweight child and 50% failing to recognise that their child is obese.
More worrying is that there are similar findings for the perceptions of healthcare professionals.
Due to changes in the delivery of health services, patients will often see different GPs or practice nurses over a period of time.
This has eroded the unique relationship once had with the family doctor and can mean that GPs feel reluctant to raise sensitive issues during a one-off consultation.
It is not surprising that there has, anecdotally, been a noticed increase in the number of complaints made by parents about the manner and attitude of doctors, especially when discussing weight issues about children.
To avoid a conversation spiralling into a misunderstanding or complaint, GPs need to use tact and show compassion otherwise they could be perceived as critical or judgemental.
When I listen to the two accounts of a consultation which is the subject of a complaint, it is interesting that there are very different recollections of what was said.
Parents often hear very different messages to what the doctor may have said, as emotions are already running high, and they could interpret advice or observations as criticism of their parenting skills.
Although doctors and nurses should raise these issues in a sensitive manner, they also have to be clear that they are doing so for the interests of the child, even if they are met with resistance from the parents.
Healthcare professionals who are knowledgeable about the support and services available to parents should therefore be able to lead a constructive discussion. Doctors also appreciate that there is often a psychological element in obesity.
They may consider discussing issues with a child alone if they are felt to be competent (have a sufficient level of understanding). This may highlight specific concerns the child has and help them open up about bullying or symptoms and signs of eating disorders.
Unfortunately, there has been a lack of education on the subject of childhood obesity in healthcare undergraduate and postgraduate training.
Even though much emphasis is now placed on communication skills training for doctors, very little is provided for dealing with interactions with children or those from different cultures.
Perceptions about weight can be very different in different countries and what one may see as "healthy" another would term as "fat".
Doctors need also to be familiar with the real physical differences between races with BMI scales being adjusted accordingly.
There is a growing focus on educating the population at large about the risks of childhood obesity and how it can be tackled, but in the meantime healthcare professionals play a significant part in helping parents realise and address weight issues facing their children, and would benefit from greater guidance on when and how to intervene.
No easy task, especially when society still shies away from openly discussing the issue of child obesity in a non-judgemental way.