Yes, there is obesity in Egypt; although the situation is far worse in other Middle Eastern countries that have undergone more dramatic cultural transitions in recent years. But that's not really my subject today anyway. Rather, I am invoking the well-known observation that the Nile -- or, rather, "denial" -- is not just a river in Egypt.
Denial bedevils our responses to rampant childhood obesity. Whether or not knowledge is reliably power, obliviousness is reliably disempowering. We don't always fix what we know to be broken, but we virtually never fix what we are overlooking. With regard to health, this most indelibly relates to alcoholism and addiction, where acknowledgement of the problem is uniformly recognized as the first part of the solution.
So as we relinquish the relatively unit-free lassitude of summer, and our kids return to school where the customary application of measures -- attendance, grades, report cards -- will resume, we are invited to confront our ambivalence about their literal "weighing and measuring," amidst the figurative.
When Mike Huckabee, as governor of Arkansas and chair of the National Governors Association, introduced universal BMI "report cards" in the schools of his state, a modest decline in childhood obesity rates statewide ensued. That was a very big deal in a part of the country inordinately prone to this intractable problem. Even so, ambivalence about weighing kids in schools prevails. The worry persists that making kids step on a scale will embarrass or stigmatize them, and sending information about obesity home to parents will, in essence, "blame the victims."
There are legitimate concerns in all that. But if we choose not to know what our kids weigh, and whether or not it is a threat to their health, it potentially leaves us all floating along denial -- with potentially grave consequences.
Two recent studies address the dangers of what I have opted to call our relative obliviousness to prevailing obesity in our kids: "oblivobesity." The first report, issued by the CDC on July 23, used a representative sample of children and adolescents in the U.S. to compare actual weight with perceptions of weight. The principal finding was that more than 80 percent of overweight boys and 70 percent of overweight girls misperceived their weight as "normal." The frequency of such misperception declined as socioeconomic status rose, indicating that families with more resources were more likely to have heightened awareness of healthy weight.
A related paper, published about a week later in Preventing Chronic Disease, also compared actual and perceived weight in a nationally representative cohort of children and adolescents. The researchers then went on to look at the correlation of these measures with attempted weight loss. As in the earlier paper, a high percentage of kids -- and their parents -- underestimated their weight. This group was roughly three times less likely to attempt weight loss than overweight kids who accurately assessed their weight.
Among the relatively small percentage of kids who over-estimated their weight, the rate of attempted weight loss was more than nine times higher than among kids who perceived their weight status accurately. This is an alarmingly high rate of "dieting" among kids who have no need to lose weight in the first place, and clear cause for worry about incipient eating disorders.
So our disinclination to weigh our kids routinely is not sparing them our culture's unfortunate preoccupation with weight. It is merely distorting their perspective of their own weight, what is healthy, and how to get there from here. Our kids are prone to the perils of a societal preoccupation with weight, rather than a focus on health and the lifestyle factors that support it. Eating well and being active are important regardless of weight, because they promote health. Weight is merely one among many measures that suggest something about overall health -- albeit an important one.
There is an alternative to oblivobesity that doesn't involve obsession with weight, that doesn't blame the victim, that doesn't ostracize the overweight child, and that doesn't imply bathroom scales measure anything important about human worth. That alternative is a focus on health and family, love and the long term.
Should we know whether or not our kids, or ourselves, are overweight? Of course, just as we should know -- before a mechanical calamity -- that the oil in our car needs changing, or our tire pressure is low. Obesity in our children, as in ourselves, is associated with a genuinely dire array of potential consequences. Avoiding these is best done with early intervention, rather than late.
As for that intervention, there will be times -- at the extremes -- when it will need to be clinical. But if we are constantly aware and efficiently responsive, there won't be nearly so much heavy lifting involved -- and the solution can be cultural instead. Families can increase their devotion to eating well and being active, together, and thereby help a child lose weight, and more importantly, find health. But not alone, and not encumbered by shame or blame. Together, and because of love.
Knowledge may or may not translate into power. Obliviousness far more reliably translates into powerlessness. We cannot ignore the threat of obesity to our children and still hope to fix it. We can, however, fix it, without fixating on it. The BMI is just a measure of potential health risk, like a dashboard indicator light. When it flashes, it is not an indication of failure or neglect, but an invitation for corrective action before things go from bad to worse.
I hear the Nile is lovely this time of year. But the future health of our kids is at stake. So I think we can and must do better than float along, oblivious.
-fin
David L. Katz, MD, MPH, FACPM, FACP is the founding director of Yale University's Prevention Research Center, President of the American College of Lifestyle Medicine, Editor-in-Chief of the journal Childhood Obesity, and the Childhood Obesity expert for About.com. He is the author of Disease Proof - which preaches what he practices. He and his wife Catherine have 5 children.