May 26, 2000 -- Are obese children considered the norm? If their parents' perceptions are any indication, they may well be. It seems even in the face of overwhelming evidence, the majority of parents with overweight children do not see them as being too fat.
While this may bode well for their children's self-esteem, researchers fear that it may underlie a growing public health epidemic that could lead to serious consequences.
One of these consequences is type 2 diabetes, a condition that, until recently, was seen only in the adult population. In contrast to type 1 diabetes, type 2 diabetes is strongly associated with obesity.
"As recently as 15 years ago, the only diabetes we saw in the pediatric age group was type 1 diabetes," Patrick Casey tells WebMD. "The numbers of children developing type 2 diabetes is just skyrocketing." Casey is a professor of developmental pediatrics at the University of Arkansas for Medical Sciences in Little Rock.
Two recent studies looked at caregivers' perceptions of their children's weight and compared them to reality. One study that looked at a population of African-American, Hispanic, and white children of lower-income families found that of the parents whose children were considered by clinical evaluation to be obese, only 28% saw them as being overweight. Of those studied, 8% even went so far as to say their child was underweight.
"Related to this, we also found that Hispanic children had the greatest percentages of obesity, with black and whites following respectively," Barbara A. Dennison, MD, writes in a press release. Her study was presented at the recent joint meeting of the Pediatric Academic Societies and the American Academy of Pediatrics.
Dennison and her colleagues at Bassett Healthcare Research Institute in Cooperstown, N.Y., found that neither race, ethnicity, nor education made a difference as to how parents of overweight and obese children viewed them. They did find that those who viewed their children as being overweight tended to limit food intake yet use dessert as a reward for finishing dinner. They also linked the amount of TV watching with those children who were most overweight.
Another study from the University of Maryland that looked at an African-American population of children found the same skewed perception, and that it crossed socioeconomic barriers.
Deborah Young-Hyman, PhD, CDE, primary researcher for the study, tells WebMD that parents can not connect their children's obesity and its relationship to health problems like type 2 diabetes.
Diabetes is a very silent disease, says Young-Hyman, whose study appears in the May issue of Obesity Research. Often, people have it long before any real symptoms occur. These parents see diabetes as an adult problem, and since their children are healthy, they cannot relate to it, she says.
She also says there is a sort of "love is blind" phenomenon called optimistic bias, in which the parent just cannot perceive the child as being either overweight or at risk for health problems. Young-Hyman is an associate professor of pediatric medicine and an endocrine psychologist at the University of Maryland in Baltimore.
So what's a parent to do?
Young-Hyman says parents need to be role models for their children, bring their concerns about weight to their pediatrician or primary care doctor, encourage exercise, particularly in the form of play, and be their child's advocate to help change things such as the foods served in school cafeterias.
Casey, who is one of the investigators of the Delta Project, a huge study looking at the health risk factors in the delta regions of Arkansas, Mississippi, and Louisiana, among which obesity is a focus, says that children and parents need to be educated about proper nutrition and lifestyle changes such as exercise. He adds that obesity in children is becoming a public health epidemic.
Young-Hyman agrees, and says that public awareness campaigns using TV and the news media are needed to hammer home the fact that obesity is not a harmless childhood condition, and that it can carry long-term health consequences.