Oblivobesity: looking over the overweight that parents keep overlooking.

[Author Affiliation]David L. Katz. Editor-in-Chief, Childhood Obesity; Director, Yale University Prevention Research Center, Griffin Hospital, Derby, CT.Arecent study reported in the British Journal of General Practice examined the correspondence, or more aptly the lack thereof, between the BMI of nearly 3000 children and parental perception of weight status.1 Parents tended to recognize children as overweight only when they were above the 99.7th population percentile; the official cut point is set at the 85th percentile. Translating this into raw numbers, nearly one of three parents underestimated the weight status of their children. From the parental perspective, only 4 of 2976 children in the cohort were very overweight (i.e., BMI above the standardized 95th percentile). Objectively, that number was 369.Invited to do so by the BBC,2 the researchers speculated that the excess weight of a given child was hard to spot against a rising population mean. In other words, as the average weight of children in the UK rises, what every parent considers normal seems to rise with it.This is by no means the first time we have heard about prevalent, at least relative, parental obliviousness to obesity in children. The tendency has been reported in New Zealand,3 Native Americans,4 the general population in the United States,5 Australia,6 Belgium,7 Ireland,8 and Pacific Islanders,9 at least. With a global footprint, the predilection may warrant a name all its own: oblivobesity.Parental obliviousness bedevils our responses to rampant childhood obesity in ways that are largely self-evident. Whether or not knowledge is reliably power,10 denial and delusion are reliably disempowering. We do not always fix what we know to be broken, but we virtually never fix what we are overlooking--whether at the personal level or that of our culture. Climate change and its consequences, such as drought, illustrate this all too well. As long as the problem could be denied, few, if any, societal resources were directed to solutions. With regard to health, the best examples of costly denial are perhaps alcoholism and addiction, where acknowledgment of the problem is uniformly recognized as the first part of the solution.But the pursuit of objective information to supplant parental misperception is controversial. 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.11 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, and we are thus obligated to ensure that the acquisition of accurate data, and the enlightenment of families to trouble under their roof, does not invite such unintended consequences. If we are to eradicate oblivobesity, it will not be with objective measures alone, but also with compassion, guidance, and empowerment in the mix. If, instead, we choose not to know what our kids weigh, and whether or not it is a threat to their health, it invites potentially grave consequences, some quite predictable, others rather less so.Two reports within the past year address such dangers. The first, issued by the CDC in July 2014, used a representative sample of children and adolescents in the United States to compare actual weight with perceptions of weight.12 The principal finding was that more than 80% of overweight boys and 70% of overweight girls misperceived their weight as "normal. …