Parents of overweight children don't know their children are overweight
theincidentaleconomist.com
theincidentaleconomist.com
Such abstract thinking just doesn't come naturally. We are incredibly biased here because our jobs often require little else except abstract thinking. This is massively atypical.
Getting across the concept that the latter terms were - in the context of the source - medical definitions and not going to change with the (ill-defined) average, was difficult at best. There was a lot of "but obviously being overweight means you are above average".
I'm not surprised to see others observing the same issue in different contexts.
Which obviously makes no sense whatsoever: the one person who gets enough food during a famine is not overweight (could be, but that's independent).
Is it really "abstract thinking" to accept an arbitrary "medically-established ideal weight range"? Shouldn't we evaluate the criterion set by the medical community too before we accept it? I hear constant criticism of the BMI system for determining healthy weights, yet I've never really known another standard system.
While I agree that it's bad to compare your chubby kid to the obese kids and write off the weight problem because fatter children exist, I'm not sure how far we should run with the insistence on conformity to numbers like BMIs.
If my children are in the "overweight" BMI range (which isn't applicable to them yet as both are under two) but I still feel that they've been exercising, eating well, etc., and are generally healthy, I'm not going to sweat it.
It's true, not all health conditions are correlated with being overweight. However, a good many of the deadliest health conditions, including heart disease, stroke, cancer, and diabetes are very well correlated with weight. Saying we should discount the effect of weight on health because my weight doesn't predict my susceptibility to car accidents strikes me as misguided.
>To my knowledge, there is no single score or data point that can be used to accurately assess an individual's health.
That's true, but it's also meaningless. There isn't a single score that allows you to predict everything. But, for most people, BMI correlates quite well with the "big-three" medical ailments: heart disease, stroke, cancer. I think that's valuable enough.
http://www.breitbart.com/article.php?id=CNG.c7aaeb7940626693...
http://www.oregonlive.com/health/index.ssf/2009/06/portland_...
PS: This difference could be social vs physical with more active people taking more risks in their daily lives.
It's not my intention to make such a statement. BMI does have a usage, but it's more nuanced that most people realize and I wished to point that out.
> But, for most people, BMI correlates quite well with the "big-three" medical ailments: heart disease, stroke, cancer.
Do you have any more information or citations for this? It was my understanding that BMI alone was not enough of a predictor for certain ailments and conditions and that usually medical professionals also look at additional risk factors in conjunction with BMI, such as family history or habits like smoking.
BMI boils down to a ratio of weight to height. The fact that this definition doesn't include the word "fat" ought to be a clue that it won't be entirely successful as a measure of a person's fatness. In particular, because muscle tissue is significantly denser than fat. Thus, a couch potato and an athlete, each having the same height and girth, will score such that the couch potato will have a better BMI score than the athlete: BMI penalizes exercise to the extent that it generates muscle mass.
A much more informative measurement would be the body fat percentage. But even this falls down. Apparently there are two kinds of fat. Subcutaneous fat poses little health risk. Internal fat, surrounding the organs, is where the potential problems begin.
The lower half of the "overweight" range is more ambiguous, but statistically speaking the health risks for this range are much less as well (and some studies have determined people in that range to be on average healthier than those in the normal range, perhaps because it includes more physically active people with more muscle). But if your BMI is at a level associated with severe physical health risks (30+ and especially 35+), it's unlikely that muscles are the explanation unless that's obvious.
My numbers: 6'5", 233lb, BMI 27.6 (solidly overweight), squat 180, bench 160, press 120, snatch 90. All numbers are 5 rep work sets except snatch, which is 3 rep work set. ORM might be higher.
The problem is that BMI was designed for sedentary people. It's a good guideline, but it's no substitute for a pinch test.
It is abstract thinking as opposed to concrete thinking, because you are imagining a hypothetical child with a certain build, (or is it a set of children with a range of healthy builds?) and comparing your child to that, as opposed to simply comparing your child to the other children you see in front of you every day when collecting your child from school.
And I don't think there's much of a leap in terms of abstraction if you just jump from "compared to the other kids, my kid is ok" to "compared to this number on a chart, my kid is ok". That is just a change in what data point you prefer to reference, not a change in thought patterns.
However, I suspect you are right and - in actual fact - this may really be what the studies are concluding: that parents of overweight children do not see the problem because the average they see around them is not medically-healthy normal. It would be interesting to see the average weights of children in the study areas to see how much the theory stands.
It would also be interesting to see a similar survey that asked whether they thought their child was within the healthy bounds (i.e. no classifications like "overweight" where they could draw comparisons).
From the study: A person's chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval.[0]
One of the authors is quoted as saying: “You change your idea of what is an acceptable body type by looking at the people around you,” Dr. Christakis said.[1]
[0]http://www.nejm.org/doi/full/10.1056/NEJMsa066082 [1]http://www.nytimes.com/2007/07/25/health/25cnd-fat.html
"Respondents were grouped by child body mass index (BMI)
percentile (<5th, 5–84th, 85–94th [at risk for overweight
(AROW)], and ≥95th [overweight])."
Apparently, those parents are not alone in thinking 'overweight' is a relative term.Parent: "He needs to gain weight, right?" Doctor: "Why do you think that?" Parent: "You can see some of his bones!" Doctor: "You're SUPPOSED to be able to see SOME of them."
See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087510/ Age modifies the genotype-phenotype relationship for the bitter receptor TAS2R38
So when some children say they don't like vegetables, it may not be such an illegitimate claim after all. I personally still cannot stand brussel sprouts, into my mid 20s.
I've always been very conscious of my child's weight, because I don't want her dealing with the same feelings of shame, discomfort, lack of energy, etc. that I went through as a kid, or to face the medical problems later in life that I'm now working hard to avoid. This is, for me, a Really Big Deal. Being overweight sucks. I want better for my kid.
If anything, having a kid has helped me, because teaching healthy lifestyle and eating habits by example is far better than telling her one thing and doing something totally different, myself.
On the other hand, I have an overweight friend with a 100+lb, average height, 9yr olds who will argue all day that the kid "isn't fat."
The first link when googling for "lifespan by bmi" is:
http://wehrintheworld.blogspot.com/2009/05/bmi-and-life-expe...
Which cites two metareviews. The first is a collaboration between the UK Medical Research Council, several British organizations including one out of Oxford, and the US National Institute on Aging (which is under the NIH umbrella). It was published in _The Lancet_ (Impact factor: 33). I will quote the quoted part from said blogpost:
> BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5–25 kg/m2. The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30–35 kg/m2, median survival is reduced by 2–4 years; at 40–45 kg/m2, it is reduced by 8–10 years (which is comparable with the effects of smoking). The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases, and is not fully explained.
While I found a few studies that didn't find a correlation (including one in AMA), I can't actually find an academic source for the claim that people with a BMI of 25-30 have the longest lifespan and see lots of claims that the optimal BMI is in the low 20s. Do you have any citations handy?
http://lifehacker.com/5303009/being-slightly-overweight-coul...
Being in a closed room with large, physically unhappy people can be intimidating, never mind that there's a waiting room full of other patients. Rather than addressing ancillary issues head on, it's infinitely more convenient to focus on customer service for their immediate issue.
The issue needs to be addressed in a more benign setting.
Denial's everywhere, I guess.
Tangentially related: I was buying a coat as a gift for my mother, and was perplexed by the sizes. So I went to my local expert: Me: "What's up with all the women's sizes? They're all 1-X, 2-X, etc." Wife: "Oh, 'woman' sizes mean fat. Misses means normal." Me: DOES NOT COMPUTE
So even sizes in stores work to make people feel they're ok. 1X isn't "extra large" It's "woman sized". WTF?
Denial's everywhere, I guess.
Assuming that the claim is true that people with a BMI of 25-30 live longer than any other BMI range, how is believing that claim denial? Or in other words, what do you think that poster is denying?
So even sizes in stores work to make people feel they're ok. 1X isn't "extra large" It's "woman sized". WTF?
There are communities where that's considered a good thing. I recall an episode of 3rd Rock from the Sun where one character was looking for a dress, and was dismayed to find that the standard sizes were designed to make women fill overweight and inadequate (it turned out that the store had been taken over by impossibly-thin supermodel aliens, IIRC).
If the trade-off is between being happy and size X, but dying early, or unhappy and size X, and dying early, which is better? How do you convince people to be happy about where they are by being happy about where they're going?
"... epidemiologists from the ACS (American Cancer Society), American Heart Association, Harvard School of Public Health, and other organizations raised specific methodologic questions about the recent Centers for Disease Control and Prevention (CDC) study and presented analyses of other data sets. The main concern ... is that it did not adequately account for weight loss from serious illnesses such as cancer and heart disease ... [and] failed to account adequately for the effect of smoking on weight ... As a result, the Flegal study underestimated the risks from obesity and overestimated the risks of leanness."
http://www.medscape.com/viewarticle/505703 http://en.wikipedia.org/wiki/Calorie_restriction
Your logic is broken (or you do not present all of it) in a different way: a quick google gives me the impression that for kids in the USA, the 75th percentile is about the edge case, but you need extra data to convert percentiles to 'being too heavy'. In the extreme, if everybody is overweight, even the lightest percent of kids will be overweight).
http://www.sciencebasedmedicine.org/index.php/does-weight-ma...
has a good discussion of the definitional issues. The article links to pro and con sources about whether excessive weight can lead to health problems, with discussion of logical fallacies related to arguments on the issue.
- BMI is a poor measure of obesity. Among other things, bone and muscle are both significantly denser than fat. People, including children, with thicker bones and/or more muscle will have higher BMI regardless of fatness. So it's at best a poor proxy for fatness, not the One True Measurement that so many people use it for.
- BMI is an especially poor measure for children. The ideal BMI (to the extent that means anything) varies according to developmental stage. Which is why you'll get tables and graphs for BMI that are indexed by age---except that age and developmental stage are themselves only roughly correlated, and a child at an earlier or later stage than is typical for their age will not be well-described by such a chart, and the "ideal BMI" that the chart lists for that child's age will actually be a non-ideal BMI for that child.
- BMI percentile is an even poorer measure, because it provides only a comparison against the population; if the population is skinny, even a high percentile might not be overweight, and if the population is fat, even a low percentile might be overweight. And that's modulo all the concerns in the previous two paragraphs.
- Even after taking all of that into account, we still have the problem that our conventional idea of "overweight" meaning "more weight/fat than is healthy" is likely inaccurate, in that some amount of certain kinds of fat actually make one healthier, and (as cited elsewhere in this thread) people who fall into the range often called "slightly overweight" actually live longer.
So evaluating kids' health (or their parents' assessment thereof) with reference to their BMI percentage is fraught in four different ways with inherent, systemic problems.