Last modified: Sunday, August 5, 2007 11:43 PM EDT Honesty best policy for docs treating fat kids BY PAIGE MacGREGOR FOR THE SUN CHRONICLE There's little doubt in the medical community today that American kids are fat - and getting fatter. Now the question is, are doctor's doing enough to inform young patients and their parents one-on-one that their child is at risk for obesity? Or worse, that they've already tipped the scales. Doctors traditionally have avoided using blunt terms, including words like "obese," with overweight children for fear "we're going to stigmatize children, we're going to take away their self esteem, we're going to label them," American Medical Association spokesman Dr. Reginald Washington said. Yet too often, the latest research indicates, children and their parents often are in denial. One Attleboro resident, now 27, recalls the first time his childhood doctor ever mentioned his weight. "I was having a physical the summer after my freshman year of college," he said. "I had lost about 30 pounds and my doctor mentioned the weight loss and me being in the best shape of my life. "That was the first time he'd ever mentioned my weight, even though I was consistently 20 to 30 pounds overweight while I was growing up." But not all doctors beat around the bush. A 15-year-old Attleboro girl recalls yearly physicals with her pediatrician in which he addressed her weight in no uncertain terms. "Everytime I had a physical, my doctor said the same thing. He'd look at my parents and say, 'Well, she's overweight. You need to watch what she's eating and don't let her quit dancing, she needs the exercise.' "It was right before fifth grade when he said that I was 'borderline obese,' " she said. Those visits to the pediatrician were not particularly pleasant, she said, and the physician's attitude didn't encourage her at the time to change her diet or to exercise more. "The doctor would tilt his head down, give me a stern look, show me the chart and say, 'This is where you are,' " she said. "He didn't really try to give it a positive twist. It was almost like he was disappointed in me." So, what's the best approach? There is far from a concensus. The way doctors address children and their parents is more important than the language used, said Lydia Burak, associate professor in the movement arts, health promotion and leisure studies at Bridgewater State College. "I believe that encouraging, compassionate, caring and positive talk about the benefits of healthy weight is more apt to be heard than something that is brusque or abrupt or dogmatic," she said. Still, she does not hesitate to spell out the dangers of childhood obesity: "Metabolic syndrome, adult obesity, cardiovascular disease risk factors, such as high triglycerides, low HDL, high LDL can all be consequences of childhood obesity." And, she added, "There is also the social stigma that is associated with obesity and the concurrent emotional and self esteem issues." The experts do agree it's best to get the word out early and to directly address a child's eating and exercise. "Obesity is inherent, but it's also a result of childhood eating practices," said Chandra Ganapathy, a Registered Dietitian at the Health and Social Services Consortium in Sharon. "Good eating habits should start at an early age." Childhood obesity generally results from what is known in the scientific community as an "energy imbalance," which means consuming more calories than you burn during the course of a day. "The number of calories put into your body should be expended each day," Ganapathy said. "Input and output should match." In a culture rampant with fast food, snacks (Americans spent $61 billion dollars on snack foods alone in 2005) and electronic games (in 2006, Americans spent more than $11 billion on electronic gaming) children are spending increasing amounts of time in activities that burn few calories while they simultaneously consume calories in greater and greater amounts. "Junk food is cheaper and easier," Ganapathy said. "So families are more likely to eat it and to buy it for children. "Counting calories the good way, starting at an early age, helps prevent obesity and the resulting medical problems. "Counting calories allows you to make sure that you're expending as many calories as you eat each day," she said. "Counting calories is only bad if you eat a chocolate bar and then realize that you've eaten too many calories and starve for the rest of the day. Starving doesn't help." It helps that even snack food companies have started offering their products in smaller portions. And, healthy alternatives have begun popping up in some unexpected places lately, including the Showcase Cinemas movie chain, which now offers apple slices at the snack bar, along with buttered popcorn and nachos. The Attleboro teen might not have liked the bluntness of her pediatrician years ago, but she says today she pays closer attention to what she eats and how often she exercises. "The whole family eats healthier now," she said.