Childhood obesity: running from this crisis of ‘normalisation’ won’t work

摘要

Increasing childhood obesity (CO) prevalence has shifted our perceptions of healthy weight leading to widespread misclassification, with ‘chubbiness’ perceived as normal and a reduced confidence in ‘skinny’ being healthy — such children often being regarded as underfed. Today’s median child weight falls on the 67th centile (rather than 50th centile) of the 1990 baseline distribution, as shown for BMI distribution in Year 6 children in the National Child Measurement Programme 2015–2016.1 Over two-thirds of parents of overweight children described their child as ‘normal weight’ at 7 years.2 This process of normalisation is not benign; perceived necessity to resolve CO will wither if it vanishes into a ‘new normality’.Parents may justifiably love their child for who they are rather than what they look like, and a reluctance to demonise excess weight in children is reassuring, but misclassification may prevent engagement with behaviour change. Affected children also misclassify weight status, and accruing psychological burden from fat-intolerant discriminatory attitudes plus tendencies for identity comparison from a young age, creates significant persisting damage to self esteem.3 Patient reflections (drawn from the Obesity Empowerment Network) on the roots of a lifelong struggle with obesity and intertwined low self esteem show how they stem back to early childhood and are influenced by interaction with health professionals: ‘By the time I became a bridesmaid, aged 7, I was very aware that I was ‘different’ from my sibling and many cousins. By the time I left primary school I was used to being called the fat girl and not being chosen by peers for the team. I felt …