Whom Shall We Fault for Childhood Obesity?

A professor of pediatrics was visiting patients with her medical students. They saw a patient, a teen with class III obesity that had begun at a very early age. One of her students asked, don’t her parents know their daughter needs to eat  healthy and stay active? Another said, it’s terrible what the food industry is doing to children. Yet another said she probably needs a psych evaluation. The professor asked them, how will any of that help this patient? You are stuck on irrelevant questions about fault, she said.

Then the professor said time is short and they must focus on patient needs. We are here to help children be well, she told them.

A Referral

It turned out that this patient had come to the clinic for a painful ankle. She strained it on a walk with her friends and was concerned that it might not heal properly. Ruling out a more serious injury was simple enough, so the prescription was for motion and strength exercises. But at the end of the clinic visit, when the others had moved on, she asked the professor about her weight.

“I’m tired of carrying all of this,” she said. “What can I do? Diets don’t work for me. And none of my doctors have ever helped.” The professor listened and asked a few questions. Then she told the girl and her mother something they already knew. This is not an easy problem to solve.

She told them about the center for healthy weight and nutrition at their children’s hospital. The team at that center might be quite helpful, she said. So when the professor offered them a referral, they welcomed it.

Decisions and Milestones

Two years later, much has changed for this patient. The professor was right. In fact, the team at the center was quite helpful. Like nothing she had ever experienced before in healthcare. They were objective and professional. It was a judgment-free zone. No fault finding. Together with her mother, they eventually figured out that she was a good candidate for bariatric surgery – a gastric sleeve.

It wasn’t miraculous. She had plenty of bumps along the way. But she is feeling good about her decision, having lost more than a hundred pounds after the surgery. Her BMI is still high by some standards, 32 to be precise. However for her own health, this is clearly a great outcome. She also knows it’s just one milestone in her personal health journey.

She feels better and has more confidence than she can ever remember. And she has her whole life ahead of her.

Finding Fault

If anything has been difficult, it’s the reaction of some other people. Lots of comments about her appearance that don’t quite feel encouraging. Some find fault with her decision. They wonder “why she had to do that” and other stuff that’s really none of their business. Even more puzzling is the occasional doctor who doesn’t seem to understand the value of a gastric sleeve for a teen like her.

Fortunately, this young woman has a supportive family and a few good friends who build her up. She knows she’s lucky and she’s making the most of it. Nonetheless, she wonders about healthcare professionals who were more interested in placing blame for her health problems than in helping her achieve better health. Why did this take so many years?

Note: The story of this patient draws on the experiences of many – not any one in particular. It illustrates how implicit bias, fault, and blame routinely influence the care that a child with severe obesity receives. It also offers a snapshot of a good outcome. We look forward to a day when the bad experiences will be unusual. 

Saint Pantaleon the Healer, painting by Nicholas Roerich / WikiArt

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September 24, 2019