AYESHA RASCOE, HOST:
A recent study published in The Lancet projects that three-quarters of Americans will be obese by 2050. Some medical schools are trying to teach the next generation of pediatricians to talk about obesity in a way that's more inclusive and thoughtful. Reporter Kavitha Cardoza has more.
KAVITHA CARDOZA: The first rule of treating children with obesity is, don't say the word obesity.
MEG BENSIGNOR: I don't use obesity in, like, any patient visits. I won't say that word.
CARDOZA: That's Dr. Meg Bensignor, a pediatric endocrinologist at the University of Minnesota. She prefers the more neutral term weight. I'm visiting a mandatory training session for second-year medical students that Bensignor helped put together. Today, they'll focus on how to discuss obesity with patients. Student Emily Beckmann knows the topic is fraught.
EMILY BECKMANN: For some people, obesity is a really triggering word, and that's going to shut down the entire conversation.
CARDOZA: Bensignor and her colleague Dr. Sarah Raatz share some basic tips with students. Remember that a number on a scale is just one data point around health, and when and where you bring up weight matters. Raatz says if a patient is coming in for something completely unrelated, like a sore throat or broken arm...
SARAH RAATZ: It's not a good time to be bringing this up. An emergency room - not a good setting. Urgent care - not a good setting. It's better suited with ideally an established primary care provider where you can have some of these more open-ended discussions.
CARDOZA: Nearly 20% of children in the U.S. - almost 15 million kids - are considered obese. Yet, fewer than a quarter of pediatric programs offer a structured curriculum on the evaluation, management and counseling of obesity.
CHARLES BILLINGTON: Most doctors, most medical schools don't want to talk about it.
CARDOZA: That's Dr. Charles Billington, a professor of medicine here. He says a big part of the problem is widespread bias among physicians.
BILLINGTON: You know, that simple phrase, you should lose weight - that's as much as they want to deal with it.
CARDOZA: Raatz spends a lot of time with families explaining the outsized role biology plays.
RAATZ: There are some uphill battles that you're facing that make this really, really challenging. And so acknowledging - this is hard. This is not all under your control.
CARDOZA: Health care professionals report they don't feel competent or comfortable discussing weight with their patients, so some don't bring up the issue at all. Others give vague advice, like eat more fruits and veggies, and some have blamed and shamed children and their parents. Bensignor recounts a horror story one mom told.
BENSIGNOR: The mother had told us that the doctor turned his monitor around to show the child's growth curve and said if he keeps going like that, he's going to be 800 pounds by the time he's 15.
CARDOZA: Apart from medical conditions like diabetes and sleep apnea, children with obesity are also at risk of anxiety, depression and being bullied. So Raatz says empathy is everything.
RAATZ: When we have a new patient appointment, the number of times that I get a message sent ahead of time - this is a sensitive topic for my child. Please don't focus on weight.
CARDOZA: Bensignor says sometimes her patients are embarrassed to say they eat candy or chips. She reassures them that's OK.
BENSIGNOR: I'll be, like, one of my favorite treats is ice cream, too. Like, I try to normalize it because ice cream's delicious. They should be able to have ice cream if they want to have ice cream.
CARDOZA: Raatz tells her medical students, to be more successful, ask the patient what their goals are. A child may not care if they have high cholesterol. They want to play soccer.
RAATZ: Figuring out where your patient is at - what are they ready for? Having it be a shared problem-solving experience rather than us just scripting, well, here's your plan.
CARDOZA: Bensignor says while it's important to talk, it's just as important to know when to stop talking. When she asks parents if they have concerns about their child's growth...
BENSIGNOR: If they say no, I just leave it for another day. And in the risk-benefit ratio, it's more important for me to establish rapport with my patients. So you can table it. Like, you're going to see them again.
CARDOZA: If there's a serious health issue, she'll call home later. Medical students Nevin Gupta and Elizabeth Breitbach say they're a little more confident now.
NEVIN GUPTA: I don't have much experience talking about weight with patients, and so I think I would've probably chosen the wrong words or not created the safe space.
ELIZABETH BREITBACH: And so it's nice to kind of have a little bit of background or structure for how you might talk about those things.
CARDOZA: They're grateful they can practice having these conversations while they're still students, before they're in a clinic on their own. For NPR, I'm Kavitha Cardoza. Transcript provided by NPR, Copyright NPR.
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