Obesity is a huge problem in this country. The APTA has initiatives regarding obesity and we have guidance from MoveForward PT. I would estimate most of my students are overweight. Obesity is linked to many diagnoses of children on my caseload. Most of my students do not have a high enough physical activity level nor adequate nutrition. Very frustrating because a lot of movement problems can happen from obesity: alignment (genu valgus, pronated feet, ligamentous laxity), poor posture (lumbar lordosis, weak abs, compensatory kyphosis), and decreased activity level because the energy expenditure required is just too great. But what's a poor school PT to do?
I decided to have honest conversation with my other team members regarding specific students and no one really wanted to address it...teachers felt it was "not nice", was addressed in health classes, what can we do, etc. No one was comfortable saying YOUR CHILD IS FAT or YOUR CHILD'S WEIGHT IS S A PROBLEM. The school team agreed that obesity was a problem, but we werent reaching the parents who are the ones packing the lunches and with the child every day. Children have metabolic disorders. Some our kids have behavioral issues and/or food is used as a reward. Parents are busy and may not realize the importance of nutrition and physical activity. nor the long term consequences.
The question is still, what is a PT to do? Our PT eval should addresss anthropometrics, and with every eval, I calculate BMI, using parent report of height and weight. And I just state the result in the evaluation. BMI=28 (per cdc.gov, weight in obese range). The descriptor of obesity is by CDC, not me. Then, when I review the evaluation and we look at the BMI in the context of the child's functional movement impairments, we can have a meaningful conversation. And it goes something like this:
"your child's weight and height fall into the obese range"
"I know. I try to pack them fruit with hteir lunch...(look of angst)...its hard"
"dad/mom is overweight, we try to eat healthy"
" the doctor said to not give my child juice 5 x per day but they like it"
"dont have time to exercise"
Once the elephant is acknowledged in the room, then we have a conversation about the evaluation/analysis portion of the evaluation: what the child's physical therapy diagnosis is, what neuromuscular impairments they have, how their function affects their activity and participation, and the impact of rest of the child's medical history I find a lot of the kids do not have aggressive weight management through the medical model, either through obesity clinics or their doctor. A lot of these kids have endocrine or other medical problems. Or need nutritional counseling, parent and child both. Most have more going on than just being heavy.
So then the real conversation happens. We collaborate to get the kid to their doctor or an obesity clinic. We talk about increasing physical acitvity at home. Make sure the kid only eats ONE lunch (you would be surprised how many order 2). We have teachers collaborate on behavior strategies or ABA supports at home. We work together on this very complex problem. It is a health issue, and as a physical therapist I can help screen for it, make appropriate medical referrals and support the health of the child. So, BMI calculators, ready, set, GO!