How Forcefully Should Clinicians Encourage Treatment When Disagreement Persists About Obesity Risk?

Abstract

Pediatric obesity is a major public health problem, and weight reduction in children and adolescents with obesity is associated with improvement in health outcomes. This case of an adolescent diagnosed with obesity whose mother disagrees with the diagnosis illustrates challenges often encountered in clinical practice, including (1) diagnosing a disease in an asymptomatic patient whose future risk for negative health outcomes is uncertain, (2) addressing ethical implications of naming a stigmatizing disease, and (3) resolving conflicting goals and opinions of a patient, caregiver, and physician. Suggestions for navigating disagreement and implementing courses of action are discussed. Case Ms D presents with her daughter, Ms W, for an adolescent medicine appointment with Dr N. Ms W is 14 years old and on weigh-in at Dr N's office has a recorded weight of 175 pounds and a height of 5'1''. As Dr N reviews Ms W's records, he notes that her body mass index (BMI) is 33 and discusses with Ms D and Ms W that Ms W meets criteria for being labeled obese. He reviews with Ms W and Ms D the long-term ramifications of obesity and encourages the patient to enact a diet and exercise routine with a goal of losing 10% of her body weight over the next year. At that same appointment, Dr N obtains a hemoglobin A1c (6.0), a total cholesterol of 310, and verifies that thyroid stimulating hormone levels are within normal limits.