Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity

Abstract

Childhood obesity is a challenging diagnosis. Children's body mass index (BMI) is an imprecise diagnostic of health, leading clinicians' interactions with patients and families to focus on the potential of future harm rather than the presence of infirmity or disease. This is complicated by emphasis on certainty in medical care; clinical diagnoses like childhood obesity are intended to help delineate good and bad health among patients. However, healthiness and wellbeing take on many meanings among individual children and families, especially in relation to weight. To better understand different forms of uncertainty and challenges in providing care, this study draws on 28 semi-structured interviews with U.S. health practitioners working with pediatric patients to examine strategies for communicating risk and defining success in the diagnosis and treatment of childhood obesity. Rather than focusing on patients' current BMIs or making the explicit diagnosis of obesity, clinicians turn to more optimistic prognoses emphasizing the gradual development of beliefs and behaviors that promote long-term physical, mental, and social health. This prognostic framework privileges the doctor-patient relationship over medical guidelines and protocols dictated by diagnoses, encouraging greater consideration of non-clinical factors shaping patients' health and weight. Clinicians expand their diagnostic framework and criteria to include information on the totality of patients' present and future lives, allowing for cognitively, emotionally, and socially attuned understanding of health and weight that is not focused on BMI. Critically, clinicians' awareness of the social etiology childhood obesity heightens their sense of futility about addressing it through clinical interventions, demonstrating the need for a diagnostic and treatment model that empowers doctors to look beyond the more proximate, biophysiological determinants of health.