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

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  • Gutin, Iliya

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.

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  • Gutin, Iliya, 2022. "Not ‘putting a name to it’: Managing uncertainty in the diagnosis of childhood obesity," Social Science & Medicine, Elsevier, vol. 294(C).
    • Handle: RePEc:eee:socmed:v:294:y:2022:i:c:s027795362200017x
    DOI: 10.1016/j.socscimed.2022.114714
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    1. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    2. Schubert, Cornelius, 2011. "Making sure. A comparative micro-analysis of diagnostic instruments in medical practice," Social Science & Medicine, Elsevier, vol. 73(6), pages 851-857, September.
    3. Mead, Nicola & Bower, Peter, 2000. "Patient-centredness: a conceptual framework and review of the empirical literature," Social Science & Medicine, Elsevier, vol. 51(7), pages 1087-1110, October.
    4. Jutel, Annemarie, 2006. "The emergence of overweight as a disease entity: Measuring up normality," Social Science & Medicine, Elsevier, vol. 63(9), pages 2268-2276, November.
    5. Cambrosio, Alberto & Keating, Peter & Schlich, Thomas & Weisz, George, 2006. "Regulatory objectivity and the generation and management of evidence in medicine," Social Science & Medicine, Elsevier, vol. 63(1), pages 189-199, July.
    6. Armstrong, Natalie & Hilton, Paul, 2014. "Doing diagnosis: Whether and how clinicians use a diagnostic tool of uncertain clinical utility," Social Science & Medicine, Elsevier, vol. 120(C), pages 208-214.
    7. Heritage, John & McArthur, Amanda, 2019. "The diagnostic moment: A study in US primary care," Social Science & Medicine, Elsevier, vol. 228(C), pages 262-271.
    8. Brown, Eliza, 2020. "Projected diagnosis, anticipatory medicine, and uncertainty: How medical providers ‘rule out’ potential pregnancy in contraceptive counseling," Social Science & Medicine, Elsevier, vol. 258(C).
    9. Nettleton, Sarah, 2006. "'I just want permission to be ill': Towards a sociology of medically unexplained symptoms," Social Science & Medicine, Elsevier, vol. 62(5), pages 1167-1178, March.
    10. Timmermans, Stefan & Stivers, Tanya, 2018. "Clinical forecasting: Towards a sociology of prognosis," Social Science & Medicine, Elsevier, vol. 218(C), pages 13-20.
    11. Looman, Willemijn & Struckmann, Verena & Köppen, Julia & Baltaxe, Erik & Czypionka, Thomas & Huic, Mirjana & Pitter, Janos & Ruths, Sabine & Stokes, Jonathan & Bal, Roland & Rutten-van Mölken, Maureen, 2021. "Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries," Social Science & Medicine, Elsevier, vol. 277(C).
    12. Nettleton, Sarah & Kitzinger, Jenny & Kitzinger, Celia, 2014. "A diagnostic illusory? The case of distinguishing between “vegetative” and “minimally conscious” states," Social Science & Medicine, Elsevier, vol. 116(C), pages 134-141.
    13. Brown, Phil & Lyson, Mercedes & Jenkins, Tania, 2011. "From diagnosis to social diagnosis," Social Science & Medicine, Elsevier, vol. 73(6), pages 939-943, September.
    14. Lambert, Helen, 2006. "Accounting for EBM: Notions of evidence in medicine," Social Science & Medicine, Elsevier, vol. 62(11), pages 2633-2645, June.
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