“The school sent a letter saying my son is obese — I’m furious and embarrassed”

Childhood obesity is a sensitive, easily-shaming topic that must be handled with compassion and zero blame, especially with the child in the room: acknowledge the parent’s feelings, affirm you are not labelling them a bad parent, and be mindful of every word in front of the child — avoid "fat" and blame, and protect his self-esteem, because the tone determines whether the family engages. Assess objectively using BMI centile for age and sex on a UK90 growth chart (not adult BMI cut-offs; overweight at or above the 91st centile and obesity at or above the 98th, NICE NG246, 2025), measuring face to face — nothing can be measured on a video call — and plotting height, weight and trajectory to ground the conversation in data rather than the emotive letter. Most childhood obesity is lifestyle-related, but consider and exclude the uncommon secondary causes (endocrine such as hypothyroidism or Cushing’s, and genetic syndromes — typically with short stature, developmental delay or dysmorphism, so a tall child growing along his centiles is reassuring), and screen for comorbidity and complications (blood pressure, acanthosis nigricans/insulin resistance, glucose/HbA1c and lipids at or above the 98th centile, sleep apnoea, joint problems) and crucially for mood, bullying and self-esteem. Take a whole-family lifestyle history without judgement (meals, sugary drinks/snacks, portions, activity, screen time, sleep, routines), framing it as understanding rather than interrogating, and identify achievable levers and the family’s readiness and circumstances. Manage as a family rather than dieting a child: agree small, specific, positive changes framed around health, energy and growing well (children generally maintain weight while growing into it rather than losing weight), signpost to a family-based, multicomponent weight-management/tier-2 programme (NICE NG246) and school nurse, and keep the child positive and involved. The hidden agenda is anger masking shame, guilt and feeling judged, with possible bullying of the child; remove blame, ally with the family against the problem, protect the child, watch for emotional impact and — in extreme/neglect situations — any safeguarding concern.