"If a parent is concerned about a child's weight, that child already knows," says Satter. "Most of the time, a child is relieved to hear it stated out loud; it makes them hopeful that something will be done about it." She says she supports an "open dialogue" about weight, if that dialogue takes place between "knowledgeable professionals" who know what they are doing. But without professional guidance, she says, "Too often it takes the form of a parent who tells their child, 'You have to cut back what you are eating. You are getting too fat.' That is a horrendous oversimplification of the problem and doesn't help anyone."

Some experts on childhood obesity have begun to advocate an even more aggressive intervention with overweight children. Mary Savoye is the director of the Bright Bodies program, a diet and exercise program for children at Yale University. She also is a certified diabetes educator, fluent in all of the health dangers that can accompany obesity, especially those that accompany Type 2 diabetes, which is often induced by excessive weight. "Let's see," she says. "You have heart disease, nerve damage, eye disease, kidney disease ..."

What frightens Savoye is that she is seeing younger and younger patients. "Most of these complications we don't see in patients until adulthood -- 35, 40, 50. But if you have a child who is morbidly obese at 10, we are going to start seeing 18- and 19-year-olds who have obesity-related health problems. Our children are the heaviest they have ever been. No one knows what will happen. It's a real problem."

The Bright Bodies program, which serves children from 9 to 16 years old, does not hesitate to confront participants about their eating and exercise habits. In the first of two sessions, kids attend a nutrition class with their parents. Next, participants (without their parents) attend a behavior modification class where they discuss how they feel about their bodies, how to be more aware of what they are eating (including keeping food journals), and how to pay more attention to environmental triggers, such as eating out of boredom, or eating while watching TV.

For those who believe that the stigma of having a "weight problem" is more damaging to a child than excessive pounds, this program might even be considered dangerous. But Savoye says she has discovered in working with overweight children that it may be possible to help a child to actually lose -- rather than simply maintain -- weight.

Savoye says that she still believes it isn't healthy to push the issue of weight with a child who is no more than 20 pounds overweight, unless the child brings up the subject. "But if a kid is 50 to 60 pounds overweight, you have to intervene. It then becomes a health issue." And she has begun to believe, after conducting some informal research, that in some cases it may be appropriate to put a child on a diet.

Last year, in response to pressure from desperate parents who had tried everything to help their children to lose weight, Savoye finally agreed to put some children on a diet. She was concerned, however, about doing harm, so she set up a pilot study: She divided 62 children into two groups, matched for age, gender, approximate weight and motivational level. One group was taught to lose weight according to conventional wisdom about children and weight -- they learned about nutrition and how to make good food choices. The other group was put on a traditional diet with a structured meal plan and restricted calories. Along the way, Savoye measured both groups for weight loss and self-esteem.

The program lasted one year. At the end, Savoye was shocked by the results: The group on the traditional diet had been more successful at losing weight and scored higher than the other group in self-esteem.

Savoye is careful to point out that her study was tiny, and that she would have to undertake a larger study over a longer period of time to come up with conclusive results. It also is too early to tell if the original group will maintain their new weight over the long term. "Of course, my hypothesis is that they will not," says Savoye. "But my hypothesis the first time was that the kids on a diet would not do as well as the other group and when we gave them the diet, against all the literature, we were surprised by the results."

Savoye is aware that even the suggestion that a diet may work for some children is likely to inflame her fellow childhood-obesity researchers. "My advisor keeps trying to get me to publish this study, but I'm a little afraid of all the angry phone calls I will get." She emphasizes that even in the case of a child who has to lose weight, a diet would be the absolute last resort. "There are so many other things that can be done first," she says. "You can eliminate the cookie jar, substitute popcorn and pretzels for chips, bottled water instead of soda or juice, cut Nintendo and TV time, get the child outside." Only after a family has done all of these things, and the child is still overweight, would Savoye consider offering a diet.

Whatever the method of weight loss, the Bright Bodies program is a remarkable development in that it favors an honest, unblinking response to childhood obesity -- which conscientious and tongue-tied parents of overweight children may find liberating. And their children may be equally grateful. "I was overweight at 17 and I didn't lose it until I was 25," adds Savoye. "Of course I felt bad when someone called attention to my weight. But is being overweight good for you? No. And in my experience, being overweight wasn't good for self-esteem either."

No one wants children to grow up feeling bad about themselves. But silence about weight isn't helping children or parents. The actual formula for anyone who is trying to maintain a healthy weight is ridiculously low-tech: Eat less, exercise more. But in order to be in a position to offer this simple solution, we need to stop encouraging girls to pursue an unrealistic body weight in the name of beauty, so that we can encourage them to maintain a realistic weight in the name of health.

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