Two years ago, when Denise Snell's family physician told her that her son Malik should lose weight and referred her to a specialist, she brushed the idea off.

"We hesitated," said Ms. Snell, of Sheraden. "We thought we could make it on our own."

		PG Poll • How does your pediatrician deal with obesity prevention and treatment issues?

Malik, now 12, stands at 5-feet-6 and weighs about 145 pounds. He is not the kind of boy one would think to describe as obese; big-boned seems more appropriate. Yet his statistics put him just over the 95th percentile for his age -- high enough to tip him into the category.

It's difficult for parents to admit their child is obese, said Dr. Goutham Rao, who directs the Weight Management and Wellness Center at Children's Hospital, which treats 2,000 overweight children annually.

Dr. Rao estimated that only half of all parents who are told their child should lose weight will eventually cooperate.

In Malik's case, his physician continued to push. And then his school, Pittsburgh Classical Academy, sent a letter. (In Pennsylvania, schools are required to provide regular body mass index reports.) Finally his family decided it was time to schedule an appointment.

The Snells' struggle is not unusual. Fourteen percent of children ages 2 to 5, 19 percent of children ages 6 to 11, and 17 percent of children ages 12 to 19 are clinically obese.

Last year, in an effort to solve the dilemma that U.S. Surgeon General Steven Galson has called "a national catastrophe," the American Medical Association convened a panel of experts who designed a series of guidelines to combat childhood obesity.

Yesterday, that panel, of which Dr. Rao was a member, released its findings. It provided five main recommendations: limit consumption of sweetened beverages, restrict fast food intake, eat dinner as a family, reduce "screen time" in front of the television or computer, and engage in physical activity for at least one hour per day.

On face, most of the advice is common sense: eat right and exercise. But for many families, the changes constitute nothing less than lifestyle upheaval.

"The recommendations are easy to make," said Dr. William H. Dietz, director of the Division of Nutrition, Physical Activity and Obesity at the federal Centers for Disease Control and Prevention, which co-funded the study. "The challenge is implementing those recommendations."

For a physician, the most difficult step is often identifying and communicating the problem.

While current protocol discourages using the word "obese" to describe children, the panel concluded that practice creates confusion.

"It's much clearer for parents if you say, 'Your child actually suffers from obesity, they need to lose weight,'" said Dr. Rao. "They understand what that means." On the other hand, current terminology like "at risk for becoming overweight" can be easy to dismiss.

For a parent, the most difficult step is making habits that stick.

Dr. Prapti Kanani, who runs the childhood obesity clinic at Allegheny General Hospital, said physicians must talk to parents about concrete solutions that will work for them.

"The first thing I tell parents to do is pack lunch," she said. For a working parent, "that's always hard."

"We don't advocate changing everything overnight," said Dr. Rao, who met with the Snells for the first time yesterday.

After three hours of evaluations, Malik and his mother left well-armed with knowledge of how to tackle weight loss, including an extensive list of goals.

Malik, who said he plays a lot of video games, will cut his time in front of the console in half, and he will sleep more; he gets in bed around 2 or 3 a.m., but now he's aiming for 11 p.m. He also will eat breakfast regularly and exercise four days a week, supplementing two days of Tae Kwon Do practice.

Malik's goals are part of a long-term strategy to focus on behavior, not weight.

"Clearly the historical paradigm where providers suggest to patients that they make this change and that change is not going to work," said Dr. Dietz. Instead, physicians need to "tie issues about weight ... to more fundamental values."

Paradigm shifts are never easy.

"There are all these mindsets," said Dr. Kanani.

For example, she said many parents have been inculcated to believe in the healthful power of orange juice, but experts recommend limiting intake of all sweetened drinks, including fruit juice.

"I say, 'Eat five oranges. Eat your fruit, don't drink it,'" she explained.

As they left Dr. Rao's office with changes swimming in their heads, the Snells were hopeful.

"When school starts, that's going to be the challenge," said Ms. Snell. "You're going to have to help me, right Malik?"

Malik is considering trying out for his school's basketball team, and he is going to avoid school lunch, which he said "isn't that good."

"Pizza really gets old after you have it for 180 days," he said.