For the last 20 years or so, childhood obesity has been, almost literally, the 800-pound gorilla in the room. The room in question, unfortunately, has been the pediatrician’s examining room.

Despite the fact childhood obesity has reached almost epidemic proportions in the past quarter century — the percentage of obese kids in the U.S. grew from 6.5 percent in 1980 to 17 percent in 2006, one in three kids born here in 2000 stood a risk of becoming diabetic, the statistics go on — it’s been an issue rarely discussed at the annual well-child exam. According to a 2008 survey of its membership, the American Academy of Pediatrics found that only 52 percent of pediatricians measured patients for their Body Mass Index, an imperfect but general indicator of obesity. Even then, if their BMI indicated they were overweight or obese, 59 percent of pediatricians said they were reluctant to discuss the matter.

Why?

Some health care observers — and pediatricians themselves — say it’s because obesity is a sensitive topic. Parents can be in denial, they may take the diagnosis as a personal affront to their parenting, it may be a cultural issue — all areas that most pediatricians haven’t been trained to deal with.

Chapel Hill pediatrician Edie Bernosky believes the problem is more basic: Until recently, pediatricians haven’t had a good course of action to recommend to parents of overweight and obese kids.

“As part of a general practice, the goal is to talk about growth, development, nutrition,” says Bernosky, with Village Pediatrics. It’s only been through a plethora of clinical studies on childhood obesity over the past few years that solid recommendations have emerged to give parents. In 2007, the American Academy of Pediatrics took these findings and created a “physicians toolkit” to help its members address the issue. On Thursday, a similar toolkit created by the Blue Cross Blue Shield Association and Blue Cross Blue Shield of North Carolina and tested for six months in five states, was made available nationally.

The BCBS Good Health Club Physician Toolkit was developed in conjunction with the American Diabetes Association and the American Academy of Pediatrics. The toolkit includes information specifically for physicians as well as handouts to give to parents on topics ranging from appropriate BMI ranges to health tips by age group to a weekly journal kids can keep.

“It’s important to be able to give something parents can take home from the office,” says Dr. Bernosky.

It’s important to keep in simple, too, she says. To that end, the toolkit emphasizes the 5-2-1-0 approach to healthy kid living. That is:

• 5 fruits and vegetables a day
• 2 hours — and no more — of screen time a day
• 1 hour of vigorous physical activity
• 0 sweetened beverages

Dr. Bernosky says she can’t emphasize enough the importance of handouts.

“Handouts help to raise the topic and open discussion. If you can send the parent home with more in-depth information it helps reinforce what was said in the office. It’s an important part of pediatrics.”

You don’t have to go to the pediatrician to benefit from the BCBS Good Health Club Physician Toolkit. All the handouts available through the program are also available at the Good Health Club Web site, which you can access by clicking here.

Photo: We’ll never know if Dr. Drake Ramoray would find a physician’s toolkit helpful since he was … canceled.