Is your child overweight?

September 3, 1999
Web posted at: 10:22 AM EDT (1422 GMT)

In this story: How is "overweight" defined? What should be done if a child is overweight? Weight control is a family affair A recipe for family weight loss RELATEDS

By Daphne Miller, M.D.

(WebMD) -- There's nothing cuter than a chubby child -- chunky arms, rolls of tummy, pinchable cheeks. But when is chubby considered overweight?

Parents should be concerned when the pounds add up, especially in light of a large study published two years ago in the journal Pediatrics (March, 1997) that found that children are more likely to be overweight than they were 20 years ago.

Kids are getting fatter, and that puts their health at risk, not only during childhood, but later on in life: Research shows that being overweight as a child is a major risk factor for being overweight as an adult, according to the World Health Organization's International Obesity TaskForce (IOTF). While being vigilant of your child's weight is important, it's equally important, however, not to put your child on a diet if he or she simply "looks" heavy. Only your doctor can make the call as to whether your child is truly overweight.

How is "overweight" defined?

It's impossible to determine whether someone is overweight based just on weight. A tall, big-boned child can be above the 90th percentile in weight, yet that weight can still be appropriate for the child's height (a percentile is a general way to compare a child's growth against national averages of other children of the same age). Body-mass index (BMI), which is calculated by dividing the weight (in kilograms) by the child's height (in meters squared), probably gives the most accurate assessment of what is overweight. The IOTF has defined a BMI of over 25 as being overweight.

Because growth charts and BMIs are very general, determining whether or not a child is overweight should also be based on a physical examination and a description of the child's lifestyle. A child whose heaviness seems to be getting in the way of physical activity, sports and making friendships should be considered overweight.

What should be done if a child is overweight?

Most overweight children under the age of 3 who have parents of normal weight will quickly outgrow their baby fat. In fact, the American Academy of Pediatrics (AAP) recommends that parents not restrict fat intake for children under age 2, since children this age need fat for proper brain development. A number of studies have shown, however, that if a child is still overweight after age 4, he or she is likely to stay overweight. This is especially true if the child has overweight parents. There appears to be a genetic predisposition to gaining excess weight; in addition, kids pick up lifestyle habits (like eating junk food and sedentary living) from their parents. These are the kids -- and families -- who need to practice weight control.

Weight control is a family affair

"Weight control" does not necessarily mean losing weight. For a child under 12, weight control usually includes making changes in his or her activity level and the kinds of food the child eats so as to slow the child's rate of weight gain. A child can rarely tackle a weight problem without the participation and support of parents and siblings. The most successful weight-loss programs for kids require family involvement and work by having parents and kids set goals together.

A recipe for family weight loss

The following suggestions can help the whole family reach healthy weights:

1. Establish weekly goals with your child -- and make these goals realistic. Useful goals include: setting a time limit on TV watching (since a lot of snacking occurs in front of the TV), planning a daily walk or cutting down on junk food. Unrealistic goals include cutting out sweets altogether or exercising for an hour a day if a child is deconditioned.

2. Have your child, if the child is old enough, keep a written record of what he or she eats, including snacks, and how much physical activity is done that week. Your child should not actively count calories; instead, teach your child about the different categories of foods and help her choose foods from healthier categories. ("The Stoplight Diet for Children," a book by Leonard Epstein and Sally Squires, divides these foods into green-, yellow- and red-light foods.) Parents can then review this diary and offer positive feedback. A diary also helps kids feel more in control of their weight.

3. Use praise and rewards. Praising your child for her efforts (instead of criticizing her when she slips up) can reinforce new, healthy behaviors. Also, try sitting down with your child and choosing small rewards (which are not food) for meeting short-term goals.

4. Make your home a place that encourages exercise and healthy eating. Don't bring sodas and junk food into the house. Instead, stock the fridge with healthy snacks, such as cut-up fruits and vegetables. Turn off the TV at mealtimes; people tend to overeat while watching TV. Encourage physical activity by spending more time outdoors as a family.

5. Cut out your negative thoughts and comments. Often children who are overweight will have negative or pessimistic thoughts ("I am fat and no one will like me" or "I might as well give up trying to control my weight because I will always be overweight"). Chances are they have also heard these things said by their parents. As parents, it is important to have a healthy body image and to encourage one in your child as well.

Consult with your child's pediatrician to find out if there are family weight-loss programs in your area. And most importantly, keep your child from being discouraged! Make sure your child understands that she can make a difference in her weight and that you will support her all the way.

Daphne Miller is a family doctor practicing in a community clinic. She is affiliated with the Department of Family and Community Medicine at the University of California, San Francisco.