First, I’d like to start by explaining how we define weight status in children. Typically, we use a measure called the Body Mass Index, or BMI. BMI is calculated by dividing weight (in kg) by the square of height (in meters), or kg/m2. BMI is actually a measure of excess weight, and not excess fat. As such, it doesn’t differentiate where the excess weight is coming from (fat, muscle, bone mass, etc.). Despite this limitation, however, BMI has proven to be an adequate surrogate measure of excess body fat and is very helpful in predicting future health risks.
The interpretation of BMI in children and adolescents is quite different when compared to adults. Adults are placed into set BMI categories regardless of age or sex. For children and adolescents aged 2-20, however, BMI is interpreted relative to age and sex. Children are assigned to percentiles based on their BMI. You are probably quite familiar with the length and weight percentiles of your children; there is also a BMI-for-age percentile that indicates how your child’s BMI compares to other children of the same age/sex. The BMI percentiles for children are as follows:
One of the first things I tell parents is to take this information seriously, but don’t panic. Being overweight is associated with some very serious long-term health consequences (high blood pressure, elevated cholesterol levels, impaired glucose tolerance, increased risk of psychosocial problems). However, the good news is that most kids actually don’t need to lose weight; instead, they need to stop gaining weight at a rate that is disproportionate to their overall growth. Most, if not all, pre-pubertal children and young adolescents that are considered overweight or mildly obese should focus on weight maintenance because as they continue to grow taller, their weight will eventually be proportional to their new height. This process may take years, and that’s OK. If your child needs to lose weight, I encourage you to speak with your pediatrician to discuss the safest way to do this.
The single most important factor in weight maintenance is diet. This does NOT mean putting your child on a diet, it means taking a look at all the factors related to what your child eats. Let’s examine a few “how” and “what” questions:
How often does your child eat? Before you make any changes to your child’s meal/snack schedule, keep track of how often you feed your child anything over the course of the day for one week. You may be surprised at how often they’re “snacking” (in the car, in line at the grocery store, in the waiting room at the doctor’s office). Ideally, kids should have three meals a day with 2-3 healthy snacks in between meals. Make breakfast a priority every morning; this meal sets the tone for the rest of the day. Closely monitor snacking during sedentary activities like watching TV or playing video games. A small snack can quickly become a very large one. Kids (and adults) tend to snack more when they’re bored, so stay busy! Limiting snacks is an easy way to decrease unnecessary calories throughout the day.
What is your child drinking? Drink more water. It really is that simple. Significantly limiting soda, juice, and other sugary drinks will cut down on “liquid calories” that provide little-to-no nutrition. Offer water for all meals and snacks. Low-fat milk, even if it is flavored with a small amount of chocolate or strawberry flavoring, is a better option than soda or other sugary drinks.
How fast does your child eat? If your child eats really fast, the risk of “overeating” is considerably higher. Something as simple as slowing him or her down while eating can potentially lead to less food consumed. Have your child wait 10-20 minutes before deciding to have another serving. In the meantime, have them drink some water and eat a few more pieces of fruit or vegetable.
What is your child eating? I don’t tell parents that they should never give their child certain foods. Personally, I enjoy potato chips, ice cream, and fast food, but I know I shouldn’t have these every day, or even several days per week. Restricting certain foods won’t really be helpful in the long-run. Instead, empower your child with knowledge of which foods are healthier choices. Let them know that it’s OK to eat not-so-healthy foods sometimes and in moderation (I also discourage using terms like “junk food”). That way, when they are old enough to make their own decisions and choices, they won’t crave foods that they were never allowed to eat.
Aim for five servings of veggies and fruits per day. These should be offered at every meal and for most, if not all, snacks. Choose whole grains and fiber-rich foods over refined grains like white rice and white bread. Lean proteins like chicken, fish, eggs, nuts, and beans can help your child feel satisfied for longer periods of time, helping to limit snacking. Incorporate “healthier” fats—monounsaturated and polyunsaturated fats—into your diet (olive oil, nuts and nut butters, seeds, avocados, flaxseed, certain fish). Saturated fats may or may not be as “healthy” as poly/monounsaturated fats, but they are certainly better for you than processed carbohydrates.
What about portion sizes? I get asked about portion sizes a lot, and I tend to ask parents to simply use common sense. Getting caught up in measuring and recording portion sizes and servings throughout the day can make healthier eating seem overwhelming and more complicated than it needs to be. However, if you would like some examples of portion sizes by age, see this article on healthychildren.org.
Speaking of healthychildren.org, it’s a great resource from the American Academy of Pediatrics to help your family with healthier living.
Physical activity is definitely an important factor in weight maintenance. Ideally, your child should be active for at least one hour per day, and they would benefit from even more. Stay tuned for my next blog post where I will address this topic in more detail.
Again, if your child is overweight or obese, you should understand that this is certainly a serious matter, but please do not panic. I always encourage families to make small changes over time. A drastic overhaul of how you feed your family is likely going to cause stress and will not be sustainable over time. Do not anticipate change to happen quickly either. As mentioned before, it may take years for your child’s BMI to slowly drop to a more appropriate level. Lastly, when I tell a family that their child should eat healthier, what I am in essence doing is telling the entire family that they should improve their diet as well; I have yet to meet a 5-year-old that does the family grocery shopping. Families should eat as many meals as possible together, and parents should do their best to model healthier eating habits.
Dr. Jervis Belarmino is a pediatrician in the Allegro Pediatrics Totem Lake location.