My Child is Overweight But Eats Healthy
A regular trip to the doctor can leave some families with disbelief and confusion when their child is told they are overweight. What could this mean for my his health? For her future? Should I help my child lose weight? Is losing weight even safe? How can a child who eats healthy be overweight?
Let's get started with the basics.
It's not uncommon for a child to be overweight. In fact, according to the Centers for Disease Control and Prevention (CDC), one-third of all children in the United States are overweight or obese. Children suffering from child overweight are more likely to grow into overweight adults. Sadly, these children are more likely to have low self esteem or another health concerns than their normal weight peers.
Most of the time, a family struggling with excess weight is aware that their diet isn't great. They might understand what they need to do, but need help changing their family's eating habits.
Sometimes though, a child with excess weight regularly eats a healthy diet. This can be confusing for parents, and leave families unsure of what to do. While we certainly want to do everything we can to protect our child's health, we don't want to create an issue around weight, especially if there is nothing to worry about. So if you have a child who eats healthy but is considered overweight, this article is for you.
My Child is Overweight But Eats Healthy
First, don't panic!
Just because a child is overweight doesn't mean they are unhealthy. In fact, a child who is overweight can have great health and fitness. The opposite is true too, a child who is normal weight can have poor health and fitness. Weight is just one component of the whole picture. So, I guess, the first thing to determine is whether a child's weight is an issue.
The first step is to talk to your pediatrician. The evaluation that should occur for an overweight child that eats healthy is detailed and will help determine the best path forward.
Understanding healthy weight
Understanding weight and BMI ranges is important for parents... and confusing. A child naturally has periods of expected weight gain, and differences in body fat based upon a child's age.
It is normal and healthy for a 16 month old to have a significant amount of baby fat. Naturally, a child tends to thin out reach their leanest point around age 4-6. After age 4-6, a child is expected to gain extra fat mass from that point on.
I've seen that excess weight tends to sneak up unnoticed in children aged four to six years old. A previously plump youngster might appear thinner at age five, but have gained more weight than expected for his or her age and now fall in the overweight category.
Overweight children: Definitions to understand.
To help us understand the natural expectations for weight gain, we use body mass index (BMI) charts to compare a child's weight to other children of the same age and gender.
BMI is one of the easiest ways to measure whether or not a child is overweight.
So what does being overweight really mean? It means that a child's body mass index (BMI) is above the 85th percentile for their age and gender. A BMI over the 95th percentile is considered obese. Normal weight is between the 5th and 85th percentile. If you are not familiar with how to calculate BMI, don't worry!
It is simple and any health professional, school nurse, or parent can plot a child on the BMI chart. Here is how to find your child's BMI percentile on a BMI chart.
How to plot a child’s body mass index on a BMI chart.
But using the BMI to determine weight status has some real limitations.
Overweight children deserve a thoughtful evaluation on all the factors that influence weight, but they also deserve a reminder that the BMI does not tell the whole picture.
Problems with using BMI to define weight status.
Not all weight is equal
A BMI chart can't differentiate extra weight as extra lean body weight (bone/muscle) or extra weight from fat. So a child who is muscular or athletic may have a high BMI even though they are metabolically healthy and have normal body fat.
Body Fat Distribution
The BMI chart can't give any indication of where the extra weight is distributed. If extra weight is stored around the chest and waist, that can indicate a higher risk for health problems then if the extra weight is stored in the lower body.
Puberty
Puberty can have a big impact on body composition, and since children hit puberty at different ages, the chart cannot adjust percentiles based upon puberty timing.
Diversity
Original BMI charts were based upon the growth of mostly white children living near Iowa City and Boston from 1930 to 1945. These charts did not represent the diversity of growth in the United states. The BMI charts were revised in 2000 to attempt to be more inclusive of different body types, races and ethnicities. These were made from national data, but they made a decision to exclude a significant amount of data for kids age 6 and higher because of a national trend toward increasing overweight.
For anyone interested in a deep dive into the history of the BMI charts, check out this historical report. But, my overall take on the BMI charts are that they are imperfect.
So clearly, some kids will be classified incorrectly by the BMI chart. The BMI will mis-classify approximately 5-20% of children with normal fat levels as overweight or obese
But, if your child falls into the overweight or obese category, it is a great opportunity to take a look at his or her habits to see if there is anything that we might want to modify to help you child avoid health effects in the future.
Things that influence weight in children.
For overweight children, it is important that we do a comprehensive review of all things that can influence a child's weight, and also evaluate those things that weight can influence. We must look for both the causes and effects.
Your child's growth will give us some clues here. If a child has been on a steady percentile and then suddenly is gaining weight faster than their peers, I pay particular attention to any lifestyle habits that may have changed around the time that he or she started to gain weight.
The number one thing that influences most children's weight is nutrition. So let's start in the kitchen.
Deep Dive on Nutrition
A child's diet has an enormous impact on a child's weight and even more importantly, a child's health.
I would define healthy eating habits as eating balanced meals and snacks and avoiding excess calories found in processed foods.
Balance
It is important to provide your child with a variety of healthy foods from all the food groups. This will help them to get the nutrients their body needs for growth and development, as well as for overall health.
To balance a meal, my goal is to aim for half of what a child eats to be fruits or vegetables. The other half is divided evenly between whole grains and lean proteins.
Intake
Some parents may think that if their child is overweight, they should restrict the amount of food that their child eats. This is often not the case. It is rare for serving sizes to be a big issue when made up of balanced, healthy food choices. In fact, restricting a child's food intake can have negative consequences for their health and lead to weight gain in the long run.
Whole, Minimally Processed Foods
It is important to provide your child with healthy foods, and avoid most processed or "junk food" For more information on healthy nutrition check out my previous blog with weight loss tips for kids
Paying attention to food labels is also important. If your food has labels, then it is processed. If that label has a lot of food ingredients, it is likely ultra-processed. Ultra-processed foods are addictive and contribute to weight problems since people consume more calories when food is processed and fewer calories when food is unprocessed or minimally processed. For more information on food processing Harvard school of public health has a nice summary.
Avoiding Sugar Sweetened Beverages
You can help your child avoid too many calories by avoiding fruit juice and sugary drinks. This includes juice, soda, sports drinks, and fancy drinks like boba or flavored coffee drinks.
Sneaky Snack Attack
Many kids eat healthy meals, but then struggle to eat healthy snacks. Healthy choices don't come by accident. Most children make the food choices that are easiest, so keeping fresh fruit within reach and ready to go can help your child choose the healthy food.
A Focus on Family
I recommend that children eat with the family as often as possible, and avoid eating while watching TV or playing video games. But when we are talking about healthy eating, it is critical that the whole family is eating healthy foods. A child's eating habits usually mirror how the whole family eats.
Physical Activity
Sixty minutes a day
In addition to a healthy diet, physical activity is also important for a child's health and well-being.
Generally, children should get at least 60 minutes of physical activity each day. This doesn't have to be all at once, but can be spread out throughout the day.
Some good ways to increase physical activity is to get the family involved. Activity is so much more fun when shared with people you enjoy. School sports are another opportunity to help a child reach their activity goals.
Physical Inactivity
While physical activity is important it is also important to limit sedentary activity. This includes time spent playing video games, watching TV and virtually any form of screen time. Being physically active is not quite enough.
While it is important to give our bodies time to rest and restore, healthy lifestyles balance this need for physical activity with an equally important need for sleep and rest.
Here is what I typically do if your child has excellent nutrition and is physically active but is overweight
Ok, so you have a child with excess weight but eats healthy. You understand the limitations of the BMI charts, and you have done a deep-dive on nutrition and can confirm that your child is getting 1 hour of moderate physical activity daily. If this is you, here are the next steps that I typically take with a family.
Evaluate other habits: Sleep, stress, exposure to light at night, endocrine disruptors, medications, metabolism, screen time, and evaluate for medical conditions.
All aspects of lifestyle are important. Since so many healthy habits affect a child's metabolism, sometimes we find an answer in an unexpected place.
Sleep
Sleeping at unusual times and inadequate sleep affect a person's metabolism, the way they process calories, food choices and intake. In fact, people who work the night shift have higher rates of obesity. High quality sleep can benefit a child's metabolism.
Light at Night
Exposure to light at night (particularly blue wavelengths of light), like the sun, suppress the production of melatonin and can affect weight. Some studies have shown that people who are exposed to light at night weigh more than those who are not.
Stress
Stress and toxic stress are increasingly being recognized as a major factor in a child's health. Keeping stress manageable and helping kids handle stress can help their body return from the fight or flight mode and back into normal metabolism.
Endocrine Disruptors (chemicals that interfere with the body's hormonal system)
Endocrine disrupting chemicals are everywhere, in food, water, air and products that we use on a daily basis. These chemicals interfere with the body's hormone system and affect metabolism.
Medications
Medications are known to affect weight in many individuals. Certain medications like antihistamines and some psychiatric medications are notorious for causing weight gain. I encourage anyone with excess weight to review all their medications (including over the counter medications) with their healthcare provider to see if they may contribute. Always seek the advice of a qualified healthcare provider prior to starting, stopping or adjusting a medication.
Evaluate for metabolic health.
Most people don't worry about their child's weight, they worry if the weight affects their health or wellbeing. Your child's doctor can do screening tests for metabolic health. This often includes a thorough family history and physical exam as well as some labs - a cholesterol panel, screening for diabetes or pre-diabetes, and screen for fatty liver. Your child's doctor will check for high blood pressure and your child's growth. This will help us determine if your child is at increased risk for heart disease, digestive and kidney diseases, hormone abnormalities or other health problems. Your doctor can also do a test of metabolism to see if your child burns calories at the same rate as expected.
So we did all that, what is next.
If child's doctor, particularly one who specialized in overweight kids or childhood obesity has done a thorough evaluation and has determined that your overweight or obese child has a healthy diet, is metabolically healthy, engages in great nutrition and physical activity has low levels of stress, sleeps well, is not exposed to light at night and has no medication adjustments to be made, then chances are weight loss is not the answer. Remember, being a certain number on the scale is not what is important.
Helping your child establish a healthy weight with a healthy future is most important.
