Obesity: Part I

Big boned, husky, chunky, chubby, overweight, obese...we all know it's something we want to avoid. Many adults struggle with their own weight, and all of us worry about our children. We feel better when we are fit, when our clothes aren't too tight, and when we can move and breathe easily.

Screening for overweight and obesity is now a routine part of a pediatric check-up. A Body Mass Index (or BMI) can be calculated for children ages 3 and older. Just like a growth chart, children are compared to others of the same age and gender using percentiles. A BMI that falls into the 5th to 85th percentile is considered a normal weight. A BMI in the 85th to 95th percentile is overweight, and over 95th percentile is obese. If you aren't sure what a percentile is, check the end of this post and I'll do my best to explain it.

To calculate your child's BMI I would suggest a website that lets you plot it on a graph, gives you percentiles, and tells you what kind of calories per day your child needs: www.kidsnutrition.org (just click on the BMI calculator when you get to the site)

A healthy weight is important not only for a positive self-image, but for the body's current and future health. With one out of three children weighing in with a BMI of 85th percentile or higher our society is seeing problems with high cholesterol, high blood pressure, pre-diabetes, type II diabetes, orthopedic problems, non-alcoholic fatty liver disease, and more--both in adulthood AND DURING CHILDHOOD.

A child who is overweight or obese should have a medical evaluation. Usually this will mean a check-up that will include a detailed history, checking height, weight, and blood pressure, calculating BMI, and a complete physical exam. Blood work is not a routine part of an obesity evaluation in a child, and would be decided upon individually. Family history is important in the evaluation of obesity.

There are some rare genetic syndromes and medical conditions that can make it more likely that a child will become obese, however, it is more common for obesity itself to CAUSE medical problems than the other way around.

The first step in dealing with obesity is recognizing it as a problem. I certainly see it daily in my office. I also see normal weight children who have a family history of obesity, or who have eating and activity patterns that put them at risk. There is much we can do to prevent and deal with obesity. But there is no easy answer, no pill, no surgery. The long-term, sustainable solution involves a change in attitudes, habits, and lifestyle. And solutions like these are always the most difficult.

In future posts I hope to touch on prevention and treatment, as well as recommendations for feeding your child. Dealing with this problem for your child and yourself could be one of the most important, life-changing things you can do as a parent.

I have used the following resources in preparing my blog:

Pediatric Obesity: Prevention, Intervention, and Treatment Strategies for Primary Care, Sandra G. Hassink, American Academy of Pediatrics, 2007.

Pediatric Obesity Clinical Decision Support Chart 5210, Sandra G. Hassink, American Academy of Pediatrics, 2008.

Addendum: Regarding percentiles: If your daughter has a BMI that is at the 50th percentile, this means she is right in the middle for her age (50% of girls her age would have a lower BMI). I also look at it like this: If there were one hundred girls her age and height, 50 of them would weigh less. If your son has a BMI at the 95th percentile, this means that 95% of boys his age have a lower BMI (I like to think of it this way: If there were 100 boys his age and height, 95 of these boys would weigh less).

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