Clinicians' Corner

What to Keep in Mind if Your Doctor is Concerned about Your Child’s Weight

You bring your 4th grader to the doctor for their annual checkup, expecting it to be like every other appointment for the last 10 years. Their height and weight are measured, their sight and hearing are checked, and vaccines are given if needed. If all is normal, the only thing your child might remember is the painful shot they had to get.

But what if your child lands on the “overweight” section of the growth chart? Just as if your child were to lose weight and fall off their expected growth curve, it is the pediatrician’s role to communicate concerns about potential risks of unexpected changes in weight. However, depending on the conversation that follows between your pediatrician, yourself, and your child, the routine checkup may not feel like such a positive experience. A child may feel uncomfortable, and understandably so if their body is being talked about as if they aren’t sitting in the room. Words like “diet,” “obesity,” or “diabetes” may feel scary or overwhelming to hear.

Messages about weight and health can be confusing to navigate for parents and children alike. Here are some elements to keep in mind as you, your child, and your pediatrician work together to establish what healthy is for your child.

Body Mass Index (BMI) is Not the Only Indicator of Health

While BMI guidelines are indicative of weight status, they do not take into other factors such as genetics and behaviors and can sometimes miss the mark with predicting actual health risk. Because children are growing, absolute BMI is not used in isolation. Rather, pediatricians use growth charts, which show a pattern of height and weight, to monitor deviations from the expected developmental trajectory. Understanding your child’s growth patterns is more important than a single calculation and will help to avoid missing potential health risks that often go unnoticed if we just focus on the number on the scale.

Dieting — Not the Fix You Might Imagine

Focusing exclusively on the number on the scale and emphasizing weight loss communicates unhelpful, stigmatizing messages about body size and reinforces a problematic idea that self-worth ought to be inversely proportional to weight. Internalizing the idea that thinness is ideal is a well-known risk factor for eating disorders, and dieting is one behavioral manifestation of this kind of thinking. While dieting does not single-handedly cause eating disorders, there are some long term problems associated with it, not just for children, but also for adults (and especially for those who may be otherwise vulnerable to the development of an eating disorder).

In one study of 14 and 15-year-olds, dieting was “the most important predictor of developing an eating disorder compared to those who did not diet.” Teens who were put on diets at a young age were five times more likely to develop an eating disorder. Those who adopted extreme restrictive behaviors in their formative years were 18 times more likely to develop an eating disorder later in life. Moreover, researchers at UCLA and elsewhere have repeatedly found that highly restrictive diets are ineffective in the long-term, as a majority of participants experienced complete weight regain.

Children who are overweight and engage in highly restrictive eating can develop atypical anorexia, a disorder in which individuals experience significant weight loss and symptoms of anorexia nervosa despite not being “technically” underweight. A recent study found that teens with atypical anorexia nervosa faced the same or similar health complications as those with classic anorexia nervosa. Patients with atypical anorexia nervosa were also more likely to fall in the “overweight” or “obese” BMI percentile ranges in the past, and to endorse lower self-esteem than their counterparts with anorexia nervosa. Highly restrictive eating or strict food rules can also increase the risk of binge eating (and eating in secret), for children and adults in all weight ranges.

Our Children Are Not to Blame

Dieting is not the answer because our kids are not the problem. And, the blame game never helps, whether we blame ourselves or our kids. We did not all of a sudden start raising children who have lost the ability to intuitively eat. Our children are not different now, the world they are being brought up in is. We may be unfairly expecting them to ignore the excessive amounts of nutrient-void foods that are offered to them everywhere they turn. Orange slices after soccer have been replaced with assorted donuts; the Carvel ice cream trip we looked forward to here and there is now a daily stroll by one of the ten unlimited yogurt and toppings bar you pass on your way home from school.

What Can Help

With recent data showing that adolescents with a history of overweight or obesity represent a substantial portion of those seeking treatment for restrictive eating disorders, as well as the general ineffectiveness of dieting with the intent to lose weight, the American Academy of Pediatrics have altered their recommendations. They emphasize:

  • the benefits of family meals
  • increases in nutrient-dense foods
  • reductions in carbonated beverages
  • prevention of eating disorder behaviors, especially in girls,
  • reductions in “weight talk” at home, and
  • the promotion of positive body image.

Pediatricians and families can work together to promote healthy lifestyles for children without the focus of weight and dieting.

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