Overweight

“Healthy at any weight” is the newish mantra when it comes to weight and health in pediatrics. Having cutoffs and standards according to a person’s Body Mass Index (BMI) is old news and not super accurate or helpful when it comes to evaluating a kid’s or teen’s overall health. Every healthy string-bean basketball player will look “underweight” on the BMI scale, and every weight-lifting football linebacker will look “overweight” on the scale even though both have more stamina, energy, and strength than their peers who are at a “healthy” BMI but sit and play video games all day.  

When I assess weight in the clinic, I look at the numbers on the scales in different ways for kiddos of different ages.

For babies, I look for a few things at several time points to determine what is healthy and what is not. After a baby is born, I am expecting up to a 10% weight loss after birth in the first few days. Babies are born with lots of extra hydration because their bodies are super smart and know that mom’s milk will take a few days to come in, and it will take a mother a few days after that to figure out the whole feeding thing. If I have a baby who has lost or is on track to lose more than 10% of their birthweight, then that will often also show up as dehydration. So at that point, we typically figure out some way to supplement the kiddo before the breastfeeding dyad magic starts occurring in the next few days. After that time/weight check-in, I am looking to see that baby is at or above their birthweight between Days 10 and 14 of life. To us, this notes successful feeding, and once they are at birthweight, their body just sort of clicks in when it comes to everything functioning on all gears. The body is like Whoa! What do I do with all these extra calories? Let’s find out! After that, I am looking to see that baby is on their way to being close to or above double their birthweight by 4 months of age. 

Did you notice that I didn’t say anything about what trend line the kiddo should or shouldn’t be on on those weight charts? Because it doesn’t really matter as long as they are gaining weight in a healthy, rather predictable manner. If they go up a bunch of trend lines in this time, cool! If not, no biggie. Around 6-9 months is when we start seeing kids stick to a trend line for weight, and it makes it a bit easier to predict at each subsequent well visit around where the kiddo should be. During this time, we are also starting to introduce solid foods. Some kiddos love solid foods from the get-go, and others don’t. That’s OK. As long as you are offering yummy healthy foods that are free of extra salt and sugar and are not processed (i.e., your grandparents would recognize the food), it’s tough to feed these kiddos so much that they gain an unhealthy amount of weight. In fact, once kids start crawling and walking, the extra calories needed for those activities will cause them to lower their trend line percentile in a very healthy way.

As kids get older, my main concern is not really how much a kid is eating but what they eating and what they are doing for exercise. Even with recess and PE (physical education) in elementary school, we always recommend outside-of-school extracurriculars that get the kiddos moving on a regular basis. This is not only fun, but also a great way for kids to find friends outside of school and, of course, necessary for building strong muscles and bones. A regular amount of predictable physical activity also helps the body’s metabolism get to a steady state, allowing kids to know how many healthy calories on average they need to keep up their energy to get through a day. Our bodies like this predictability. As a parent, you just start noticing how much your kiddo is typically eating, and you set up the meals at home accordingly.  

Well, what are we eating? Most kids are metabolically sound and do not suffer from inborn/genetic errors in their metabolism. If we follow the biochemical pathways in our Biochem 101 books, it is super difficult for the body to make bad things out of healthy proteins and vegetables. It is the extra starches and sugars that can be processed for storage in unhealthy ways in the body. So if you have a ravenous teen, make sure to make it much easier to grab a healthy vegetable or protein than a bag of Doritos and to get water rather than a soda or juice box.  

Therefore, if I have a 13-year-old with a “healthy” BMI but not participating in any extracurriculars and mainly eating chips and processed food, in the long run, that kiddo is more at risk for weight and diet concerns than a kid with an “unhealthy” BMI but playing a sport and eating mainly protein and veggies. There are super-scientific ways to get to know each child’s basal metabolic rate or actual body fat percentage, but we don’t have the fancy exercise evaluation and body dunk tanks that the sports pros do in pediatric clinics. So by asking about diet, exercise, stamina (Are you able to keep up with the other kids on your team?), etc., we can glean rather accurately how weight may or may not be affecting your child’s body’s performance. 

If your pediatrician is worried that your child’s weight is a result of unhealthy habits, recent guidelines and studies do support a much more intensive approach to nipping nutrition concerns early. Often, we will have the child see a nutritionist and healthy lifestyle coach, commonly at childhood resiliency or nutrition centers at large pediatric academic centers. Your pediatrician may even recommend medication or surgery to help with weight loss in rare settings where children start showing early signs of diabetes and heart disease. Now I know this sounds harsh, but studies support that the earlier we tackle this health concern, the easier it is to get a child to a healthy body state and the longer lasting the healthy body effects and habits are.

What does not help is having family members always point out what their kiddo is eating or commenting on their weight. This will often cause the child to become defensive or feel like they are at fault or that their weight is solely up to them, which it is definitely not. As a parent, if you have a concern about your child’s weight, please let the pediatrician know for either reassurance or a productive discussion with your child from someone who can be an independent third party for their health and well-being.