ARTICLE: Is your child obese, but you can’t see it?

ARTICLE:  Is your child obese, but you can’t see it? 

Carson (not his real name) was a charming four year old who was very attached to his parents and his parents clearly adored him.  Awhile ago I was having a serious discussion with his mom and dad because Carson had high blood pressure, sleep apnea (trouble breathing when he falls asleep), and early signs of diabetes.   His parents were appropriately concerned about these very serious health problems that are usually seen in overweight adults.  In the course of our discussion I explained that Carson’s obesity was a major factor in his illnesses and I asked them for their thoughts about his weight.  They looked at each other a bit puzzled and said “we think he’s about right.”  This was a jaw dropping moment for me because little Carson, at four years old, weighed 105 pounds!  His tummy hung over his pants, his cheeks were plump and round, and his movements were more slow and lumbering than a typical child his age.  Any casual observer would have recognized his obesity, but his parents didn’t.   How could this be? Was this denial? Did they really not think it was unusual that he was wearing size 12 Husky pants at age four?
As I began to explore this issue I learned that Carson’s parents are not unique.  In an article published in the journal Pediatrics in 2003 mothers were asked to describe their child’s weight and almost one in three mothers of children who were actually overweight described their child as “about the right weight”.  In another article published in 2006 in the same journal parents were shown several sketches that represented children of varying weights from underweight to overweight.  The parents were asked to choose a sketch that best represented their child’s body appearance and then to describe their child’s weight in words.  The majority of parents whose child was obese correctly circled a drawing of an obese child, but almost 2 out of 3 of these parents described their child as “about the right weight”.  It is interesting that these parents recognized their child’s body shape, but they just didn’t see it as extreme.   The problem is obvious.  If parents of obese children don’t believe there is a problem they are very unlikely to help their child lose weight.
The first step in determining if your child is getting too heavy is to ask your doctor to calculate a BMI.  BMI stands for ”body mass index” and it is the primary measure used to determine obesity in adults.   Unfortunately, BMI alone doesn’t give enough information for children because in children body fat is different for boys and girls and it changes with age.  So after calculating the BMI your doctor will plot the number on a “BMI for age growth chart”.  It is essential to use this chart because the definition of obesity changes with age.  In fact, the same BMI can be obese at one age and healthy at another. That’s because obesity in children is determined by comparing children to their peers of the same age and sex.  A child whose BMI is more than 95% of children of the same age is considered obese.  A child with a BMI that is between 85% and 95% of other children would be considered “at risk for overweight.”   For example, a 10 year old boy with a BMI of 23 is considered obese while a 15 year old with the same BMI is considered a healthy weight.  Using adult standards without the chart would suggest that both boys are a healthy weight.  If you’re confused don’t worry.  Your doctor can explain where your child’s BMI falls on the chart.  Then if it’s too high you and your doctor can develop a plan to help your child become healthier. 
Carson’s parents in the story above were surprised to learn that his BMI of 32 meant he was heavier than 99% of other four year olds and was definitely obese.  For them this new information along with his health problems were a call to action.  They immediately began limiting his high calorie snacks and started walking him to school instead of driving.    They enrolled him in park district sports and cut way back on fast foods.  And today Carson’s health is improving. 
The above studies don’t tell us why parents find it difficult to describe their child as obese, but one thing is clear: knowing a child’s BMI for age is important even for parents who don’t think their little one is obese. Remember, almost two out of three mothers of obese children don’t think so either and as Carson’s parents learned the risks of not knowing can be serious.  Only accurate information and a solid plan can give every child a chance to grow up with the best health possible.
This column is not intended to be medical advice. Consult your personal physician for specific health concerns.