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Help, is my child overweight?

overweight kids.jpgHelp, is my child overweight?


At present, childhood obesity is a hot topic among parents, media and health practitioners alike.  Announcements of government initiatives have caused a flurry of interest however for parents it can often be difficult to identify if your child is too heavy for their health.
 

Isn’t it really just an issue in America?

Unfortunately not!  Childhood obesity is becoming a big problem in New Zealand, as it is in most Western countries.  The 2006/07 New Zealand Health Survey have confirmed that nz map.jpgoverweight and obesity IS an issue for our New Zealand children; with 1 in 5 of children (2-14 years) overweight and 1 in 12 children obese. Pacific Island children were at least two and a half times and Maori children one and a half times more likely to be overweight or obese compared to the total population. Based on those statistics you could easily be a parent of an overweight child! Quite alarming really isn’t it?
 

Is my child overweight?

This can be a relatively complex question.  Simply put, obesity and overweight develops when the balance between food (input) and activity (output) is upset (imagine a set of balance scales).

For babies and toddlequestions.jpegrs your Plunket Nurse and the history of height and weight plotted against percentile charts in your Well Child Book should be a guide as to whether or not your child is heavier than other children of the same age. At this stage parents are usually more worried about whether or not their child is putting on enough weight not the other way round.

However, as a child ages ‘healthy weight ranges’ can be more difficult to determine as there is no longer a formal, annual health check for height and weight to assess development.  Another challenge is that children don’t always grow out and up at the same rate all the time!

So I bet you are wondering how the statistics I quote above are calculated?  As with adults, a child’s weight (relative to their height) is calculated using a Body Mass Index (BMI) number.  You can work this out by dividing your child’s weight in kilograms by their height in metres squared. 

BMI alone does not determine if a child is overweight.  For children and adolescents, BMI is age and gender specific so is referred to as BMI-for-age.  This is important as a child's BMI can be affected by both age and gender.  To calculate your child's BMI-for-age see below.
 
Use BMI as a rough guide but try not to jump to any conclusions yourself.  If you are concerned I recommend that you consult your family doctor.


How to calculate BMI:
BMIWeight (kg)
           Height x height (m)

By plotting an individual BMI value on a BMI chart (gender specific) we can obtain a percentile ranking. This percentile ranking indicates the relative position of a child’s BMI among children of the same age.
  • BMI-for-age from the 5th percentile to less than the 85th percentile means a healthy weight.
  • BMI-for-age from the 85th percentile to less than the 95th percentile means the child is overweight (approx a BMI of 25+).
  • BMI-for-age greater than the 95th percentile means the child is obese (approx a BMI of 30).

 

Why are our children getting ‘fatter’?

The usual culprits once again – too much highly processed food and not enough activity come into play.  In the 2002 NZ Children’s Nutritional Survey they found some very interesting correlations between certain lifestyle factors and the risk for increased weight gain.  While the below findings do not prove a cause in childhood obesity, they do imply a link.tv.jpg
  • Missing breakfast and/or skipping lunch
  • Buying lunch from the school tuck shop or dairy every day as opposed to bringing it from home
  • Drinking fizzy drinks more than once per week
  • Watching TV for longer than 1 hour per day
  • Physical inactivity
 

Will an overweight child lead to an overweight adult?

I am afraid to say it but most of the studies tend to say YES!  Some studies have found that across all ages, the risk of adult obesity was at least twice as high for obese children as for non-obese children.   The age and level of obesity does seem to play a roll too with the risk of adult obesity being greater for children who were at higher levels of obesity and for children who were obese at older ages.  So if you are concerned do something about it now!
 

What to do as a parent of an overweight child:

educate.jpgMany parents are concerned about this issue but are not sure on how to approach such a sensitive topic. While they want to help their child they do not want the pendulum to swing the other way and start off the cycle of dieting and excessive weight loss. This concern is most apparent in parents of overweight girls.

The term “diet” in my mind equates to a restricted eating pattern with a long list of foods to avoid.   Dieting for children is not recommended. In fact for children the aim is not so much weight loss as any rapid weight loss will result in failure to grow and is associated with potential vitamin and mineral deficiencies.  The focus should be on trying to halt further weight gain and allowing them to ‘grow into’ their height until their weight is appropriate for their height (i.e. their weight remains constant as they grow taller).

It is important to start dealing with the problem sooner rather than later. The longer poor eating patterns and/or low activity levels are left unchecked, the harder they will be to correct.  So what can you do?

Yum Yum Kids Tips to Help:
  • Choose the right foods:  Whilst “dieting” is not recommended a child’s diet can be reduced in energy by roughly 20% by reducing the amount of high-fat, high-sugar foods and reducing portion sizes of high-energy foods.  These simple changes are likely to be enough to allow a child to grow into their weight.  Educate your children on what are ‘everyday foods’ and what are ‘occasional foods’.
  • Eat breakfast:  The importance of breakfast cannot be underestimated. Breakfast helps to kick-start our metabolism for the day and studies do indicate that non-breakfasters often actually eat more during the day. See some of our breakfast ideas if you need some new ideas.
  • Snacks are not the same as treats:  Healthy snacking is part of a normal healthy diet however taking stock of how many treats are had over the day is also important. They may seem small but they can have a significant impact.  Often a child may have a small packet of chips in the daily lunch box - at 25 grams the packet may seem insignificant, but over 5 days this adds in an extra 45 grams of fat (imagine 9 teaspoons of butter or oil).  On a regular basis this has a significant impact.
  • Make it a family focus: It is important that the problem is dealt with as a family rather than placing all the focus on the child. The child with the weight problem should not be left to feel that they are the only one who has the problem.  Generally speaking, it is not the child who is responsible for buying or preparing the food, so healthy options should be bought in for the whole family.  Get some child appropriate cookbooks and get them interested in healthy food and cooking.
  • More than just weight: It is also a positive idea to talk about improved health rather than just focusing on the child's weight. Focus on improved energy levels or better exercise tolerance for the whole family. This may help to avoid or reduce the negative feelings that the child may have about his or her body image.
  • No banning: No food needs to be banned, but some foods should be considered as occasional foods while the healthier foods are considered everyday foods. These occasional foods then need to be monitored.
    • Child sized plates also help as they are smaller and help to guide children’s serving sizes.
  • Get moving: Lastly, the importance of exercise cannot be underestimated. Regular exercise is a vital habit to start in childhood. Again it should be a family project not just focusing on one child. Don’t forget that if your child is quite large or if they have not done much exercise the idea of doing exercise as part of a team sport may seem very daunting for them. This is where doing things initially as a family can be very important. Things like walks, bike rides, going to the park, and kicking a ball around are all important. Setting limits on the television, computer and play station may be necessary. Considering TV-free days for the whole family may be appropriate so that the child does not feel that they are the only one with new limits imposed.

So if you are concerned about your child’s weight don’t wait to see if they will ‘grow into their weight’. The earlier you start with positive changes the better. The younger the child is when good habits are developed the more likely they are to maintain those habits and attitudes for life.

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References:
  • Ministry of Health. 2003. NZ Food NZ Children: Key results form the 2002 National Children's Nutrition Survey. Wellington. Ministry of Health.
  • Ministry of Health. 1996. Food and Nutrition Guidelines for Healthy Children (aged 2-12 years): A background Paper. Wellington: Ministry of Health.
  • The New Zealand Medical Journal. Obesity in New Zealand children: A weighty issue. 24 August 2007, Vol 120 No 1260
  • Grant BC, Bassin S. The challenge of paediatric obesity: more rhetoric than action. NZ Med J. 2007; 120(1260)
  • The Burden of Overweight and Obesity in New Zealand Children - background paper