A Difficult Discussion About Weight

How can you even tell if your child is overweight? In children, the body mass index, or BMI, which is a ratio that uses height and weight, might be the most helpful first step.

By Dr. Robert B. Golenbock

Your pediatrician measures height, weight, and BMI at every well visit, and it is reasonable to review those numbers. Pediatricians try to be careful when talking about weight because the subject often makes children uncomfortable. Nevertheless, there are three basic areas to consider if your child’s weight percentile is rising faster than the height percentile: exercise, nutrition, and genetics. While many people think that someone who is gaining weight should have their thyroid tested, that is, in fact, the least likely cause. Genetics, we are learning, is indeed an important factor, but rather complicated. For example, some families have a satiety set point that is higher than normal. That means it takes them longer to feel full. So overweight parents might have overweight children simply because they are all used to eating large quantities. To overcome our inherent need to store fat, the whole family must agree to work together if they want to help each other. 

Losing weight is a long-term project. It is very difficult because we have retained the genes of our ancient ancestors who couldn’t be assured of getting enough to eat on a regular basis. Our Ice Age ancestors had to be able to store fat the best, or they wouldn’t survive and have offspring. Since we don’t have to hunt for our food, it’s easier for us to store fat even when we don’t want to. Thus, we must be intelligent about our food choices. Just going by our feelings of hunger will get us into trouble. 

Children’s portions should be smaller than adult portions. Use a 9-inch plate to serve them. If you, as a parent, are also concerned about your weight, try using the same plate. Don’t bring the food to the table and serve them. Fill their plates and bring the plates to the table. Have them wait 20 minutes before allowing seconds. Forty minutes is even better. They will find out they’re not hungry, or they may get involved in some other activities. And it’s fine to go to bed a little bit hungry. Remember that food should never be a reward – or a punishment. If your kids eat vegetables, make sure that vegetables are a major part of their diet. Whole fruits are better than juice, which is just water filled with sugar. Try not to buy processed food such as chips, sugary snacks, soda, cookies, and cake. If you don’t buy them, your child can’t eat them. And you won’t either. For a more detailed discussion of meal planning and healthy snacks, you can meet with a dietitian. Some pediatric practices even have dietitians associated with their offices. 

Encourage family exercise. At the least, anyone who wants to maintain or lose weight should be walking regularly. We recommend twenty to thirty minutes of activity five times a week. If you can get a little out of breath doing it, that is even better. Anything counts. Walk around the block. Make Tik Tok dances with your kids. Learn body weight exercises that don’t require expensive equipment, like jumping rope or doing pushups, and have contests. 

But the most important thing is that everyone needs to agree in advance that they’ll do the work and cheer each other on. Sit down and write out a contract. Everyone needs to agree. If your child is unwilling, you’ll need to respect their decision. 

For older children who have developed type-two diabetes or are at risk of developing it, you need to have a serious talk with your pediatrician about medication and even weight-loss surgery. These are not steps taken lightly, and you will need to meet with various specialists before your child can make the final decision to take such steps. Recently, several new medications have become available. While not without the possibility of side effects, their efficacy makes them valuable in preventing life-threatening complications of obesity. 

In this new year, I encourage you to make resolutions that will improve your health. Adults who act as role models with respect to smoking, drinking alcohol, and eating nutritious meals are much more likely to have healthy children. 

Robert B. Golenbock, MD, is currently retired. He has cared for children in the Danbury area for 43 years, including at the Center for Pediatric Medicine. The CPM is located at 107 Newtown Rd, #1D, Danbury, CT, 06810. For more information, please call (203) 790-0822 or visit https://centerforpediatricmedct.com.