Believe it or not, there is no national or international consensus on the precise definition of overweight and obesity in children. For several years, doctors have been inclined to use 'percentile' weight for age charts which need to be intepreted on an individual basis taking into account the child's height - obviously if your child is much heavier than average, but also much taller than average, than he may not be overweight at all.
However, in 2000 a British team from the Institute of Child Health with the International Obesity Task Force produced a set of international cut-off points for overweight and obesity in children based on the Body Mass Index. This produces guidelines for children based on their weight and height from age 2 - 18, after which the standard Body Mass Index charts are used. These cut-off points correspond to an adult BMI of 25+ for overweight and 30+ for obese. Although these cut-off points for children have not yet been taken on board internationally many experts believe that they offer the best assessment of overweight or obesity in children.
An adapted chart appears below.
Some experts also suggest simply looking at your child with the rest of his or her class at school and seeing if he or she seems much fatter than most of the others as a reasonable way to tell if there is a weight problem. It is also advisable to see your doctor who will no doubt be able to add a professional opinion and further advice.
Body Mass Index chart for children
Your child is overweight if he/she is:
2 years old with a BMI of more than 18.4 (boys) or 18.0 (girls)
3 years old with a BMI of more than 17.9 (boys) or 17.6 (girls)
4 years old with a BMI of more than 17.6 (boys) or 17.3 (girls)
5 years old with a BMI of more than 17.4 (boys) or 17.1 (girls)
6 years old with a BMI of more than 17.6 (boys) or 17.3 (girls)
7 years old with a BMI of more than 17.9 (boys) or 17.8 (girls)
8 years old with a BMI of more than 18.4 (boys) or 18.3 (girls)
9 years old with a BMI of more than 19.1 (boys and girls)
10 years old with a BMI of more than 19.8 (boys) or 19.9 (girls)
11 years old with a BMI of more than 20.6 (boys) or 20.7 (girls)
12 years old with a BMI of more than 21.2 (boys) or 21.7 (girls)
13 years old with a BMI of more than 21.9 (boys) or 22.6 (girls)
14 years old with a BMI of more than 22.6 (boys) or 23.3 (girls)
15 years old with a BMI of more than 23.3 (boys) or 23.9 (girls)
16 years old with a BMI of more than 23.9 (boys) or 24.4 (girls)
17 years old with a BMI of more than 24.5 (boys) or 24.7 (girls)
At 18+ the adult calculation for BMI applies.
How important IS overweight in children?
We in the Western world are facing an obesity epidemic which looks set to get worse unless we can find solutions quickly. The main problem is that studies show that a high percentage of children and adolescents become fat adults with all the health implications that brings (see "Your Weight, Your Health").
There are not many truly fat children who manage to lose the weight and go on to be slim adults, so it is obviously much better to prevent overweight in your child as a way to combatting adult obesity. And if your child has become overweight, the sooner you do something about it, the easier it should be to resolve.
What is the best way to prevent a child from becoming overweight?
When children are small, many parents encourage their children to 'eat up' and equate a healthy appetite with a healthy child. This is understandable as many very small children are faddy about food, have poor appetites and are consequently underweight. Any parent who has dealt with such a child may feel nothing but relief if that child later begins to eat like a horse, or if she/he has another child who relishes all food.
Getting your kids to eat well is perceived as a sign of being a 'good parent'. For many children, though, a healthy appetite for decent food is but a short trip to a big appetite for all kinds of food, followed by the first signs of overweight. So that is one pitfall to look out for. Encourage your child to eat well - but that doesn't mean overeating.
It is also important to look after yourself, as parent, and eat sensibly yourself. Research shows that overweight tends to run in families, as does the amount of exercise taken. The overweight factor may be partially due to a genetic predisposition but even so, children tend to take their eating habits from the parents and older siblings and if what is offered, and what everyone else eats, is healthy and balanced, reasonably low in fat and sugar, then the child is unlikely to get fat, especially if the parents encourage lots of physical activity. Take your child out hiking, swimming, cycling - help him to join sports clubs.
Sadly, PE and sports at school are tending to be sidelined by curriculum demands and so even school sports may not offer as much exercise as it once did. By the time children - particularly girls - are into their teens, their exercise habits (or lack of them) are pretty much entrenched, so it is important to develop your child's awareness of physical activity by encouraging her at every opportunity. Lead by example - and keep slim and fit yourself!
Lastly, you need to take an active interest in what your child is eating. Research shows that modern children tend to eat a great deal of 'snack' foods both outside the home (from the school cafe or tuckshop, from shops on the way home, at other children's houses) and in the home. Many kids have access to a 'snacks' cupboard and the fridge stocked full with crisps, cakes, fizzy drinks, and so on.
Peak times for 'raiding the larder' are when they get home from school (especially if no-one is there) and over the weekend. Hundreds of surplus calories can be eaten this way, and they are likely to contain little in the way of good nutrition. Self-choice school lunches for children are also, in my opinion, a bad idea as a high proportion of kids will pick the fattiest, most calorific thing on the menu. A lunch packed by yourself is a safer alternative and the only way to know what is being eaten.
One good way to monitor your child's calorie intake is to revive family mealtimes - sadly a minority of families now sit down to a main meal or breakfast together regularly. 'Proper' meals have been replaced with eating on the hoof or snacking in front of the TV. One recent report found that increasing numbers of children can't even use a knife and fork when they start school because their meals consist of hand-held pizzas, burgers and nuggets.
If you don't want your child to be overweight, you need to take back control of what he eats and drinks and how much exercise he does. Maybe letting the kids go down the 'fast food and TV' route gives you, the parent, more time for the rest of your life. But children are too young to know what is best for them, or care about their health.
Too much freedom to choose their own diet and too many hours spent in front of the TV or computer will, in the end, make a very high percentage of them fat.
Is it true that you should never put a child on a low-calorie diet?
This is one of those trick questions with no simple answer. Every time a child loses weight he has probably reduced his calorie intake significantly to do so - or taken a great deal of exercise to burn the calories off. Although many child nutrition experts say that you shouldn't put your overweight child 'on a diet', as we've seen, very many children DO need to lose weight - so it's catch 22 - if you can't put your child on a diet, how is he ever going to lose weight? Calorie restriction seems to me to be an almost essential part of the equation.
But here we have the dilemma of what a 'low-calorie diet' actually means. If you give your overweight child a healthy diet with restricted fat and restricted sugar but with extra fruit and vegetables and bread, for example, so that the total calorie content is reduced but he still has plenty to eat, that is a reduced-calorie diet, I would say. But perhaps a low calorie diet conjures up a picture of a poor child existing on meagre rations of lettuce, cottage cheese and water. So if 'low-calorie' in your book equates with 'crash dieting' then of course, the answer is no, don't put your child on one of those.
This is not only because it will be demoralising and miserable for the child, but also because even overweight children need all the nutrients that other children need, to grow and build bone, muscle, organs, and so on. They also need enough of all the vitamins and minerals to help this along and to help them to health. A poorly thought out calorie-reduced diet, especially one too low in calories overall, may easily not supply all these needs.
It is fair to say that any parent who feels their child is overweight should firstly see a doctor (who may refer you to a dietician) for advice and secondly follow the diet guidelines they are given. This will then be an officially-approved, well-balanced, calorie-reduced diet, which is fine.
Having said that, obviously if your child has been eating a great deal of sweet snacks, crisps, greasy chips, pork pies and so on, make an effort to cut these out, or down, from his diet to help reduce his calorie intake - no dietician would disagree with this strategy. Often such methods will be enough in themselves to help a child slim down over time and this is, let's face it, dieting by any other name.
I suppose the key is that children should be helped to lose weight, if they need to, in a gradual, non-obtrusive way which won't have them feeling hungry or rebellious, or which will make them feel 'at fault' or depressed with their weight.
Some experts hence believe that the best way to slim down a fat child is simply to try to maintain his weight at its current level and wait until he literally 'grows into' it.
For example, a 10-year-old boy who weighs 10 stone now may not be overweight at all if he still weighs 10 stone at age 14. (This is just an example, children vary and height is a factor). To ensure that your 10-stone 10-year-old doesn't put on any more weight you still do need to watch the calories, but looking at this long-term picture of his weight may be better for the child psychologically and physically. You never once need say to the child 'you have to lose weight' and he can follow a 'calorie-containing' diet rather than a 'calorie-restricted' diet so it may make him feel better all round. All you do is check his weight from time to time, and if he hasn't put on any more, all is well.
Again, the doctor or dietician who knows you and the child may offer the best advice on which method to follow. All the advice on feeding overweight children that comes in the rest of this section is general advice given in the best of faith - but it is always wise to treat your child as an individual.
Eating disorders
I should point out that because of the rise in the number of cases of teenage eating disorders (and in even younger children) there is an understandable fear from some parents about encouraging their children to diet. If the child is genuinely overweight, this fear should not prevent you from reducing her weight by the means outlined here and in the next question.
The incidence of health problems associated with overweight and obesity are so much greater than the risks of an eating disorder developing in an overweight child who slims, that I feel the sensible course of action is to help prevent the child from becoming an obese adult. Research indicate that it is very unlikely that your overweight child will turn into an anorexic one if you responsibly and sensitively help him to slim down.
What is the best way to slim a child down?
The answer to the previous question will tell you, in broad terms, the lines along which you should be thinking if you have an overweight child. Here are some more detailed guidelines you can follow:
- Aim to produce a weekly weight loss of a maximum of a half a pound. This will mean reducing his/her daily calorie intake by about 250, which isn't drastic and should ensure adequate nutrition.
- If your child has been eating regular between-meal snacks of sweets, cakes, biscuits, pastries, crisps, and drinking a lot of high-sugar drinks such as cola and lemonade, these are the first things to cut right back on, replacing them with less energy dense foods such as fruit, and plain water to drink. For some children, this alone is enough to produce half a pound a week weight loss.
- Increase his energy output by encouraging cycle rides, kicking a ball around in the park, walk with him to school, and so on.
- Limit takeaway meals and meals eaten outside your control - prepare food yourself where possible.
- Don't reward good behaviour with snacks or chocolates and aim to gradually alter his mindset into accepting that food isn't always associated with 'leisure and pleasure' time. For example, that a visit to the cinema need not mean a huge box of popcorn and a litre of cola.
- Reduce portion sizes of high-density high-fat foods such as pies, pastries, Cheddar cheese, fatty meats and increase portion sizes of fruits, vegetables. Portions of bread, potatoes, pasta, etc can remain about the same.
It isn't easy persuading an overweight child to change her eating habits, but with the right approach from you it can be done.
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