The BMI (Body Mass Index) is a tool for understanding obesity and its use in children is growing. Your pediatrician has probably used it at your child’s annual check-up and you may have seen it used in the school setting soon.

But what is it exactly?

The BMI is an assessment tool that looks at the relationship of weight and height, determining the status of a person’s body weight for their current height.  The BMI calculation will classify an individual as underweight, healthy weight, overweight, or obese.

The BMI is a screening tool that was developed for populations to determine public health risk for chronic diseases such as heart disease and diabetes. Its use in children over the age of two has increased over the years due to the rising incidence of childhood obesity. Most pediatricians are routinely assessing the BMI at your child’s annual check-up.

The best thing about the BMI measurement is it can help you see trends in your child’s growth and allow early intervention if needed. Normally, children grow along a self-established channel and curve. If there is a sudden jump up on the BMI growth curve, this may indicate your child is picking up extra weight. If there is a drop on the curve, weight loss may be a concern.

The BMI measurement has its limitations. For example, the BMI provides a total body index and does not differentiate body frame size and muscle mass from fat stores.  In other words, you may have a large-framed child that is muscular who may be classified as overweight or obese.  Looking at children as individuals including what they eat, how they eat, how physically active they are, and the parents’ frame size can help keep the right perspective when it comes to your child’s weight and interpreting his BMI result.

If you are told your child’s BMI is too high, consult with your pediatrician, registered dietitian, or other health care provider to gather information and education that is tailored to your child, family, and lifestyle.  An elevated BMI and the associated risks for chronic disease can be normalized and/or reversed with healthy eating, physical activity, and lifestyle changes.  For a BMI calculator tool, go to http://apps.nccd.cdc.gov/dnpabmi/.

Hunger is a primal force. If left unattended, it can create an unhealthy array of habits and eating patterns that can contribute to a damaged relationship with food and weight disruption.

We are all born with a natural sense of hunger, an ability to recognize it, and a desire to quench it. Babies expressly tell us when they need to eat by crying. Toddlers tell us by whining, or “melting down.” Children coming home from school may tear into the refrigerator or pantry, “starving” and desperate to eat.

By adulthood, folks generally have figured out how to manage their hunger, with some respectfully honoring their body’s signals and feeding it when the telltale signs emerge.  Others have strategies that help them manage their hunger and ultimately their weight. These can be healthy techniques and not-so-healthy ones. In my observations, children are not inclined to use the delay tactics and strategic distractions common to adulthood management of hunger. Hunger, for many children, is powerful and leads them to seek out food.

What’s going on?

Children are in the dynamic process of growing and hunger is the body’s natural prompt for eating. A great example of the hunger-growth relationship is the teenager who won’t stop eating, and his mother who is off to the grocery store every two days just to keep the kitchen stocked.  As children get older, they are able to satisfy their hunger and become self-sufficient at making choices for themselves. Often, we fail to appreciate the power and influence of hunger in children.

The degree of hunger and the responsiveness from the parent to that hunger plays an important role in childhood weight. Intense hunger can occur as a result of long stretches without food, meals that don’t provide enough calories, or an improper balance of nutrients.  Just as a car without gas sputters down the road until it eventually stalls, likewise our bodies get tired and unfocused when nutrition is low. If hunger is ignored or put off, it can cause havoc in a child’s ability to regulate their eating patterns. Hunger can build, causing overeating and inappropriate food choices.

The easiest and most important way to address hunger in the growing child is to quench it with filling, nutritious foods.  Here are some other things to keep in mind:

Understanding the growing child.  Growing children are hungry and eating can be variable depending on the growth stage. For example, babies and teens are growing rapidly and their hunger and eating generally reflect this. Toddlers, preschoolers and children are in a steady state of growth, so their food intake reflects this. Restricting or controlling your child’s food intake during what appears to be vigorous eating or a growth spurt may actually cause them to overeat due to getting too hungry.

Stay ahead of hunger. Plan meals and snacks to occur every 3-4 hours, so your child is offered an opportunity to eat. Skipping meals or snacks can lead to overeating later on.

Use filling, nutritious foods.  Whole grains, fruit and vegetables provide fiber, a component of food that keeps you full longer. Sensible amounts of low fat dairy products and lean meats, eggs, nuts, and beans pump up the protein and also fills up growing bodies.

Load up early.  A nutritious breakfast starts the body’s “engine” and sets the pattern for eating at regular intervals. Kids who skip breakfast may find themselves hungrier after school and at dinner time.

Ditch the convenience notion.  Include a variety of foods from at least 3-4 of the MyPlate food groups at mealtime.  Offer “power snacks” at snack time, making sure to include a source of protein and whole grains, fruit or vegetables for a satisfying, hunger-defying snack.

A “starving” child will eat. It’s up to you to have a healthy plan in place because the power of hunger lives in your child.  Anticipate it and react when it occurs with healthy, nourishing, satisfying food options that your child can enjoy!

In a culture plagued with weight problems and thin idealism, it’s no wonder kids are asking their parents, “Do you think I’m fat?” According to a 2008 Canadian survey, 37% of ninth grade girls and 40% of tenth grade girls believed they were, in fact, too fat.

Many parents are blind-sided by this question and are stumped into silence or heading to Google, the doctor, or a friend for advice. According to Laura Lewis, a psychotherapist and eating disorder specialist in Nashville, TN, the timing of this question is an important factor in deciding how to respond. “If this is the first time this question has come up, tell them they look fantastic, and make sure to stay away from using words like ‘big’ or ‘small’, ‘thin’ or ‘heavy’,” states Lewis. If this is not the first time the question has been asked, then this is a real concern that needs your time and attention. “Sit down with your child and have a conversation, beginning with, “you have asked me this question a couple of times—what’s this about?” she advises.

Lewis states that kids get these questions from a variety of influences, including their own parents, peers, and the media. Coming up with a thoughtful and meaningful response depends upon the influence your child is concerned about.

The Parent: Without even knowing it, parents pass on their own body image and weight concerns to their children. “If you find yourself asking, “Do I look good?” or “Do I look fat in these jeans?” to your hubby or other family members, you may want to temper those questions in front of the kids,” says Lewis.

The Peers: Children surround themselves with their friends and find themselves in situations where body comparisons come naturally, such as the gym and the locker room. Particularly during pre-adolescence, the child has a developmental urge to find out if they are normal. “Answering the question, “Am I normal?” is developmentally on target and relies, in part, on looking at others and comparing oneself with others,” states Lewis.

The Media: The ‘thin is in’ ideal makes its mark on children, too. And when you combine media power with a general desire to fit in, it’s easy to see how questions about self-worth and inadequacy can surface.

So what can parents do?

Most importantly, your child needs to hear you accept and love them regardless of what they look like. Period.

Here are some other things Lewis encourages parents to keep in mind:

Respect and Honor your own body. No matter what the size or shape it is—it is your body after all–and the body that produced your child, and takes you where you want to go.

Tolerate normal child growth.  Pre-pubescent girls and boys gain weight in preparation for the rapid growth of the teen years and this is a normal process.

Focus on your child’s inner qualities. Begin pointing out inner qualities as early as possible to help build self-esteem and worthiness.

Limit media influences. Think twice about buying that fashion magazine for your 11 year old and be sure to scrutinize the TV shows your child is watching.

Attitude is everything! Everybody has value, no matter what it looks like.

When your child asks, “Do you think I’m fat?” she is asking you to discuss your values and ideals about body weight, shape and size. He is also giving you the option to debunk media messages, thin idealism, show your acceptance and assure love. Seems like a golden opportunity to me.

We all know that childhood obesity can have long-term health effects. Kids who are overweight in early childhood tend to retain their chunkiness and even become heavier as they grow older, out of proportion to increases in their height. The good news recently is that childhood obesity rates have leveled out. The bad news is that parents of overweight kids may actually think children’s weight is normal.

Are you blind to your child’s size? According to a new study published in Sweden, involving parents of 16,000 children aged 2 through 9 from all across Europe, half of parents whose children are too heavy for their height believe their children’s weight is just fine. Four out of 10 of these parents are even worried that their kids might become too thin. How can this be?

OVERCOMING CHILDHOOD OBESITY

Parents in the study were asked to describe their child’s weight as under- or over-normal or right on target. They also were asked about their concerns about a change in weight their child might experience in the near future. These perceptions were then compared with children’s actual measurements and Body Mass Index.

Parents of children whose measurements indicate they are overweight or obese were likely to believe their children’s weight is just fine. Half the parents living in Northern and Central Europe believed this, while a whopping 75% of parents in Southern Europe were blind to the facts.

Parents of children who were obese or overweight were more likely than parents of children who were underweight to believe their children were too thin or might become too thin. Forty percent of parents of heavy kids thought this way, in contrast to just 33% of parents of slender children.

The study didn’t indicate the weight status of parents, so there’s no way to tell if parents’ perceptions were influenced by their own weight issues. However, overweight is less of an issue in Europe than it is in the United States, so the population of children to which overweight kids might be compared by their parents is smaller than it is in this country.

DOES SLEEP DEPRIVATION CONTRIBUTE TO OBESITY?

The study’s author, Susann Regber, speculates that parents simply don’t notice. She believes that as small children grow, it’s difficult for parents to tell when weight becomes out of proportion to height, so concerned are they about children’s overall health and food intake. She says, “Many parents simply do not see the increase in growth, and are dependent on objective information from, for instance, child welfare centers and school health care to act.”

Since we all know the negative effects overweight and obesity can have for children’s health and also for their acceptance by other kids, it’s natural to be in denial about children’s weight. We tend to believe that early pudginess is just puppy fat that will disappear as children grow taller. It’s reasonable to imagine that our kids’ weight is within the normal range.

THE SECRET TO FAMILY HEALTH AND WELLNESS

So what can we do instead?

• Pay attention to what pediatricians or your child’s teacher tells you. If they say there’s a problem, don’t argue.
• Ask your pediatrician about your child’s size. Now that you know you’re not a very good judge of this, go ahead and ask for an expert opinion, if your child’s doctor doesn’t offer one on her own.
• Make certain the meals and snacks you serve contribute to your child’s nutrition. Avoid junk food and fast food meals. Maybe you’ve thought your child was of normal weight and her food choices didn’t matter. Now that you realize you could be wrong, be more careful about food.
• Stay active. Make being active what your family does. Keep the television and gaming devices off more than they’re on. Get outdoors every day and play hard.
• Yes, I’m including you. Be a role model, both of what and how much to eat and how and how much to play. Good health is good for everyone!

The idea that we may be blind to the reality of our children’s weight is eye-opening. Now that our eyes are open, we must pay attention to what we see.

© 2014, Patricia Nan Anderson. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Ask for Dr. Anderson’s new book, Parenting: A Field Guide, at your favorite bookstore.

We all know that childhood obesity is a problem in the United States. Weight issues have been linked to early onset heart disease, diabetes, asthma, high blood pressure and joint problems, not to mention teasing and discrimination at school. But the threat of obesity shouldn’t blind us to the beauty of our children, just as they are right now.

Our daughters are more vulnerable to weight issues than our sons. Girls are bombarded with images of stick-thin beauties, unrealistically proportioned dolls, early dieting advice, and popular media that equate thinness and physical beauty with worth. Although boys are endangered by obesity too, they are not so endangered as girls are by unrealistic expectations.

It’s easy for parents to get caught up in the hype. We want our kids to reflect well on us. We’d like them to be perfect. We don’t want our kids to embarrass us. And we don’t want people to think we let our girls get fat.

So we over-react.  We make our girl’s appearance a big deal. We fuss over slimming clothes. We buy her diet books. We give her grief any time she eats. We make fun of her, thinking somehow we are doing her a favor. “Better coming from me,” one mother said. “She might as well get used to it.”

It’s obvious this is abuse. It’s no surprise that most of the misery of being overweight is caused by unkind behavior. And, since eating makes us feel better – that’s why there’s “comfort food,” after all – heaping abuse on a chubby child doesn’t make her any slimmer. It only makes everything worse.

So, what to do? If your child – of any age – is overweight, how should you respond?

1. Quality time. Spend time with your daughter doing fun stuff. Physical activity is great – walking, bicycling, doing yoga – but anything you both enjoy is fine. Could you both take up painting or garage sale-ing? Could you start a business? Turn off the television and do good things. Spend time with your daughter and you’ll send her the message, “I love you and I think you’re terrific.”
2. Quality food. Give up junk food and don’t let it in the house. Yes, your daughter may find other places to get it, but if it’s not at home you won’t be put in the position of standing guarding over it. Food – junk food – won’t appear to be more important than your child.  And if everything at home is okay to eat, then eating at home is not a problem. This means, of course, that no one in your home eats junk food. Good.
3. Quality support. If your child is dangerously overweight, get advice from your family doctor. But don’t take advice from your best friend, your worst friend, magazines, TV, and other unreliable, even dangerous sources.  Shut your ears to comments intended to hurt. Know that your child’s happiness means more than others’ opinions. Be there for your girl.

At one time, body image issues were limited to teens. These days elementary school children – even preschool girls – talk about diets and worry about their weight. This is unnatural and unhealthy. This is something we adults have done to our kids. It’s time to stop.

The best way to encourage health is to encourage life: “Does this life make me look fat?”

“No, my dear. This life makes you look pretty  and funny and very smart.”

Obesity among preschool children has fallen 43% in recent years. But that still means that 8% of kids aged four and under are seriously overweight. That’s one child in every preschool classroom of 12 children. Is that one child yours?

It might be if your child’s mother is inactive. A study published by the American Academy of Pediatrics looked at activity levels of over 550 mothers and their four-year-olds. The study found that children were about as active as their mothers were; their activity levels matched. But they also found that only about half the mothers were active for 30 minutes each day. Half of the mothers – and their children too – were less active than is healthy for them.

If you’re a mother, I know what you’re thinking: you’re thinking that you’re busy all day, every day. There’s no way you don’t get in half an hour of moderate to vigorous exercise each day. But stop and really count things up. How much of the time are you “busy” but not physically active? How often do you spend an entire half-hour walking, running, lifting weights, bicycling, or playing sports?

Too much of the time we are busy but not really active. We don’t have a moment to ourselves, it seems, but even so not any part of the day is physically strenuous.

The good news, as lead researcher Kathryn Hesket notes, is the “maternal physical activity levels can influence the activity level of their child.” An easy way to make your child more active is to be more active yourself.

How do you make time for your own activity when you’ve got a child or two to care for? Here are some ideas.

1. Take your kids along. Run or take brisk walks (uphill as well as down) with the children in a stroller or bicycle with the children in a carrier or trailer.
2. Exercise at home. Use an exercise video or in-home equipment to work out during naptime or when the children are playing on their own.
3. Enroll in an exercise program that includes child care. Check out what’s offered by your local park district or Y.
4. Trade off workout time with your best friend. Remember your “best friend” might be your husband. Leave him home with the kids in the evening while you head out for a run.
5. Notice what objections are coming up in your mind as you read this short list. Realize that it’s not that you don’t have time to be active but that you’ve got a lot of excuses for staying inactive. Make a commitment to your health and the health of your children.

Like anything else, children copy what their parents do. Do you want your child to copy you when you’re sitting still, moving as little as possible, or do you want your child to copy you when you’re feeling strong and capable? Get up and get moving and your children will too.

© 2014, Patricia Nan Anderson. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Ask for Dr. Anderson’s new book, Parenting: A Field Guide, at your favorite bookstore.

A review of data gathered as part of the ongoing Early Childhood Longitudinal Study published this week in the New England Journal of Medicine reports some startling findings on childhood obesity.

• Babies who weigh more than nine pounds at birth are more likely to be heavier in grade school. More than one-third of overweight elementary school children were big babies.
• Children who are overweight in kindergarten are four times as likely as other children to be obese by middle school. During kindergarten, 5% of children who weren’t overweight at the start of the year became overweight by the end of the year.
• The period of greatest change from “normal” weight to obesity happens in early elementary school, between first and third grades. Patterns of overweight change very little between 11 and 14. Nonetheless, between ages 5 and 14, almost 12% of children are or become obese:  10% of girls and nearly 14% of boys.

What does all this mean?

• It means that a tendency to become overweight and obese starts early – even at birth.
• It means that children at the age when we might regard chubbiness as cute and just “puppy fat” actually are at risk for maintaining their extra poundage throughout childhood and into the teen years.
• It means that the old assumption that children will “grow into” their weight might be not quite right.

What should we do?

Well, we shouldn’t be complacent about children’s weight. But at the same time that we shouldn’t put children “on a diet.” Keep in mind that children do not shop for their own food or prepare their own meals. To change our children’s future, we must first change our own present behavior.

Here’s how.

1.    If you’re pregnant, watch your weight. Yes, it’s easy to gain weight when you’re eating for two, but women who gain more weight during pregnancy are more likely to have larger babies. As we’ve seen, large babies begin life with a weight problem already underway. So keep your pregnancy weight under control.

2.    Feed your children well. Nutrition is a zero-sum game. There’s a limited amount of space in children’s tummies and if it’s filled up with junk food, there’s no room left for more nutritious fare. Start right now to eliminate sugary treats, packaged foods, frozen foods, and fast food. Never permit a child to drink soda, especially diet soda, and cut way, way back on juice.

3.    Keep only nutritious food in the house. You cannot have a secret stash of Oreos if you expect your children to avoid eating them. Kids can’t eat what’s not available but if you’ve bought something to snack on when the children nap, you’ve let your enemy in through the front door. You know you don’t need that stuff either. Now is the time to give it up.

4.    Keep your children active. Make being active what your family does, instead of letting what your family does be watching TV or playing video games. Reading is great, and playing with Legos is lovely but balance those with lots and lots of active play.

Head off overweight early. Don’t give it a place in your home. Start now to change basic habits in ways that will put your entire family on a healthier path.

© 2014, Patricia Nan Anderson. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Ask for Dr. Anderson’s new book, Parenting: A Field Guide, at your favorite bookstore.