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There's no way to merely look at a child and determine whether he's obese. Doctors use specific diagnostic criteria to determine how serious a child's weight problem is and the likelihood of the child developing (or already having) weight-related health issues. Because it's always best to nip problems in the bud before they spiral out of control (health issues like diabetes, in particular, can be very difficult to manage), play it safe and let your child's doctor evaluate his weight.
Differentiating between baby fat and a true weight issue
If your child is taller and larger than his peers or has a round, chubby face, it can be really tough to say whether that's his natural, healthy state of being or an indicator that he may be on the heavy side. It's a call for your pediatrician to make, using height and weight charts as his main diagnostic tools.
 | Babies are hardly ever diagnosed with weight problems, and they're never put on calorie-restricting diets. The same is true of toddlers. Small children need to eat enough calories to ensure proper development; a healthy diet provides enough calories for kids to grow at an appropriate rate. One exception: For kids under the age of 2, doctors usually recommend whole milk because it aids in development of the nervous system. |
Understanding family history and other factors
When assessing your child's weight, one thing that a doctor takes into consideration is any factors that may predispose your child to becoming obese. These factors may include:
- Family history: A child who has at least one obese parent is more likely to become obese.
- Race: African Americans, American Indians, and Hispanics have a higher rate of obesity. Approximately one-quarter of the children from each of these minority groups are obese.
- Lifestyle: A sedentary lifestyle coupled with a high-fat diet is a recipe for obesity.
Obviously, family history and ethnicity can't be changed. However, lifestyle factors are usually very malleable if at least one parent is willing to jump in and contribute to making significant changes in the child's diet and activity level. When a doctor talks to you about making changes to your child's lifestyle, you need to already be in the mindset that your entire family will be taking part in a healthier way of life.
Understanding body mass index (BMI) and children
When diagnosing obesity, the doctor takes the three components of the height and weight charts (see the preceding section) and plugs them into a formula for assessing BMI. The formula, in English measurements, is:
[Weight (lb) divided by Height (in) divided by Height (in)] multiplied by 703
Here's an example of how to use the BMI formula to figure out a child's BMI. Suppose a girl is 8 years old; 4 feet, 6 inches tall; and weighs 100 pounds. Plugging those numbers into the formula above tells you that this child's BMI is roughly 24.1. Simply calculating this child's BMI doesn't give an accurate indication of obesity, though. Because children are still growing, doctors use a special table for assessing their BMI scores that produces the BMI-for-age score.
If you're familiar with adult BMI tables, you know that obesity isn't a concern until someone reaches a BMI of 30 or more. However, evaluating BMI for children is different in that it takes into account the child's age, gender, and rate of growth. The Centers for Disease Control (CDC) breaks down the criteria for overweight children as follows:
- A child with a BMI-for-age greater than the 95th percentile is considered overweight.
- A child with a BMI-for-age in the 85th to 95th percentile is considered at risk for becoming overweight.
- A child with a BMI-for-age less than the 5th percentile is considered underweight.
Note that these ranges don't use the word "obese." The American Obesity Association , however, doesn't shy away from the term; it considers a child with an 85th percentile BMI-for-age overweight and a child with a 95th percentile reading obese.
 | The risk for obesity-related health issues increases along with BMI-for-age readings. Recent studies have shown that more than 50 percent of kids with a BMI-for-age over the 95th percentile had at least one obesity-related health issue, like diabetes or sleep apnea. |
Along with these readings, your child's pediatrician can give you a healthy weight range for your child's age, height, and gender. Sometimes, the difference between their child's current weight and their ideal weight is what truly shocks parents into facing the magnitude of their child's weight problem.
| Although BMI charts give a fairly accurate reading of how overweight a child may be, they aren't perfect, especially where adults are concerned. A professional weight lifter, for example, can meet the BMI criteria for being overweight even though his extra weight is pure muscle. |
Discussing the family's lifestyle
Your child's pediatrician probably won't stop at diagnosing your child with a weight problem and recommending that you do something about it. He'll want to get a good feel for your family's lifestyle and for the factors that may have contributed to your child's weight gain. He may ask about your child's:
- Diet: What types of food does your child typically eat over the course of a day? Would you say that she eats a large amount of food?
- Eating habits: Does she sit in front of the TV and eat or take a bag of chips up to her room before bed?
- Activity level: Does she enjoy getting outside with friends? Is she interested in sports?
- State of mind: Does she seem concerned or depressed over her weight?
- Physical well-being: Is she feeling well, generally speaking, or does she complain of various ailments that may be related to her weight?
Be prepared to answer these types of inquiries — and be honest! The doctor already knows that a child usually doesn't become obese in the absence of unhealthy lifestyle factors. In other words, there's no use trying to sugarcoat your answers, so to speak. The more forthcoming you are about your family's lifestyle, the better equipped the physician will be to help your child.
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