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DEAR MAYO CLINIC: At what age should I be concerned about my child’s weight? My six-year-old son is healthy and gets plenty of exercise, but I feel like he is quite large for his age. He does have a huge appetite and is always saying he’s hungry, and I don’t want to keep food from him when he wants to eat. Are BMI calculators for kids accurate or useful?
ANSWER: There is not one specific age at which weight should become a concern. Instead, keep track of weight consistently at each well-child visit from the time your child is born. If at any time weight begins to rise quickly, a health assessment can identify diet and lifestyle changes that may help. Calculating weight for length or body mass index (BMI) can often be a useful part of that assessment.
In a situation like your son’s, it is a good idea to make an appointment for him to see his primary health care provider to evaluate his weight and review his diet and health history. At that appointment, the doctor will weigh your son and calculate his BMI to see where he falls in the weight range for his age.
BMI is a formula that uses weight and height to estimate body fat. It takes into account age and gender. For most people, including children, BMI provides a reasonable estimate of body fat. BMI between the 85th and 94th percentile typically is considered overweight in children. BMI at or above the 95th percentile is obese.
If your son is overweight, then the doctor will likely assess his eating habits and his activity level. Discuss what your son usually eats and his typical portion sizes. Review how much exercise and physical activity he gets each day. Making changes, such as substituting foods that have low calorie-density for those that have high calorie-density, often can help.
Examples of high calorie-dense foods include cheeseburgers, ice cream, French fries, whole milk, doughnuts, nuts, potato chips and raisins. Examples of low calorie-dense foods are fruits such as grapes, strawberries and apples, green leafy vegetables, skim milk, unsweetened breakfast cereals, grilled chicken and air-popped popcorn.
When your son eats foods that are less calorie-dense, he can eat bigger portion sizes with fewer calories. That means you do not need to deny him food when he’s hungry. Instead, you can offer him foods with fewer calories that are better for him and will help control his weight.
Look at your family’s eating routines, too. They have a strong influence on the way your child eats. Strive to provide healthy, well-balanced meals at consistent times each day. At least once a day, try to have all the members of your family sit down and eat together without distractions. Turn off the television, phones and other electronic devices during family meals. This encourages more mindful eating and decreases overeating.
For many children who are overweight, a health assessment with their primary health care provider includes all the information needed to start them on a healthier path for weight management. In some cases, however, a health care provider may recommend a consultation with a dietitian. This can be particularly useful for children who have other medical conditions or health concerns that make eating a healthy diet more difficult. For children who are obese, a referral to a physician who specializes in childhood obesity also may be helpful.
When it comes to weight control in children, the earlier you intervene, the better. Many parents believe that an overweight child will simply “grow out” of the weight eventually. Unfortunately, that is not true in most cases. Many children and teens that are overweight tend to stay that way as they become adults, unless they make the changes needed to get to and stay at a healthy weight. — Seema Kumar, M.D., Pediatric Endocrinology, Mayo Clinic, Rochester, Minn.