The smiley faced 4 year old was tagged as obese during a pre-school screening for body mass index (BMI), much to the surprise of Mom who thought her child looked healthy. At above the 99th percentile for age, this child was on a trajectory for life-long obesity with concomitant health problems such as diabetes and hypertension. The parents were encouraged to meet with the pre-school dietitian for nutrition counseling in hopes that changes in feeding and physical activity patterns would lead to slower weight gain in subsequent years.
Once the purview of the doctor’s office, schools have taken a more pro-active role in identifying overweight and obese children in an attempt to combat the dramatic rise in obesity, but whether this is helpful is unclear. In fact, one study suggests that advising parents of their child’s weight status can do more harm than good. In a study spanning 8 years, Australian researchers tracked 3557 children from the ages of 4-5 until they reached 12-13 years of age. Height and weight was measured and BMI calculated every 2 years throughout the study. To find out whether parent’s perception of weight status aligned with measured weight status, they were asked whether they thought their child was underweight, normal weight, or overweight before being told of the results.
The findings were surprising. A significant number of parents of overweight or obese children perceived their kids to be a healthy weight. And disturbingly, children who had been identified as overweight/obese when they were younger gained more weight in the subsequent 8 years of the study than those who were not identified.
Why did this happen? The authors of the study theorize labeling a child as overweight or obese may negatively affect the way parents interact with their children. It may make them more likely to restrict food, which can impair the child’s ability to self-regulate, and may make it less likely that exercise will be encouraged.
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It’s important to note that in this study parents were advised of weight status but were not offered assistance in changing eating and exercise behaviors. In the case of the smiling 4 year old, his diet and activity patterns were discussed with his parents and specific recommendations for change were made. Simple changes, such as changing milk from 2% to 1% and not offering additional food after dinner were accepted by mom as reasonable. With additional counseling and reinforcement by pre-school teachers, this child is more likely to realize a slower rate of weight gain than the child whose parents are simply told that he is obese.