Rarely do I ever call a child obese or overweight in the preschool years. I’ve learned that once that is mentioned during the course of a well-child-care exam, it takes away from the message that I hope to convey during the exam. Now a term I will often use is an elevated body mass index (BMI) percentage. Although it is not a perfect reflection of a child’s weight status, it gets us closer as it looks at a child’s weight in light of the child’s height as well. I’m able to show parents on standardized curves where their child’s BMI lies in order to convey the thought it may not be ideal but simultaneously also present a positive if things are addressed now.
And one further thing I also try to avoid is saying a preschool child “needs to lose weight.” I prefer saying “we need to have the child grow into his/her weight without necessarily losing any weight.” Presenting it in this fashion paints a more positive outlook to parents and if the parents aren’t on board from the get-go, positive outcomes will often be hard to find. So some of the basic things I discuss include good healthy eating (obvious one,) portion control (this is a huge one,) daily routine physical activity (even family walks,) limiting screen time (and eating in front of one,) and good sleep practices.
But the one thing that I’ve always felt is critical, particularly if the parents have elevated BMIs as well, is the importance of making it a family-based program. Now I’m not a nutritionist so I don’t design in-depth family programs, but what I do stress to parents and caregivers is that it is important that everyone must play a role in the treatment process. If we are limiting the sweets, daddy can’t have his own stash of Kit-Kats whenever he wants and if the child can’t eat in front of the TV, neither should the parents.
And so a just-published article in this month’s Pediatrics
validates my last sentiment in that positive results can be found when the entire family is targeted and both the parent(s) and pre-school children have elevated BMIs. What the researchers did is create two study populations where both received the same general guidance when it came to modifying behaviors. But the intervention group also received more 1-on-1 training and specific guidelines they needed to follow. And after 3- and 6-month time periods, greater BMI drops were found in the intervention group…with both the preschool children and even their parents as well.
So the take home message here is (and should probably extend to anyone who is looking to decrease his/her BMI regardless of age,) is that best results are found when weight management becomes a family/household affair.
- Dr. Jeremy
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