Worried About Your Kid’s Weight? – The New York Times

This week at NYT Parenting, we have a rousing defense of snacks from Virginia Sole-Smith, the author of “The Eating Instinct: Food Culture, Body Image and Guilt in America.” Parents of young kids often stress about whether snacks are healthy, and they often react to that anxiety by either restricting them or allowing a near-constant snack buffet. “Both responses are rooted in a culture that categorizes every food — and often, the sheer act of eating itself — as unequivocally good or bad,” Sole-Smith wrote. The answer to your snack conundrum? Make them a routine and focused part of your child’s day.

We have also run pieces this year about how to encourage healthy eating without food shaming, and how to avoid fighting with a picky eater. In both guides, we encourage parents to worry less about eating on a day-to-day or meal-to-meal basis, and to focus more on helping their kids develop healthy relationships with food, which allow them to self-regulate without parental involvement.

What we haven’t yet addressed is what to do if a doctor tells you that your child’s weight is a problem. On both ends of the weight spectrum, I have heard from parents and readers that their pediatricians have made them panic, they felt, unnecessarily.

The most absurd anecdote I heard was from a friend with identical twins. One twin weighed a single pound more than the other at their 4-year checkup, and Mom received a lecture about the heavier child’s weight and diet, despite the fact that she and her sister looked, well, identical. The doctor said the extra pound pushed her daughter into the “overweight” range on the body mass index, or B.M.I., chart.

B.M.I. is typically used to screen for overweight and underweight children over 2. It’s calculated by dividing a child’s weight (in kilograms) by her height (in meters) squared. It’s not meant to be a diagnostic tool, and using it is so controversial for kids under 6 that experts do not agree on its efficacy. A 2017 study of 663 overweight and obese children, for example, found that B.M.I. poorly predicted the total fat mass and body fat percentage in children under 9.

So what do you do if a medical professional sounds the alarm about your young child’s weight? I spoke with a childhood feeding specialist, a psychotherapist and an eating disorder specialist about how to know if your child’s weight is truly a cause for concern, and what to do if there has been a dramatic and unexplained shift in your child’s size.

Focus on the growth chart. At your child’s well checkups, her pediatrician will plot her height, weight and head circumference on a series of curves to compare her growth to the average growth of other children her age. Such comparisons will tell you what percentile she’s in. If she’s in the 45th percentile for height and the 38th percentile for weight, for example, that means that out of 100 children her age, she’s taller than 45 kids and shorter than 55; and heavier than 38 kids and lighter than 62.

Keira Oseroff, a psychotherapist and certified eating disorder specialist based in the Atlanta area, said that it’s most important to pay attention to changes in — rather than placement on — the growth chart. For example, if your child has been at the 95th or 5th percentile for weight for years, and continues at that percentile each year, she is growing appropriately for her body, so it should not be cause for concern. But, if she goes from the 50th percentile to the 75th percentile to the 95th percentile (or down to 25th and then to the 5th), that may be something to investigate.

If your pediatrician flags your child’s weight, the first question should be: Is this a change on his chart, and can we have a conversation about that? If it isn’t a change, ask your doctor why she’s concerned. Weight should not be taken alone as a measure of health — your child’s sleep, eating and activity levels should also be taken into account. If your child is eating an array of healthy foods, knows when she is full and is active, you should be confident in pushing back. If your doctor will not have a real conversation with you, it may be time for a new doctor. On the flip side, if your child is not eating well and isn’t active, it may be time to reassess your family’s habits.

Teach ‘the division of responsibility.’ A way to rethink your family’s mealtime behavior is to start with a framework called “Satter’s division of responsibility in feeding,” which we recommend in our picky eating guide. The framework was developed by Ellyn Satter, a registered dietitian and founder of the Ellyn Satter Institute (where Oseroff is a faculty member).

The division of responsibility is based on the idea that children will listen to their bodies’ hunger and satiety cues as long as they and their parents play the appropriate roles in the feeding relationship. The parent’s job: to provide structure and support for a positive eating experience, which includes serving a variety of foods and making mealtime conversation joyful. The kid’s job: to decide how much he wants to eat, and to behave well at mealtimes. Or even more simply: “The parent is responsible for what, when and where. The child is responsible for how much and whether.”

If you try to control how much your child eats at a meal, you’re crossing the line into his role — and it may lead to behaviors like refusal to eat, power struggles at the dinner table, increased pickiness, obsession with so-called “forbidden foods” or eating more than is right for him, Oseroff said.

Let them play. Physical activity is good for all parts of developing kids — their brains and bodies thrive best on movement. Provide lots of opportunities for your children to get outside and play, said Dr. Katja Rowell, M.D., a family physician and childhood feeding specialist. Resist the temptation to focus too much on how they’re playing. If they just want to swing and play in the sand instead of run around a playground, that is perfectly fine. Try different kinds of physical activities to find ones they will enjoy and keep going back to, whether it’s joining a sports team or a dance class. The important part is teaching the joy of movement, which is a habit that can last a lifetime.

Keep your anxiety in check in front of your kids. Even if you have reason to be concerned about your child’s weight, try not to show it to her — she will pick up on that fear. “If we are thinking about health from a place of fear and anxiety and control, our efforts are likely to backfire,” Dr. Rowell said. Eating disorders are increasingly “being recognized in children as young as 5 to 12 years,” according to a 2016 clinical report from the American Academy of Pediatrics. We want our children to thrive and to feel that many types of bodies are worthy, even in a culture that may tell them otherwise.

P.S. Pamela Paul and Maria Russo, editors at the Times Book Review and the authors of the new book “How to Raise a Reader,” will be answering your questions about kids’ books and how to instill a love of reading on our Instagram @NYTParenting. If you have questions for the pair, submit them here.

P.P.S. Forward this email to a friend. Follow us on Instagram @NYTParenting. Join us on Facebook. Find us on Twitter for the latest updates. Read last week’s newsletter, which is about kid-inflicted injuries.

• Weight Watchers recently released a new health app for kids ages 8 and up called Kurbo by WW. Many experts believe this app won’t make kids healthier — but will lead to more weight anxiety.

• We have an excellent essay by Paul Underwood, whose 2-year-old son is off the charts in size, about how his family is dealing with the cultural anxiety that foments around larger-than-average kids.

• Deb Perelman, the genius behind Smitten Kitchen, wrote a sensible and delicious piece for us about family meal planning for real life. One of the recipes she suggested, her one-pan farro with tomatoes, is an essential part of my repertoire.

• Have you subscribed to Emily Weinstein’s five weeknight dishes newsletter? I have saved my family from the food-blahs many weeks by getting inspiration from Emily, who has an adorable daughter and about as much time to cook as you do (i.e., none).

• Another thing that causes parental anxiety — food allergies. We have a piece with the latest guidance on food allergies. Its major takeaway: If your child has a food allergy, nothing you did or didn’t eat during pregnancy or breastfeeding was responsible, one of our experts said. “It’s not mom’s fault.”

Parenting can be a grind. Let’s celebrate the tiny victories.

My daughter “washed” (read: lathered) her hair in Aquaphor, which is nearly impossible to get out. My kid is not a fan of shampooing her hair on a regular basis, so a deep clean with dish soap was a tough sell. I showed her commercials of oil-slicked penguins being cleaned and told her the dish soap was “penguin shampoo.” Definitely made hair washing more tolerable for both of us.

— Jennifer Horn, Arlington, Va.

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