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Cedars-Sinai Magazine

When to Address a Child’s Weight

Mother and daughter reading

Pudgy cheeks and chubby bellies are healthy on growing infants. Active toddlers should grow out of “baby fat” and into a whole range of healthy shapes—but how do parents know if their child’s size is a health concern?

Healthcare providers are taking a more proactive approach to obesity in kids and teens. Recent guidelines encourage pediatricians to treat children earlier with evidence-backed approaches, such as healthy lifestyle interventions, medication and surgery.

If you’re concerned about your child’s weight—or wonder whether you should be—seek advice from a doctor who can help you consider options that prioritize safety and self-esteem.

In most cases, a child’s weight should be addressed through whole-family changes to diet and activity, said Stephanie Byrne, MD, and Frances Pang, MD, pediatricians at Cedars-Sinai Guerin Children’s.

“Parents should address their kids’ weight as a positive, family-oriented quest for health,” Byrne said. “It’s not about being thin. It’s about trying to be the healthiest versions of ourselves so we can have long, productive lives.”

Why the Guidelines Changed

Research proves that without intervention, children and teens who develop obesity are more likely to maintain a higher body weight into adulthood. They are also at higher risk for complications, such as diabeteshigh blood pressure and high cholesterol.

The new guidelines acknowledge that obesity is a complex, chronic disease that can’t always be treated with diet and exercise alone, said Amanda Velazquez, MD, director of Obesity Medicine at the Cedars-Sinai Center for Weight Management and Metabolic Health.

“We really want to see kids have their health addressed as soon as possible in the disease process, using existing treatments that are proven to work,” Velazquez said.

Pang said while surgery and medication are not options for children and teens with mild obesity, doctors shouldn’t rule out those treatments for young patients with severe obesity.

The guidelines suggest such children should also enroll in a comprehensive, family-based weight management program, such as Guerin Children’s Adolescent Health Program.

Pang also notes that the guidelines advise pediatricians treating childhood obesity to be mindful of inequalities that contribute to a greater percentage of children of color being categorized as obese or overweight. These children may experience barriers to accessing healthy food and exercise.

Nutritionists and other health professionals should offer simple, economical strategies to improve children’s eating habits, she said.

When to Address Your Child’s Weight

The body mass index (BMI) scale, which applies to kids who are 2 years old and older, calculates how a child’s height, weight and age compare to growth charts from the Centers for Disease Control and Prevention.

Children whose size falls in the 85th-94th percentile are classified as overweight, and children in the 95th percentile and above are classified as obese.

The BMI scale is an imperfect measurement and should always be taken in context, Byrne said. The calculation doesn’t consider muscle mass or bone density, and parents and doctors shouldn’t judge a child’s weight solely by any number.

“Too much focus on a number on a graph could send the wrong message to kids,” she said.

In addition to BMI, parents should watch for behavioral signs of a health issue.

Snoring could be caused by extra fat tissue on the neck that can indicate a weight-related health concern. If your kid struggles to catch their breath during exercise, has trouble keeping up with their peers, snacks a lot, frequently returns for second or third helpings at meals, or begins to restrict what and when they eat, they might be at risk.

What to Consider Before Medical Therapy

If you have concerns about your child’s weight, see a pediatrician. They will determine whether it is or could become a health concern, and they can also rule out underlying conditions that cause weight gain, said Byrne.

One of the most important ways parents can prevent and treat obesity in children is to set up a healthy, active home and model healthy behaviors themselves, Velazquez said.

Children need at least an hour of physical activity a day, five days a week, as well as structured meals centered around protein, fruits and vegetables. Families should make healthy choices together, Byrne said. A child should never be given their own diet.

“No one should be singled out or eating on their own—it’s not fair, and it’s a set up for disaster,” she said. “It won’t work unless it’s a group effort.”

When parents are implementing measures to address a child’s weight, it’s helpful to see a pediatrician regularly. Follow up three to six months after the initial visit to evaluate progress and identify successes and challenges.

How to Be Sensitive and Proactive

When it’s time to address childhood obesity, Byrne first approaches parents alone. She notes that parents should be mindful of the messages their children receive that could impact their eating practices, body image and self-esteem.

Childhood obesity rates are increasing, but eating disorders are also on the rise in teenagers. Pang suggests that parents make thoughtful, forward-focused efforts to encourage healthy changes.

Younger children and preteens, especially, can be very sensitive about attention to their weight and shape, and conversations should prioritize positive self-image, Pang said.

“All bodies are important and deserve to be taken care of,” she said. “Kids shouldn’t absorb negative connotations about their shape or size.”