Making sense of your child's health numbers
Eyeballing a child to determine a healthy weight and height can be difficult, but objective measurements can be helpful.
February 14th, 2012
09:46 AM ET

Making sense of your child's health numbers

Dr. Jennifer Shu, CNNHealth's Living Well expert doctor, is a pediatrician, mother of two and co-author of "Food Fights: Winning the Nutritional Challenges of Parenthood Armed With Insight, Humor, and a Bottle of Ketchup."

In my pediatric practice, it is sometimes difficult to look at a child and tell whether he or she is at a healthy weight for his or her height and age.

Many children tell me they think they are overweight, while parents believe their children are just right, or perhaps too thin.

This is where numbers come in handy - objective measurements, including a child’s weight, height and body mass index, or BMI are useful tools when talking to families about a child’s size.

While factors such as body frame and muscle composition may make a person’s BMI higher or lower than expected, these measurements are generally more accurate than eyeballing a child to see if he or she is over- or underweight.

So, what do all these numbers mean? Weight and height are self-explanatory. BMI, a calculation that takes into consideration the height and weight, is a fairly good reflection of a person’s body fat.

For children, height, weight and BMI are plotted on standard growth charts that give percentile curves for the measurements. A healthy weight means having a BMI percentile between 5 and 85. A BMI over the 85th percentile (meaning the child’s BMI is greater than 85% of other children of the same age and gender) is defined as being overweight, while 95% or greater is considered obese. A BMI below 5 percentile is considered to be underweight.

Unfortunately, as obesity becomes more common among children, diseases once thought to be primarily a problem of adulthood are showing up in kids. For this reason, children should be screened for medical complications of obesity, such as diabetes, high blood pressure and high cholesterol.

Not everyone agrees when you should start screening your children, but the latest recommendation is to test cholesterol between 9 and 11 years old and then again between 17 and 21. Ask your pediatrician for his or her opinion based on your child’s BMI and your family's medical history. Blood pressure can be measured with a cuff at the doctor’s office, and diabetes and high cholesterol can be checked with simple blood tests.

These tests may include blood sugar, hemoglobin A1c and insulin levels for diabetes; a lipid panel (such as cholesterol and triglycerides) which, along with blood pressure, is a marker for heart disease; and tests for liver problems that can occur with obesity.

In some situations it might be important to rule out medical causes of obesity. For example, patients who have a higher concentration of fat in the neck and head region could have Cushing's syndrome, and those who are relatively short for their weight and age and have other symptoms might have low thyroid function.

When counseling families about nutrition and exercise, I find it most effective to emphasize healthy habits for the whole family, rather than to single out individual children since they ultimately need their parents' help to stick to new routines. Also, the entire family can benefit from following a healthy lifestyle.

Finally, while the categories “overweight” and “obese” are used when determining the best treatment approach for a child’s size, they aren’t always the best terms to use with children.

Telling children that they are at an “unhealthy weight” or that their “weight is not well matched with their height and age” can be a better tactic - this philosophy applies whether a person is over or under his or her ideal weight range.

For information, visit wecan.nhlbi.nih.gov or letsmove.gov.

soundoff (38 Responses)
  1. Educated in West

    A very good point, our kids today are more prone to lack of excercise and most parents ideas for dinner are, "McDonalds or Taco Bell?" A bunch of professionals are going to be needed: a nutritionist: a doctor: and a psychologist. All of this is for the parents.
    Is a 3 year old that tips the scales at 100 pounds, are they the ones making their food decisions? Think about it, the parents need to be retrained and let go of their guilt and other dramas to insure their children eat from the 4 food groups. We have a friend of the family, child is 9, started getting chubby at 5. Want to know something? The child plays with the WII and DS most of the afternoon, will NOT eat any fruits or vegetables. If there is a cheese quesadilla, she will not eat it unless it has sour cream on it. Who is the one that intriduced the sour cream? The lazy parent who would rather not start a fight then to shut up the child then put down a firm no. You tell me who is to blame?

    February 14, 2012 at 13:23 | Report abuse | Reply
    • Heidi

      Do you even have kids? So judgmental – the way I used to be before the reality check of actually having children. My guess is you are childless or old, but defiantly opinionated on your "friend's" child.

      February 14, 2012 at 16:02 | Report abuse |
    • Linda

      I agree with you and disagree with Heidi. It is SHE who is judgmental, not you. You are absolutely right that is the parents' responsibility to teach their children healthy eating habits and an active lifestyle with plenty of exercise.
      And yes, Heidi, I have raised three children, so I know what I am talking about.

      February 14, 2012 at 16:21 | Report abuse |
    • t3chsupport

      Heidi sounds like the kind of parent that would allow a toddler to make food decisions.

      Pro-tip: if your kid throws a fit for wanting one thing, and refuses the other thing, you deny them the thing they were throwing the fit over until they cease to throw fits over it. Yeah, it's hard, and you have to be firm when they have tantrums, but it really is worth it in the end. Especially when the end does not come at 30 years of age because mommy wanted to be 'nice' and let them eat whatever they want whenever they want.

      February 14, 2012 at 18:01 | Report abuse |
    • IGuessImAMeanMom

      I agree with you. It is entirely the parents' job to make sure their kids grow into healthy adults by teaching the kids what's healthy at an early age. We told our kids what exactly was in their food to explain why they couldn't eat certain things. Once we were done explaining McDonalds, they never wanted to go again. Same for donuts, Lucky Charms, Hostess, etc. (We haven't won the soda war yet, but one a week won't kill them.) They even try to get their friends not to eat junk because they know it's disgusting. And surprise, surprise, they're both below 20% BMI. Parents need to realize that parenting is a responsibility. It's not supposed to be easy!

      February 23, 2012 at 13:20 | Report abuse |
  2. Doug

    I lost 113 pounds using injectable HCG. RealRxHCG Once you get past the daily injections its not so bad. Tried the drops in the past but they did not work.

    February 14, 2012 at 14:52 | Report abuse | Reply
    • Anthony

      Really? Daily injections instead of leading a more healthy life style. Sure buying fruits and vegetables is more expense then fast food... but how much are injections?

      February 15, 2012 at 15:29 | Report abuse |
  3. AngelaD

    Our schools in MA measure the students during different grades, then they send a letter home with the BMI to the parents and explain what it means. The same thing happens at the doctor's office at least once a year since birth. And although I agree that BMI might not be a perfect measurement for every body type it gives the parents a general idea about the child's size. A parent who has not figured out what it means after several years of the same thing might not care about the weight of their child or other aspects of their wellbeing. So I doubt that telling them about a healthy life style will matter. It will only change when processed and junk food is much more expensive than unprocessed, whole and fresh foods that has to prepared and cooked in a child's home.

    February 14, 2012 at 15:24 | Report abuse | Reply
  4. Father of a skinny kid

    I find it interesting that so much media is focused on childhood obesity. While I understand the rising issue, I see an equal if not slightly larger group if children in my son's school that are distinctly smaller and thinner than the growth charts would seem to say is within the "normal" range. Shouldn't we take our own advice and look at growth and development in a balanced fashion along with our balanced diets?!

    February 14, 2012 at 15:25 | Report abuse | Reply
  5. Shauna

    My child is in the 100 percentile for height and weight. Our doctor said she was healthy....proportionate ...I have struggled with my weight forever and don't want my children to have to go through that....but i also don't want her to have to have this image in her mind of what she thinks she should look like...it starts so young!

    February 14, 2012 at 15:31 | Report abuse | Reply
  6. Heidi

    My daughter at age 3 was "off the charts" in height and weight – growing to fast AND was diagnosed hypothyroid. It went undiagnosed for years (it was probably congenital) because she was still growing and gaining weight. Thyroids should be tested regardless if there is a weight problem. (When kids are born only T4 is tested not TSH – your kid does not have to abnormal in both to have a thyroid problem!) The only way I finally got the doctors to test her was to bring my other daughter to the appointment to show that we don't just over-eat (the other daughter is thin) – that there was truly a medical problem. And for any "medical professional" reading this saying it was impossible to be growing, gaining weight and be hypothyroid – go back to med school – it happens – elevated IGF (insulin growth factor) no known origin.

    February 14, 2012 at 15:54 | Report abuse | Reply
  7. jim

    @Educated in West One has to wonder, educated in what? Certainly not in the raising of children. You should stop getting all your information from television shows and borrow a child for a a few months. You'll be surprised at the stupidity of your own comments.

    February 14, 2012 at 16:12 | Report abuse | Reply
    • Linda

      Here's another one picking on "Educated" and making rude and judgmental comments based on unwarranted assumptions.
      If YOU have children, I only hope that you are "educated" enough in parenting to not fault them so quickly and use labels like "stupid," as you have done here.

      February 14, 2012 at 16:33 | Report abuse |
    • Heidi

      Jim – I agree with you. I don't think "Educated" spends much time around kids and obviously Linda is related to him. LOL

      February 14, 2012 at 18:43 | Report abuse |
    • Adjective

      I've seen what "Educated in West" talked about, I don't think he/she is that far off in his/her observations.

      3 main examples come to mind:

      My next door neighbor, age 7, came into my backyard last summer. My husband and I were snacking on fresh cherries. She asked what they were, we told her. She then told us that we weren't eating "real" cherries. When I asked her what she meant, it turns out the only cherries she's ever seen were the maraschino cherries in the bottom of a Sonic drink. Luckily she's not overweight, but she obviously doesn't get much non-processed/pre-packaged food.

      My husband's family member, age 5 at the time, was at some sort of celebration at my in-law's house. She kept asking if she could have another brownie, her mom kept saying yes. My mother-in-law finally told her she had enough after 4-5 brownies. She was overweight at the time, and keeps getting bigger. Her parents keep feeding her whatever junk she wants.

      My family member, age 10. His parents showed up at Thanksgiving dinner 2 years ago with a box of pizza in-hand, "in case he doesn't like the food". This year, the kid still didn't eat much, his mom told him "go to the car and get an orange out of the trunk", sounds healthy right? Nope, "an orange" meant "an orange soda". They get him super-sized sodas to drink whenever they stop for gas. He didn't know what cooked turkey meat looked like last summer, he's only seen lunch meat turkey. They brag about how he likes to eat salad, but if you watch him, there's more salad dressing than salad. He's very overweight.

      Just look in the carts of people when you go to the grocery store. Fat parents with fat kids almost always have a cart full of junk. Thin people with thin kids tend to have real, minimally processed food in their carts.

      February 15, 2012 at 12:59 | Report abuse |
    • Adjective

      And if you think it's impossible to get your kids to eat well, this blog might help you: http://itsnotaboutnutrition.squarespace.com/

      February 15, 2012 at 13:00 | Report abuse |
    • IGuessImAMeanMom

      Jim. I feel sorry for your kids. You may be the "fun" dad now, but when your kids are unhealthy and uneducated about food as adults, you will have failed them. My girls are teenagers now and they are so thankful I mandated healthy eating when they were little. Of course they got birthday cake at birthdays and candy on holidays. But then we went back to healthy eating as the norm. They don't have to diet/fail/diet/fail and feel bad about themselves like many of their friends. I was like that as a teenager and I was so mad at my mother for not paying attention to what she put in my mouth.

      February 23, 2012 at 13:27 | Report abuse |
  8. Amped

    It is tough. I take responsibility for my own kids weight, but they're trim so that's easy for me to do. I still think it would be nice if physical education was daily at schools AND if school lunches were significantly more healthy. When I pack lunches for the kids, cold stuff doesn't stay cold and hot stuff doesn't stay hot no matter how hard I try, so they do eat school lunches quite a bit.

    Once my kids are home after school, they are often busy with other activities/clubs and homework so they're unable to get a good solid time to exercise as a family, especially with the dark of winter. Once we have more daylight, sending them out to play is so awesome. Evening is a busy time for parents - we're making supper, cleaning up, helping them to manage their homework and chores, running them to practices/clubs, and exhausted from our day - so getting out to exercise with them regularly is a challenge.

    So, Mrs. Obama, help schools to fund physical education more frequently (daily!) as well as improve those lunches! And I love the idea of doctors sending the bmi info about their children annually. I should have that done for me too...maybe it'll inspire me to lose those extra 15 lbs...or maybe it's 20.

    February 14, 2012 at 20:02 | Report abuse | Reply
  9. Vince Medlock

    Height-weight charts were pretty thoroughly discredited as indicators of health in the 70s. And yet here we are, 30 years later, and they've come back disguised as Body Mass Index. It's still malarkey.

    Only in the US are we obsessed with cholesterol. What do these "doctors" suggest for children whose numbers are higher than the medical profession would like? Start them on statins at age 9? Wouldn't Big Pharma just LOVE that?

    February 14, 2012 at 23:02 | Report abuse | Reply
  10. Youth Advocate

    Yesterday on Valentine's Day, my child's school gave the children pizza, ice cream, cup cakes, and candy. Three days per week they promote ice cream sales. Every Friday they reward good test scores and behavior with candy. My 9-year old child does a good job of 'saying no thank you,' but it places us in a difficult position when all the other children are receiving this, not to mention how his sense of 'norms.' I cannot get the school to stop forcing these things on my child. Despite and obese staff and many obese children, they just don't see the connection between what they do and obesity, or even why obesity is a problem

    February 15, 2012 at 05:37 | Report abuse | Reply
    • Abby

      There's no harm in giving kids pizza, cupcakes, and candy as a special treat. It teaches moderation. And it should be just that, a treat reserved for special occasions.

      The problem is when kids eat that way every day; when it's the "norm", not "on special occasions".

      February 15, 2012 at 12:35 | Report abuse |
    • Youth Advocate

      Abby – my point is not an issue of 'bad food' – 'good food' – the point is that as a parent, I cannot get the school to stop offering these food items to my child. A school, or no other person has the right to feed my child what THEY want against my wishes. I should be the sole decision-maker as to IF my child should receive certain kinds of foods; WHAT kind of foods my child should receive; and WHEN my child should receive certain kinds of foods. I should determine and define moderation. The fact of the matter is that schools play a contributing role in this country's obesity epidemic, and unless a child is home schooled or can attend a health-conscious school, the child is exposed to and faces pressure to adopt unhealthy lifestyle norms.

      February 15, 2012 at 14:09 | Report abuse |
    • Abby

      Youth Advocate, If you raise your child right and a pizza party at school isn't going to derail their entire dietary philosophy.
      Or keep them home on party days to "protect" them. Don't let them go to any of their friends' birthday parties either, there may be treats.

      What do you want the school to do, make parents sign a release form before any sort of treat is given to the kids at school? I can see not wanting excessive treats, but zero treats ever? That's a bit extreme.

      I consider myself a health-food nut. No prepackaged convenience foods, no soda, no snack cakes, nothing with HFCS, nothing with artificial sweeteners, nothing with unfermented soy, nothing with chemical preservatives, nothing with artificial dyes, etc., comes into my house. I only keep "real food" stocked. But if my kid goes to a party at school or for a friend, they get to eat treats. You'll set your kid on a better track for making their own decisions about food if you explain to them that treats are okay once in a while, but they are treats and only for special occasions, rather than outright banning your child to eat any treats at all.

      When you ask someone from France what they associate with chocolate cake, the most common answer is celebration.
      When you ask the same question to someone in America, the most common answer is guilt.

      French learn moderation. Americans don't. Teach your child about moderation!

      February 15, 2012 at 14:36 | Report abuse |
    • IGuessImAMeanMom

      Wow! I'm kind of shocked. Here in MA we basically can't have any food at all in the schools (except cafeteria lunches) because of allergies and obesity. Not to go back on some of my earlier posts, but I do think kids should be able to have a treat for special occasions like Valentine's Day, etc. But to offer ice cream three times a week and get candy every Friday? That seems ridiculous and like you said, it makes candy seem like an every day thing instead of a treat. Whats wrong with offering one cupcake on Valentine's Day? Why do they have to offer Pizza AND Cupcake AND candy. The kids would have been happy with just one of those. I went to school in France and trust me, there was no handing out of candy in the school! This isn't moderation, it's overboard. I would be frustrated too.

      February 23, 2012 at 13:34 | Report abuse |
  11. Crimson Wife

    The question I have is when does a "catch-up" weight gain become a concern? My 3 y.o. was off-the-charts small for both height and weight, but they were proportional, until we switched her to a gluten- and dairy-free diet. Since we made the switch at the beginning of December, she has jumped from the <3rd percentile to the 25th percentile for weight. She has also gained 1/2" but that still only puts her at the 5th percentile for height. She is now looking rather chubby. Her pediatrician takes the weight gain as a good sign, that she was previously malnourished because of her gluten intolerance but now she's catching up to where she should be. I realize that the height will take longer, but I worry about the chubbiness. At what point does it become a problem ?

    February 15, 2012 at 07:02 | Report abuse | Reply
  12. LeoBCrutcher

    I think that health care reform is a great idea. I have type 1 diabetes and for me to get insurance, it was a nightmare until I found "Penny Medical" search for them online and you can get affordable health insurance instantly.

    February 15, 2012 at 07:52 | Report abuse | Reply
  13. WaterisGood4U

    Unless you have kids yourself don't give parenting advice because you don't know what you are talking about. I am the stepfather of a now college aged overweight child. No matter what we did he would find ways to satisfy his cravings. Sneaking food etc eating Peanut butter and Jelly, downing orange juice. If you think it's always "all the parents" fault think again because there are differing situations

    February 15, 2012 at 16:25 | Report abuse | Reply
  14. mongopoo

    Just tell them they are fat are going to die.

    February 15, 2012 at 16:30 | Report abuse | Reply
  15. chris

    I think we need to start getting more serious and less soft on the whole obesity thing. No more telling people it's okay to be fat. It's not okay. It's a health risk. It's unpleasant. You will live a less fulfilling life. You will force society to waste their money on supporting you and your weakness when you go to the hospital, or need more handicapped spaces or ramps because you can no longer carry your own weight over short distances. You advertise to the rest of the world that our culture is one of weakness and excess, and that we simply don't have self control. You make us look weak to others around the world. Obesity is NOT okay. It is a SERIOUS problem. It is a national security concern when 2/3 of America can't even pass the VERY BASIC physical requirements of the Army Physical fitness Test. STOP EATING. IT"S DISGUSTING. Go run a mile and eat some veggies for chrissakes.

    February 15, 2012 at 17:30 | Report abuse | Reply
  16. Katie

    One of my children was in the middle of the height-weight chart, the other dropped down and fell off the bottom of it. At first the doctor thought he wasn't eating properly, then he said to me – right in front of my seven year old son – that if he kept up this pattern he would only be around 5'6" and thin. I am 5'1". The tallest of my siblings is 5'8" and she is taller than both my brothers. I asked the doctor what the heck was wrong with 5'6" and chided him for acting like it meant my son would be deformed. He had the grace to apologize. (That son is an adult now, at 5'9" and about 150 lbs, my other son is 6' and 140 lbs.) Those height-weight charts are as useful as the ones the insurance companies use, and about as accurate when it comes to be physically healthy. All bodies are different structurally when it comes to bones and muscle. It's the amount of fat one carries that determines health, and height-weight charts will never tell a doctor that.

    February 15, 2012 at 21:08 | Report abuse | Reply
  17. Mitch

    I graduated high school 6'2" and 160lbs in 1988. The difference from now? I did outdoor activities and ate home cooked meals 95% of the time. I ate whatever I wanted, but I was active and didn't eat McD's everyday. Even though I ate a lot of fried food, it was home cooked and I actually moved around. Get kids out of the house!

    February 15, 2012 at 23:04 | Report abuse | Reply
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