Overweight 3 year old

[123Magic]

Just done the NHS child BMI calculator and it says my 3 year old is very overweight. He weighs 19.5 kg (just over 98 percentile) and is 102 cm tall (91st percentile). His weight is something I've been monitoring for about a year and a half as he has a huge appetite and will eat and eat unless we stop him. We are very careful indeed about his diet but I suppose it must be portion sizes making him overweight. A typical day might be as follows:

Apple when he wakes at 6.

Breakfast: 2.5 weetabix with semi-skimmed milk, another apple and glass of water

Snack at 10.30: Apple or pear and 1 rice thin (18 calories) with scraping of peanut butter

Lunch: Chicken stew, new potatoes, together with unlimited vegetables (mixed peas/carrots/sweetcorn) - he eats a bowlful of veggies. Pudding is either an adult sized pot of full-fat yoghurt or a piece of fruit.

Snack at 2.30 - same as morning snack

Tea - Salmon and brown rice and unlimited green beans. Pudding same as lunch - if he's had yoghurt at lunch he has to have fruit.

I try and give him a normal sized portion and then small seconds when he asks. As well, throughout the day he might have about 4-6 raisins for various bribes. If he complains of being hungry, I offer him mixed veggies so he sometimes has additional veggies eg. broccoli/peas/carrots etc. He only drinks water at home but I allow juice at friends' houses/parties.

We stick strictly to the routine most days and don't have unhealthy food in the house. He does however have treats at friends' houses or parties and I'm not strict then as I don't want to make a massive fuss about cake/chocolate etc and make him obsessed with them. So treats probably evens out to equivalent to a couple of cupcakes a week. Also we sometimes go to a cafe for tea and the portion sizes are larger there so he might have a large ham sandwich once or twice a week. He walks one way to nursery (20 mins) every day and then on top of that I try to make sure he has some physical activity every day, eg. trip to the park. But might need to do more on that. He also swims once a week..

I've read quite a bit about children with seemingly insatiable appetite and I'm very conscious about not making him feel too deprived as that can lead to bingeing when he's older and I'm not in control of his diet but equally I feel awful at the thought that he's so overweight. He doesn't look 'fat' if you look at him but he is clearly bigger than his friends - taller but also more well covered.

I don't know what I'm asking really - I just feel rubbish that he's so big but I really don't want it to become an obsession for me or him as I don't think anxiety around food will help in the long run! Anyone got any experiences of a child like this?

But it is working! He's a tall boy, whose height and weight centiles are pretty close. I'm assuming he's just 3 as 91st centile for a just 3 yo is 102cm. If he was 2cm taller he'd be perfect weight for his height - 2cm isn't really a lot!

I've read Ellyn Satter too and she really helped me to encourage my ds to eat without making an issue of it.

My sister has your problem with her ds and she used to spend a lot of effort trying to monitor his eating. Recently I commented to her that her ds had really slimmed down a lot in the last 6m and she said she had quit trying to control his food so much. And his appetite is HUGE. He would easily eat 2.5 weetabix for breakfast. Hard for me to say exactly what has made the difference though. Her ds is 3.7 now or thereabouts.

tbh I don't think anyone gets fat eating fruit and veg.

Are you giving him the snack because he is hungry or is it just your routine/habit? You could try a drink first and then a piece of fruit if he appears hungry. But I wouldn't give it unless he was saying he was hungry.

It might be a good idea to give him more protein and get him to wait awhile to see if he really wants seconds.

But otherwise I'd be reluctant enough to limit him. Afterall, appetite is a very fundamental drive and it is risky to interfere with it too much. You want him ultimately to be able to self regulate.

Also, you do realise BMI measurement is a bit of a blunt tool? A full assessement to ascertain whether there is really any issue might be a good idea rather than going straight to a dietician. Plus if your GPs don't think there is an issue, you should take that on board too.

I sympathise so much. My DD1, who is nearly 8, is the same. She was born 10lb1oz and has stayed over 98th centile all her life. When she was in reception I had the letter from the NHS after they weighed them all to tell me she was clinically obese and how I should be feeding her. We eat relatively healthily - very similar to how your family eats by the sound of it. And I've been working really hard on the portion control for a year now. The irony is that my DD2, 6, is very skinny, and whilst no one at school has mentioned DD1s weight, DD2s form teacher brought her body shape up at last parents evening!! It makes me so mad, I am doing my absolute level best and am criticised from all sides! I have also been to the dr to ask for a referral to a dietician to help all of us (DH is overweight, I am skinny, but pre diabetic) and as soon as she gathered that we didn't eat fast food all the time she wouldn't help.

So just lately I have been doing a lot of reading on nutrition and taking advice from friends with knowledge in that area. I am convinced that DH and DD1 have some sort of chemical imbalance or problem which means that their appetite does not "shut off" when they've eaten enough or that means they store fat more easily. It is possible that they could have something known as insulin resistance - google it - it would appear that people who suffer from this are literally starving all the time as their body locks away energy from food as fat much more easily, leaving them feeling hungry. I have discovered that protein can be just as good as carbs at providing energy, and leave people feeling fuller for longer (something to do with triglycerides and leptin - I forget!). There is also some research that suggests that children whose mothers had gestational diabetes have a higher chance of being obese. I was diagnosed with it with DD2 and quite possibly had undiagnosed GB with DD1 - how to make me feel guilty!

So my plan now is to improve our diets even more. I've stopped buying bread, pasta and biscuits (definitely no sugary treats) and trying to cook meat/fish/beans with veg most days. They still have root veg so not cutting out carbs completely, and also porridge for breakfast some days. I also do bacon and eggs for breakfast and a lot more salads for lunch. It is working a treat with DD1 as she will eat anything and she likes cooking, so I often let her loose in the fridge to make what she wants for the three of us. It is much harder with DD2 as she tends to only pick at the carbs in a meal, but it is gradually forcing her to eat more veg too. DD1 is also reaching the age where there is a lot more sport available to her - she's joining the swimming club in november so will be swimming 3 times a week for an hour! I'm hoping that will help. I think vacillating's post was really helpful about keeping the diet healthy and lots and lots of sport.

Lots of luck. It is so maddening when you feel like you are being ticked off the whole time for how you feed your children when you are trying your best! I'm sure you will find a way of feeding him that works for him if you keep trying different things.

My DD is in similar centiles to yours - are you sure you should be worrying? Diet sounds healthy. TBH I was told as long as the stay on the line they were born on that is the healthier way. I don't expect DD to change centiles for weight until around 5, but then maybe I am looking at it wrong? Is your Dr/HV concerned?

Re: the centiles. I'm not sure they're that useful, a bit like BMI. I think it's probably more useful to look at your child and whether they look healthy or not. I don't think my daughter looks clinically obese, but I do know that she has rolls of flab round her tummy which I don't think is a good thing for a 7 year old.

I would also be focusing more on the centiles they were born on and have been on, and how they look.

I have big boys who eat similar amounts at times, but one now has a much smaller appetite and is very lean/slim - he was quite round at 3.

I was deprived, in a sense, of certain foods as a child and did go crazy when I left home, but my weight hasn't actually changed at all (apart from pregnancy). I have an enormous appetitie and eat pretty much non stop all day.

Mine is the same. My hv gave me a booklet on portion sizes.

We've slowly been cutting down his portion sizes and cut down the snacks and he's lost weight, so is now no longer over weight

Thanks so much for your supportive posts. We saw the dietician yesterday and much as you said tootsietoo, once she saw what we were feeding him she said it was very healthy and didn't have any suggestions. The only suggestion she actually made was to replace full fat yoghurt with weight watchers low fat low sugar yog which didn't sem like a brilliant idea to me.

I asked her if she thought DS was fat and she said no, he looks like a little rugby player. She said the same about he centiles- the fact that he has been on the same one more or less since 5-6 months is ok and they generally worry when they go up and up. So I think we are going to carry on what we are doing basically with a bit more attention to portion size.

Interesting what you say about your dh tootsie. My dh also has a huge appetite but be doesnt put weight on at all and is very tall and thin. I do wonder if DS has inherited dh's appetite but not metabolism!
And I am starting to think that maybe some people are just meant to be a little larger- I remember people I knew at school who were a little bigger and they are he same size now- not fat but just broad and well covered.

Thanks again for all your thoughts and sharing experiences. It's so hard!!

Thanks for the update OP. I wouldn't be very impressed with a recommendation of low fat yogurt either.
My ds2 is 4 and has similar measurements, although he was 5'14 at birth so has moved up the centiles massively since then.

Ps - from my understanding metabolism isn't something you are born with and can't change, but can be increased with aerobic exercise.

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2.5 weetabix? That's crazy. I would struggle to eat that. Sounds like he's not having time to get full and just shovelling it down. Reduce to one weetabix and find ways to entertain him instead to take his mind off eating.

Agree that switching to a weightwatchers yogurt doesn't sound like the best of ideas. Also agree on upping his protein, did you try the eggs for breakfast?

If he has been on the same centiles for that long I don't think you have much to worry about. My DN has been on the 98th for both for a long, long time and isn't overweight. She's just very tall and healthy.

If it was me I'd stop worrying, up the protein and make sure he gets plenty of exercise

I have a small 4yr old who eats 2 weetabix plus a bowl of rice crispies/cornflakes/similar almost daily. He eats fairly slowly. It's not that crazy.

I'm not saying its crazy that they eat it, just crazy that it's offered.
Offering a four yr old 2 weetabix is excessive. I have a 5 year old who is in size 8-9 clothes, I appreciate how hard it is to monitor intake. No way would I give her 2 weetabix even at her size. She gets one and when it's gone its gone, she knows there is nothing else til mid morning fruit, even though she usually has breakfast at 5:30am. Otherwise she'd been even bigger. DD is the height of an 8 year old, with waist measure of 12 year old but she's 5 and in reception. Hopefully she'll slow down and her peers will catch up a bit though I know she'll always be tallest in her class.

I don't offer, he actually asks for 4 at a time and gets 1. If he's still hungry he asks for another one. Sometimes he eats 2 big bread rolls at lunch or 3 small bowls of rice/cous cous for dinner. Sometimes he's just really hungry.

Have you thought about trying to distract him, particularly between meals so you reduce snacks? Adults who are dieting used to be recommended to eat a meal then go and wash up because it took 20 minutes for your stomach to say if you were still hungry. You could give him his lunch then go and read two stories and see if he asks for more. Offer him a drink if he's hungry at 3pm, maybe a glass of milk, then say he can have something else after you've done a puzzle.

What jumped out at me was the amount of sugary & high GI food, especially at the start of the day. Weetabix have a GI of 69, that's fairly high, & not very sustaining. My DH has said he would potentially eat 3 Weetabix for breakfast, but would leave the apples. However, he is 6'4" & built like a viking.

I do sympathise, OP. This concerns me, too. Our DD takes after DH. She is only 2.2 & is nearly up to 98th centile for weight & is on 91st for height. However on an active day she will willingly walk/run 2 miles or more - round town, to the shops, and play at the park. Can you get your DS to run about a bit more (genuinely not being critical) or do you think this would increase his appetite?

It could be blood sugar levels that are driving his "hunger"? There's a lot of sugary carbs in things like apple which turn to sugar in the blood quite quickly (and cause a resulting 'sugar crash' which makes you want more food to get sugar levels up) rather than slow-release foods which keep blood sugar levels more even. Could you try swapping some of the fruit snacks to protein-based nibbles? Have a look into glycaemic index and see if you can swap to lower GI foods maybe.

I agree swapping to low-fat yogurt is not good advice - there's a lot of research that suggests many artificial sweeteners actually stimulate appetite.

My DSs 7&9 eat a lot of food at meal times - certainly more than me at breakfast. Equivalent of 2 weetabix plus 1 or 2 toasts. But very few snacks. They are fit and borderline skinny - both do a lot of exercise (9 yo cycled 50 km on Sunday!)

The 7 yo in particular will alwAys say he is hungry if he is a bit bored. Typical exchange on car journey might be, "I'm soooo starving I'm going to die!" This about an hour after above breakfast. If asked whether an iPad might help with the hunger pangs he will agree and no more will be said. Similarly stuck at home he will be starving, but a walk to park and football will distract him.

Good luck.

What about plain low fat yoghurt with a bit of honey? And/ or berries?

for portion size i have a kids plate and i stick to that.
make anything else he is allowed to eat something very dull indeed (according to him)
for my son it would be an apple for my daughter chocolate.

Have you decided on anything yet 123?