To ignore BMI as an indicator of a child being overweight?

[HappyHolidays22]

My DD is 4, 5 in 2 months time. She’s tall for her age and looks older than she is because of this. (Just for context, her dad is 6 ft 5 and I am the shortest female in the family at 5 ft 6… so she doesn’t come from small stock!)

Today we had a letter from some NHS service to say that they have done some measurements in school (with our permission) and that she is overweight. Her height is just over 118cm and weight slightly over 26kg. According to the BMI calculator this puts her over then 90th percentile and therefore overweight…

but my problem is that she looks totally in proportion for her height! Never in a million years would I have thought to say she was overweight…

we eat healthily and encourage DD to eat a range of foods (with varying levels of success as I think is normal for a 4 year old).

my question is - AIBU to ignore this BMI calculator/info from the NHS if I believe my daughter is fine? Or should I be doing something to trim her weight down? (Of course, I’d never ever tell DD this as don’t want her to ever have a complex!)

Thats totally understandable. I think you should be kind to yourself. The adjustment is hard!

Could you sign her up for some clubs? I have a disability that means I can't be consistently active (right now even typing is too much exercise ) but my 9 year old daughter does 6 hours of dance a week plus swimming and so she is really fit and strong.

thank you. Swimming is a great idea! Shes on a waiting list for lessons… but I hadn’t actually thought about us taking her at the weekend. She has also just started a ‘drama’ class… which involves a lot of running round and dancing so this should help!

Don't worry too much, a couple of pounds makes a massive difference. People have lost sight of how a healthy weight looks. I was forever being told that DS2 was 'skinny' - he wasn't, he was spot on the centre of the green bit (50th?).

You’re right - I’ve calmed down a little bit now I’ve realised it’s not stones we’re talking but just a few (6ish) pounds to get down into the healthy green section.

it’s funny because I have spent so much time recently trying to lose my own weight after giving birth that hadn’t even given any thought to my DD’s weight. My oversight.

I suppose the NHS letter has had its desired effect on us today! I think I’ll feel more positive about it all with a nights sleep… when I can eventually put this little cluster-breast-feeding 7 month old down!!! 😴

Your dd is 4. I wouldn't be overly concerned at this point. She's just getting to the age where sport can start to play a part in her life and this can make a huge difference coupled with small changes to her diet she may not even notice.

I would look for something physical that needs a range of movement, netball, basketball as she gets older, martial arts are amazing for fitness. Dance, cheerleaders things that need strength and stamina. Above all, try different activities to find what she enjoys and then roll with it.

My second daughter was bordering on overweight in primary school, although you’d have only noticed in swimming togs.

She was a good swimmer and started swimming with a club from 10 years and that really helped and continued to help through puberty.

She would be ravenous after a 90 min training session, but would want proper food rather than snacky junk and I honestly think that made all the difference.

Shes nearly 15 now and has naturally gone from having a massive sweet tooth to disliking most sweet things. She’s just given up competitive swimming but has started boxing instead and looks fit and healthy.

vigorous exercise was helpful in that it normalised her appetite and made her hungry for more nutritious food. Plus, if you’ve just swum 3-4 km there’s a bit more leeway for the odd bag of crisps 😀.

So you're a child nutritionist then?

It's not about demonising carbs. It's about balance. Cereal for breakfast isn't balanced. It's carbs. Pasta bake isn't balanced, it's carbs. Ditto baked potato. Toast snack, guess what? Carbs.

Your body needs fats and protein. And they regulate your appetite better. Carbs are fine for burning when you exercise. OP's child isn't exercising. She's changing that. Good for her.

My DD eats carbs, I don't eat a lot. She walks to school, does sports, is skinny. I don't. Carbs aren't the enemy but they certainly shouldn't be 90% of a child's diet.

To be honest, I do think that BMI measurements in this age group are problematic for the tallest children, and suspect that they could also be undercalling potential problems in the shortest.

From infancy through pre-school, children's BMI drops, before slowly increasing again till it reaches adult levels in the late teens or early 20s. The lowest point is possibly (without looking it up) around age 5-6. I have wondered about trying to analyse the growth data in quartiles to see if the nadir of BMI is reached younger or older for shorter / taller children, as this might be meaningful when interpreting the utility of these one off school entry measurements for predicting risk of later obesity.

My children weren't measured on that system as not in state schools, but I remember thinking we'd probably have "had the letter" as they were still very much slimming down towards the "primary school children should be thin" appearance others have referenced. Both have been very healthily slim from perhaps age 7 to their now late teens. Without going back to their red books I'm not sure if they weighed as much as the OPs daughter but it wouldn't have been all that different I think.

I wouldn't ignore it OP. It is true that BMI may not work for some people but I wouldn't want to set my child up for a lifetime of obesity and it's related problems.

Your child is tall. My DD is the exact same height at 118cm but she's 6 and weighs 17kg. I wouldn't even consider her skinny, just slim and she still has a baby tummy.

My seven year old is 132 cm and weighs 26 kilos. There is no way your child is not overweight for her height.

in my experience a pasta bake doesn’t arrive on a plate solely as fusilli and nothing else, neither does a jacket potato arrive solely as a jacket potato. The fact your imagination when someone tells you that they had a jacket potato or pasta for dinner can’t stretch to what it may have been served with is not my problem, it’s yours.

your understanding of carbohydrates is not correct - but congratulations on your little knowledge, it is indeed a dangerous thing.

Carbs should count for 50-60% of a child’s caloric intake, which is why they tend to make up the foundation of a meal.

we have an issue in this country (as does the US) where we’ve been sold fad diets - the low carb diet is one of them - and it has made carbohydrates the enemy (evidenced by your own response), and created good vs bad foods. Foods do not have a moralistic value, they're simply more or less nutritious. Carbs are not the enemy; they are an important macronutrient that make up a healthy diet.

That's one of the most uninformed posts on the thread (and that's saying something)

Sugars in fruit are naturally occurring and in no way unhealthy. It is simply not possible for a child to be eating too much fruit (in the sense of weight gain)

(From a dental point of view, there can be issues of constantly snacking on fruit, but that's a separate issue).

Look at this advert for Pears Soap from the 1920s, and how slim the kids are:

https://www.dailymail.co.uk/news/article-2303212/amp/Johnny-Hill-dies-Face-Pears-soap-grew-D-Day-hero-dead-91.html

Now they would be called ‘emaciated’, but actually they were perfectly healthy.

No. The boy is emaciated. He is clearly extremely thin, or the photo has been shot in a particular way (as his arm is much thinner than his face appears to be).

Don't forget that right up to the 60s (when broadly nutrition, availability of food & state supports increased) childhood poverty & lack of food was very common.

Of course we have an issue with childhood obesity but these generalisations are also massively wrong.

Finally, a knowledgable post. Agree 💯 with this.

It's not about demonising carbs. It's about balance. Cereal for breakfast isn't balanced. It's carbs. Pasta bake isn't balanced, it's carbs. Ditto baked potato. Toast snack, guess what? Carbs.

None of these items are problematic.

Cereal, pasta bake & a baked potato are all fine. The lack of balance is if that's all that's eaten ie no fruit, dairy, protein at other points in a diet.

People make sweeping, incorrect statements like this with such confidence.

This is also a good post.

It's also important to remember (as I haven't seen it said already), that the growth charts are meant to be adjusted for parental height particularly where there are extremes (ie very tall or small parents). It's included in the guidance notes.

I'm not in the UK so I don't know the system applied but it sounds as if this might not have been done.

@HappyHolidays22

I think the changes you suggest sound sensible in themselves - for me, activity in childhood is the most important thing (along with a good and balanced diet, which broadly, your DC has).

There is a significant amount of misinformation on this thread. In relation to your DC's weight, if you have concerns or need more reassurance, discussing it with your GP is a good starting point.

I also suggest taking a look at the growth charts directly yourself, if you haven't done so already https://www.rcpch.ac.uk/sites/default/files/Girls2-188yearsgrowthhchart.pd

This will explain the variations, the way results are calculated and read and discuss adjustment for parental height.

@EarringsandLipstick Thank you very much for your messages, I was really comforted to read them just now and you are absolutely right - DD doesn’t just have pasta or baked potato on their own, I do put a variation of vegetables and protein with these meals. In reference in an earlier post, I’m also lucky that DD prefers water as her main drink of choice so we don’t have hidden calories here and she will always choose healthier options like brown bread and wholewheat options… although then deffo has a sweet tooth for dessert which I now suspect is habit.

Upon calmer reflection, the issue is definitely what the snacks are, desserts and an unnecessary supper combined with not actually doing very much that is physical at all outside of school (until we started drama last week which I know is not enough in itself).

I’ll have a closer look at the charts later today on my laptop :)

thanks again all.

@EarringsandLipstick I disagree. It is quite a common opinion amongst health experts now that 5 portions of fruit and veg should be more like 4 veg, 1 fruit. Smoothies are not a healthy option either.

Have a look at Dr Gundry, J J Virgin.

Fruits are a trap lots of people fall into. Especially tropical fruits, grapes, dried fruits which are essentially sweets. Blood sugar is a very good indicator of overall health and too much is what lays on fat, not generally too much fat.

Also it’s not just the type of food but portion control. All the carbs mentioned above are fine but it’s so easy to give small children way more than they actually should be having:

www.nhsaaa.net/media/1857/20170301portres.pdf

This is quite useful!

Smoothies are not fruit - you lose all the goodness of fruit and are massively high in sugar. So I agree with that - but that's not my point.

Your other examples eg berries, dried fruit, equally are not what's usually referred to by 'fruit' (tho berries alone are not problematic) and are not what you said in your first post.

Eating fruit does not equal excessive sugar consumption

@EarringsandLipstick it can though. You're right, berries etc are great.

The use of continuous glucose monitors in studies has shown a very high spike after fruit consumption in most people. Sugar is sugar. Doesn't matter if it is in fruit or sweets.

Fruit is designed by nature for weight gain. Animals, including humans, are designed to eat lots in the summer ready for the scarce months. We are not designed to have it year round.

I know this is likely an unpopular opinion, but it is increasingly being noted that precious advice on fruit consumption may be misleading.

I wear a continuous glucose monitor 24 hours a day so can see in real time what anything I eat does to my blood sugars. Tropical fruit does cause a big spike. Not so much apples, pears etc - but certainly grapes, mango, kiwi etc.

Veg causes no spike at all. I could sit and eat broccoli and green beans all day and they wouldn’t budge.

The other culprit is carbs - bread, pasta, cereal etc so while those things are fine, the portion size needs to be well controlled. Not just dumping a load of pasta on a plate.

There is an oft repeated mumsnet trope though that kids are tall because they are overfed. Some kids are just tall? I'm the shortest woman in my family at just shy of 6ft. I was the tallest kid in my class until I was 12, when a couple of boys caught up and skinny. I've never been overweight in my life. DDs are the same- the 9 yo is in age 11-12 clothes.

You've had some really good advice on this thread OP but I don't want any parents of tall kids to think that just because they're tall they are somehow doomed to a life of obesity. It's hard enough getting trousers to fit, without anything else.

No point asking them to measure her if you're just going to ignore it