Overweight: It’s not a dirty word

Healthy child - February 2005


Dr. Alyna Chien


My 7-year-old son is overweight. I say this despite my husband’s request not to (“it will hurt his feelings if he reads it”), my editor’s upset at my choice of words (“that’s insensitive”) and my pediatrician colleagues’ discounting of his condition (“you can’t tell by looking at him”).

Overweight has a specific medical meaning. If we are going to battle the epidemic of childhood obesity, we must be able to use the correct terms.

Medically speaking, the word overweight describes children whose excess body fat poses a health threat.  Health professionals deliberately avoid using the term obese about children for fear of hurting the child’s feelings, alienating the family and stigmatizing the child. Instead, health professionals use the term overweight when discussing an individual child and “childhood obesity”  when speaking about overweight children as a group. Therefore, for children, the terms overweight and obese are loosely synonymous.

Doctors determine a child is overweight by taking routine measurements of weight and height, making a simple calculation called a BMI (body mass index) and locating the calculation on carefully researched tables. Children between the 85th and 95th percentile BMI are considered “at risk of overweight.” Children at or above the 95th percentile are “overweight.”

The percentile takes into account the child’s age and gender. Childhood body fat fluctuates in a predictable fashion. For example, babies tend to carry more fat just before they begin to walk. Pre-teens accumulate fat for a puberty growth spurt—about age 9 for girls and 11 for boys. Thus, the BMI percentile allows children to carry more fat during the times they need it. 

It’s really simple: Excessive amounts of body fat puts children at risk for premature disease and death.

So, if your doctor tells you your child is overweight, it means your child is more likely to be obese as an adult, and may develop adult-like diseases (such as diabetes, osteoarthritis or sleep apnea) as a teen or in his or her early 20’s.  

Except in extreme cases, overweight children are not put on diets and told to lose weight. Instead, doctors often recommend a child maintain his or her weight while growing taller, thus allowing their height and weight to become proportional.

My son needs to stay the weight he is for another year—while he grows the expected two inches—in order to move from the “overweight” to the “at risk of overweight” category.

Fighting the fat When a child’s weight is a health issue, it becomes a family matter. And the proper tone needs to be set in your home. Overweight children should not be singled out, treated different, ridiculed or victimized. In general, anything an overweight child needs to do to become healthier also will benefit the entire family.

In developing a plan for your family, remember: the more physical activity, the better and the more nutritious the food, the better. The key is to pick something that fits your family—some starting point where you know you will succeed. Start it, succeed and pick the next step.

Some families can make an improvement simply by substituting water for juice. Others eat fairly healthy, but aren’t active enough.

In my home, we have made several small changes over the past few years. My children generally eat healthy foods, but my my son will linger at the dinner table and eat past when he is full. To counter this, we started making after- dinner plans—playing a board game or going to the gym. This makes it easier for him to put down his fork and say “I’m done.”

I gave my kids a choice about dessert: They could have one Life Saver-sized piece of candy every day or “save up” for a regular-sized dessert at the end of the week. They chose the daily treat. But most days, if I put out fresh fruit for dessert, they don’t even ask for candy.  

We also have made a concerted effort to get out and do things together regularly.

At first it was feasible to fit in activities only on the occasional weekend, but now we do something nearly every day. Three years ago, we were able to ride only a quarter of the Bike Federation’s Bike-the-Drive, now we ride the seven or eight miles downtown to see movies instead of driving or taking the bus.

Last week, we started taking the “the long way” to and from school. It is five more blocks through our neighborhood each way, which totals a mile a day. It gives us more time to talk about the day, still gets me to work on time and is the minimum amount of exercise they need each day at their age.  

Being overweight is not a hopeless lifelong situation, nor is it a condemnation of one’s values or personal ability. It is what it is and should be dealt with directly. And the bottom line is that for a child, the most important health messages still come from your parents and siblings.


Alyna Chien is the mother of two, a pediatrician and a Robert Wood Johnson Clinical Scholar at the University of Chicago’s Department of Pediatrics.

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