My pediatrician said that my child's body mass index was too high, but I think she looks perfectly fine. What should I do?

My pediatrician said that my child’s body mass index was too high, but I think she looks perfectly fine. What should I do?

Question:
Ellen Rome, M.D.
ABOUT THE EXPERT

Ellen Rome, M.D.

Dr. Ellen Rome is a board-certified pediatrician who was among the first in the U.S. to be board certified in adolescent medicine. She... Read more

Body mass index, or BMI, is a screening tool used to identify possible weight problems in children (and adults). It’s not a direct measure of “fatness.” The reason we use BMI instead of a weight chart is because a child or teen’s weight and height changes from month to month. There are times when the BMI does not give us the full picture, such as when an adolescent is very large-framed and muscular, but for the most part, it is a good screening tool for determining the normal weight range for a given height.

 

Your child’s BMI is based on the ratio of her weight relative to her height and factored as a percentile, which represents a range similar to the growth chart your pediatrician uses. Unlike adults, the BMI percentiles for children and teens also factor in their age and gender. A BMI above the 95th percentile usually means your child needs further evaluation and possible treatment to prevent the medical complications of being obese. These complications include high blood pressure, back and knee pain, sleep apnea (having pauses in breathing while asleep due to the added weight around the airway), elevated cholesterol and even prediabetes or diabetes.

 

If your child has a BMI over 95 percent (click here to calculate), ask your pediatrician to recommend a weight management program for children in your area. Good programs encourage strong parental involvement and provide education/interactions, ideally weekly for 10 to 12 weeks, with a dietitian, psychologist, exercise physiologist and pediatrician. After your child has completed the program, monthly follow-ups are also important for tracking progress. If you don’t have such a program in your area, you might consider arranging for individual monthly visits with a dietitian, pediatrician and psychologist while you encourage consistent play/exercise opportunities for your child.

 

If your child’s BMI is between 85 and 95 percent, she may be overweight. Having her visit her pediatrician every four to six weeks may help encourage her with her healthy eating habits/exercise and allow her to ask questions and track her progress. At the Cleveland Clinic Children’s Hospital, we recommend our 5 to GO! Program:

 

 

0–10 Years

5 – Eat FIVE fruits and veggies a day.

4 – Give and get FOUR compliments a day.

3 – Consume THREE servings of calcium a day.

2 – No more than TWO media hours a day.

1 – At least ONE hour of exercise a day.

0 – NO sugar-sweetened drinks, ever. Go – Be well, inside and out!

 

11+ Years

5 – Eat FIVE fruits and veggies a day.

4 – Consume FOUR servings of calcium a day.

3 – Give and get THREE compliments a day.

2 – No more than TWO media hours a day.

1 – At least ONE hour of exercise a day.

0 – NO sugar-sweetened drinks, ever. Go – Be well, inside and out!

 

According to the AAP/USDA, children up to 10 years old need only three servings of dairy per day.

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