Hemby Children's Hospital

Parents, do you suffer from 'obliviobesity'?

Many families are unaware when childhood obesity sets in

boy About 17% of American children ages 2 - 19 are obese, according to Centers for Disease Control and Prevention data. That’s triple the childhood obesity rate of the previous generation.

Would you be able to recognize it if your child became overweight? Research shows that parents are increasingly oblivious when it comes to kids’ weights, leading to a widespread case of “obliviobesity” that could mean trouble for the fight against childhood obesity.

“There’s a huge number of people who don’t have a clue their children aren’t at a healthy weight,” said Dr. Anne Walker of Novant Health Walker Pediatrics in Charlotte, North Carolina. “It’s scary, because it’s well known that preschool or toddler weight predicts future health. If you’re having problems as a child, addressing them early is the only way to avoid issues later in life.”

A study by the British Journal of General Practice found that parents typically only recognize their children as overweight when their kids are significantly heavier than their peers. Out of the study’s 2,976 child subjects, 369 were objectively overweight or obese. Of those 369, parents only identified four as being too heavy – a mere 1%.

“If you don’t know there’s a problem, you can’t work for a solution,” said Dr. Eric Warren of Novant Health Waxhaw Family & Sports Medicine “The more overweight children there are running around, the more parents say ‘Oh, he looks just like all his friends,’ or ‘She’s not as heavy as some of her friends.’ The excuses create a dangerous spiral.”

The problem doesn’t stop with parents. A report issued by the CDC in July 2014 found that 81% of overweight boys and 71% of overweight girls believe their weight is normal.

“That is a big problem, when everyone, including the child, is oblivious there’s a problem. It becomes hard to motivate change,” Warren said. “If we break it down to what’s healthy for the individual based on the numbers and facts instead of a peer comparison, it becomes more real and we start to see people wanting to change their habits.”

The report also points out significant differences in weight perception among different populations, with high-income groups more accurate at perceiving obesity than low-income groups.

“There are all these easily accessible food options out there in fast food,” Warren said. “It’s unhealthy, but it’s cheap. So it becomes a good ‘fun’ meal, especially for those families that may be on a budget. But the trade-off is that these options are high-fat, high-calorie, which feeds into the higher obesity rates among the lower socioeconomic classes.”

Knowing ‘normal,’ recognizing ‘overweight’

“I think we’ve forgotten what normal looks like,” Dr. Walker said. “When children raise their arms by their sides, you should be able to see some of their ribs. We’re an obese nation and we’re letting our children start to blend into that.”

Adults use body mass index (BMI) to gauge whether they are a healthy weight or not. Adults with a BMI over 25 are considered overweight, those with a BMI over 30 are obese.

In children, the parameters are a little more complicated. Here are the medical standards outlined by the CDC growth chart:

  • Underweight. Children with age- and sex-specific BMI less than 5th percentile.
  • Normal weight. Children with age- and sex-specific BMI in the 5th to 85th percentile range.
  • Overweight. Children with age- and sex-specific BMI in the 85th to 95th percentile range.
  • Obese. Children with age- and sex-specific BMI over 95th percentile.

“Normal for a child is not the same as the adult normal,” Walker said. “For instance, a 4-year-old child should have a BMI around 15, while an adult with that number would be considered underweight.”

Walker and Warren both stressed the importance of regular child health checkups with a consistent provider who can get to know the child and track BMI over time, raising flags where necessary.

Choices for change

“A lot of the issue – and the solution, actually – lies in understanding eating habits,” Walker said. “Food should be nutritional fuel, not emotional comfort.”

She said increased portion sizes, “chain eating” and endless snacking, food-as-reward practices and low-cost high-sugar foods all play into childhood weight issues, but there are ways to combat these factors.

“Whether you’re thin or tall or short or overweight, there are four things I like to encourage to promote good childhood nutrition,” Walker said. “Reduce sugar intake, seek out and destroy hidden fat in your diet, reduce eating opportunities and emphasize portion control.”

She recommends the following steps for weeding out excess calories:

  • Switch to skim milk, either soy or cow's
  • Avoid sugary sports drinks. Stick to water instead.
  • Limit eating opportunities, which include meals and snacks. Toddlers and preschoolers should have about five eating opportunities per day; school-age children should have about four.
  • Offer healthy snacks such as fruit or low-sugar, low-fat treats.
  • Try age-appropriate, nonfood rewards such as praise, extra playtime, time off from chores or added computer time.

Warren said it’s important to remember that the change doesn’t just occur in the child’s life, as research shows a correlation between overweight parents and overweight children.

“It starts with you,” he said. “Your child looks up to you; they are looking for an example in you. You have to model the healthy behavior you want to see in your child. A nice byproduct is that you’ll get healthier, too.”