DD (5yo) is in the 97th percentile for BMI...doc says she's in the obese category - Page 2

[Storm Bride]

OP, you said:

You're right. Muscle does weigh more than fat; I don't understand why that isn't being taken into consideration?

It's not being taken into consideration, because BMI is a number. While most places that explain it (articles, calculators, brochures, etc.) do include a comment about it not working as well for muscular individuals or those with a big frame or whatever (the mom of the overweight kids that I was talking about above has a shoulder span that's about equal that of several men I know, and those men are also over six feet tall - the woman is about 5'6"), that's overlooked when people are just using the number itself. Your dd's BMI is in a high percentile, and that's that...even though it's not.

I hate, hate, hate the BMI. There are no words for how harmful I believe it to be.

[LynnS6]

My dd is in the 94th percentile on BMI like your dd (my online calculator said 94th, not 97th) -- "at risk of being overweight". She's in the 94th percentile for weight and the 84th for height.

The thing is, that dd has had these SAME percentages since she was an infant. Her doctor (who isn't holistic at all, but very practical, and I love her), said "well, this has been her growth curve all her life. If we see the weight and the height percentiles starting to diverge, then we need to be a little concerned." Honestly, dd came out built like a linebacker. She was OVER the 97th percentile at birth, and about the 95th for height at birth. She's got beautiful broad shoulders and a lovely little hour glass figure (from her dad's side of the family). The women in my family are chesty with broad shoulders. As one of my friends put it, "She really does look like German peasant farmer, doesn't she?" She's strong as an ox and has a fair amount of muscle and a little fat. She's never going to be a size 0 or a size 2. It's not in her genes. When she's grown and at a healthy weight, she'll be a size 10 or 12. (That's what my mom and my sisters who are at a healthy weight are.)

Dd is 4' 3 1/2" tall, and weighs 73 pounds. Her brother is 4' 10 1/2" tall and weighs 72 lbs. He's always at risk of being underweight. The thing is, if you look at their diets, dd's is probably more healthy than ds'. For her snacks, she chooses yogurt (low fat), turkey, ham, and fruit). She gravitates toward protein. Ds's pants stay up, as far as I can tell, because of the copious amounts of Nutella that he eats. He is much more likely to tend toward carbs. He stays lean because he moves constantly.

Dd is, probably, at risk for being overweight, but that's largely because she's more sedentary, and has decided that she doesn't want to do any sports where she has to "run and get hot". So, we've enrolled her in swimming. We're reducing the amount of TV she watches (it got a bit excessive at the end of the summer because I was ill). But her favorite things are to read and play imaginary play with stuffed animals (where she does things like do homework with her stuffed animals!). Her brother's favorite things are basketball and soccer. Even in the living room, he does soccer kicks with a balloon. Dd reads.

I think your doctor is concerned because her weight jumped up fairly high in the last year, but her height hasn't. But all that says to me is: Watch out for the growth spurt! If she's fairly active, can do what she wants without getting winded, and you think her diet is well balanced, I'd relax.

[TiredX2]

Originally Posted by mamatoablessing 



Thank you. This is something I asked the ped about. I said, "feel her - she's all muscle". Her response is that her build hides it well. The more I think about that comment, the more it upsets me. You're right. Muscle does weigh more than fat; I don't understand why that isn't being taken into consideration?
 

If you want to look intothis in the future, they can take it into account by taking a body fat measurement.  My BIL was "overweight" for the Army, but they just sent him to a doctor.  The doctor said he had a 3% body fat and was just super muscular.  He'll never be a "healthy weight" but that doesn't mean he's unhealthy.

[seraf]

She looks healthy to me.  She is almost as tall as my 8 1/2 year old and weighs a few pounds more, but he is built like a bird.  I plugged both my kids into a BMI calculator and he is in the 24th percentile where my DD6 is in the 95th (42" and 48 pounds).  She also looks healthy.

I am going to choose not to worry on this one.  I think you know your child better than her doctor does, but it would be irresponsible for the doc not to bring it up. 

[cameragirl]

Kids often have growth spurts around their birthdays, and then again about six months later. It is normal to put on a little weight first, and then hit a growth spurt and gain an inch or two. That growth spurt completely changes the growth chart percentiles. As mentioned above, I do see a little tummy in one picture, but she does NOT look like she's overweight. She looks like a normal, healthy five year old. Teaching her about healthy foods, and seeing her regulate her intake based on hunger is a great thing. I don't think you have anything to worry about.

[frugalmum]

Originally Posted by Alyantavid 

I did read your whole post.  And it's full of judgment.  Your very first sentence was "she's not fat, but she's not lean".  The op's daughter is a perfectly healthy size, she's active, she has a good diet.  And you brush all that aside with that one phrase like there's a problem with the fact that she isn't "lean".  

Well I could say the same thing-- she's not fat but she's not lean.  She looks like she's right on the edge in terms of healthy weight, and given that there has been a big jump over one year, I would be concerned too as a mom and a pediatrician.  If my 5 y.o. DD were that size I be a bit concerned and keep an eye on things .  The OP says she eats big portion sizes and a small amount of "bad" stuff.  No harm in cutting out all bad stuff, even if it's minimal to begin with, and maybe keeping track of portion sizes (without making it obvious to DD) for a while just to get a clearer idea exactly how much she is eating.  If she's eating within a reasonable intake level, it's probably just how she's built.  But it can be easy to underestimate how much food one eats.

[McGucks]

I think the child looks lovely and vibrant and healthy.

There are names for different body types:  mesomorph, endomorph, ectomorph.  We are all built differently and one person's "ideal" weight for their height may be quite different from another's.

[Alyantavid]

Originally Posted by frugalmum 

Well I could say the same thing-- she's not fat but she's not lean.  She looks like she's right on the edge in terms of healthy weight, and given that there has been a big jump over one year, I would be concerned too as a mom and a pediatrician.  If my 5 y.o. DD were that size I be a bit concerned and keep an eye on things .  The OP says she eats big portion sizes and a small amount of "bad" stuff.  No harm in cutting out all bad stuff, even if it's minimal to begin with, and maybe keeping track of portion sizes (without making it obvious to DD) for a while just to get a clearer idea exactly how much she is eating.  If she's eating within a reasonable intake level, it's probably just how she's built.  But it can be easy to underestimate how much food one eats.

My 5 year old is that size and there is no way in the world I will track portion sizes or cut out everything unhealthy.   I do think there's harm in cutting out everything that might be considered a treat.  And as a mom, I'm not concerned.  My son's doctor is not concerned.  I'm really surprised that there are people who think the op's daughter is on any edge of healthy weight. 

 There are enough girls in this country with eating issues, why add another one because of 1 comment made by a doctor?  Sure, if she keeps jumping off the charts, look into it, but because one time her curve went up?  No way.
 

Edited to change "anything" to "everything."

Edited by Alyantavid - 9/27/11 at 2:06pm

[cameragirl]

Originally Posted by Alyantavid 

My 5 year old is that size and there is no way in the world I will track portion sizes or cut out anything unhealthy.   I do think there's harm in cutting out everything that might be considered a treat.  And as a mom, I'm not concerned.  My son's doctor is not concerned.  I'm really surprised that there are people who think the op's daughter is on any edge of healthy weight. 

 There are enough girls in this country with eating issues, why add another one because of 1 comment made by a doctor?  Sure, if she keeps jumping off the charts, look into it, but because one time her curve went up?  No way.
 

I would agree that have to be careful about limiting food or even mentioning weight to a child. I feel that encouraging a healthy diet as a family, and healthy physical activity is much better than even mentioning weight or cutting out the occasional treat.

[mamazee]

Peds are crazy about this issue lately. My 2-year-old dd looks average to thin, but because she's 85th percentile for weight, her ped told me she's overweight. Nevermind she's 95th-100th for height! They don't even use logic when looking at these numbers anymore. I see the photo, she doesn't look thin but she certainly doesn't look at all obese either. I wouldn't worry about it.

[Storm Bride]

FWIW, op...my mom was just here, picking up dd1. Mom's kids were your dd's age in the late 60s (my brother) and early 70s (me and my sister), when childhood obesity wasn't a big concern. Her concepts of what children look like were formed a long time ago. She looked at your dd's picture, and thought she looked like a normal, healthy little girl. She also thought her tummy looked like a child on the verge of a growth spurt, not like a child who has a weight problem. So do I.

[JudiAU]

I think that your doctor is trying to be careful because so, so many children are heavy in this country.

And she sees a little girl with a healthy diet but who has had a big jump in BMI and she wants to be careful. Sometimes doctors look at the family as a whole when they think about where a diet/weight might be going. So, if you or your DP are on the heavier side that might play into her concerns. (No idea what your weight is like, just an observation because the overall health/weight of the family comes into play.)

Your daughter doesn't look overweight or obese to me but she does look stocky. She might be the perfect weight. She might be about to have a jump in height. Or she might be eating too many calories for her activity that will continue to add weight to the same frame. Your Ped is concerned that it might be the later.

I think she is being cautious and that is she is taking the difficult choice. Imagine how much easier it would be for her not to express her concerns?

My DS's BMI is also high, although he looks a little leaner overall. He used to be a bit taller in proportion of his weight. He likes food, he likes to eat, he has a terrific diet overall. We are in the habit of providing him with lots of food because he eats it. He is not super athletic and isn't very coordinated. I don't limit what he eats at all, but I am conscious of his intake because I can see how easily a shift in behaviors (less activity, less thoughtful food preparation, too many adults shoving food at him) could result in simply too many calories.

Bascially, I am aware of his weight and his BMI in a way that I wouldn't be with a leaner kid with a slightly lower BMI. (Our ped didn't mention his weight at our 4y checkup.)

[Tigerchild]

Yep, when the computer barks at them to give you the fat lecture, they will.

My DD has been off the charts for height and weight since she was born.  Now she's almost 5'3" and is around 90 lbs, at 9 years old...which is a precipitous DROP for her her weight, but there was no gasps of horror from the ped this time!  Frankly, I'm disgusted that despite the fact that DD went from *off the charts for BMI and weight* which meant that doctors called her fat every year to being underweight, they didn't express concern to me!  Especially given the epidemic of eating disorders amongst preteen girls on up!  It was really disturbing to me that nothing was said, wheras if she'd been 5 lbs "over" what they wanted, it'd be no problem to talk to me about her risk of obesity in front of her, like she wasn't hearing that info.

It also made a difference over who was taking her to appointments.  Whenever DH took her (he is not fat) they never said anything.  Whenever I did (I am) they ALWAYS said something, even if it wasn't a well-child visit.

Gross.

Did I press the issue?  No--because DD eats like a teenage boy and was going through a massive growth spurt at the time, I know she'll round out eventually.  But now I wish I had made a comment to the doctor about why underweight all of a sudden wasn't a concern yet a 97+ percentile weight combined with 97+ height since birth was worth commenting on, in front of her, EVERY time?

[KatWrangler]

Originally Posted by TiredX2 

This is something that really bothers me AND seems to happen often:
 

I did the same (well, looked at the CDC growth charts) and also placed your DD's BMI of 18.1 at under the 95th%.

I don't take BMI too seriously with kids for a few reasons:

1) many kids tend to grow in real "spurts."  So they might put on 3-5 lbs very quickly and then grow an inch just as quickly.  If you happen to measure the child between putting on the weight and putting on the height the picture is totally different than it could be in just a couple weeks.

2) kids are notoriously hard to measure.  If the OP's DD measured just 1/2-3/4" taller, she would drop under the 90th%.  Same thing if she was like 1-2 lbs lighter.  What if she ate right before going in?  Was wearing heavier clothes?  Maybe she wasn't standing up right.  Heck, maybe the scale was off! 

3) Kids are not adult propoprtions.  This is especially "hard" on bigger kids.  Because their height/weight is higher people often expect them to have more adult measurements.  But a 5 year old who is the height of a 7 year old will generally be heavier because they will have larger torso for height (and torsos are just heavier than that amount of leg).

And so on.

OP: What is your "mom" sense telling you?  If you had no concerns until seeing the doctor and DD seems healthy and happy, I would letit go for another while at least.

Agreed.  I also think it is possible she is headed for a growthspurt. 

[KatWrangler]

Originally Posted by Storm Bride 

FWIW, op...my mom was just here, picking up dd1. Mom's kids were your dd's age in the late 60s (my brother) and early 70s (me and my sister), when childhood obesity wasn't a big concern. Her concepts of what children look like were formed a long time ago. She looked at your dd's picture, and thought she looked like a normal, healthy little girl. She also thought her tummy looked like a child on the verge of a growth spurt, not like a child who has a weight problem. So do I.

I do as well.  She looks normal and healthy.  But a growth spurt could be around the corner.

[mamazee]

Very true. Both my kids put on a bit of weight before a growth spurt, and then they get tall and thinner all of a sudden.

[Smokering]

I hate, hate, hate the BMI. There are no words for how harmful I believe it to be.

I agree. It's beyond meaningless.

OP, your daughter looks fine to me. Yeah, a bit of tummy-squish, but kids have that. And you can see how toned her arms are - she's obviously muscly. If she doesn't have a growth spurt, or you start noticing she's getting bigger than her classmates, or whatever, you might start considering it an issue... then. I just... I've gone back and looked at the photos three times, and I live in NZ, where the rates of childhood obesity are pretty low (as far as I know!), and I just don't see the "obese" thing. I wouldn't look at her twice (weight-wise, I mean! She's cute). You know?

[lilmom]

I agree with all those who've said the BMI is meaningless and does not take into account body types, etc. It just doesn't, not for adults either.

I personally am really sick of the whole medical community not taking individual people's health/build/symptoms/etc into consideration. Everything is based on a test. Or based on a number plugged into a computer. Whatever happened to using common sense?

OP, your daughter is a beautiful child, and she looks just fine to me!!! I would probably tell this Doc that you have no intentions of subjecting your daughter to all those invasive tests without a very good reason, and you want to wait and see if she has a growth spurt.

We haven't done a well-child visit since DS was 15 months old, and he is now 4. I just hate being harrassed about vaxes, BMI, and who knows what else. You know your child best. Let intuition guide you. If you think something is wrong, then go in. But I think she looks great.

[meemee]

Originally Posted by mamatoablessing 

I am so confused, mamas. We just returned from our pediatrician's office where DD had her 5yr check-up. The ped was shocked to see the jump in her percentile in the BMI category, from 70th% last year to 97th percentile this year. Ped is worried about obesity. 

i think you and your ped are looking at the figures in a whole different manner. she wants to find out abut why this sudden jump. if she IS eating well and everything is normal why this sudden jump. she wants to test adn rule out medical causes for the rise in weight.

to me she comes across as a concerned ped. wondering why the jump from 70 to 97 like pp said above. 

[Storm Bride]

Originally Posted by meemee 

i think you and your ped are looking at the figures in a whole different manner. she wants to find out abut why this sudden jump. if she IS eating well and everything is normal why this sudden jump. she wants to test adn rule out medical causes for the rise in weight.

to me she comes across as a concerned ped. wondering why the jump from 70 to 97 like pp said above. 

IMO, a concerned ped would want to see the child again in a few months, and see if a growth spurt or something had brought her back in line with her former growth curve. A paranoid ped would be talking about blood tests. In the absence of any other sign of problems (eg. low energy, low muscle tone, inability to exercise at a normal level for her age, etc.), jumping to blood tests is premature. The last thing a five year old girl needs, especially in this culture, with its wigged out ideas about body shapes, is to get the idea that having a bit of a tummy
and being bigger than average automatically means there's a medical problem.

Personally, I'd dump the ped, but as I said above, I don't do well child visits, anyway. But, if I were going to keep the ped, I'd refuse the recommendation of blood work. If I wanted to mollify the doctor (which is far from my personal mission in life), I'd see about rescheduling a visit in 3-6 months, so that he/she can monitor the little girl's BMI. (Despite the widespread popularity of this particular number, however, I'd have trouble trusting the competence of anyone who has this much faith in it...especially when they're getting a different number than three other people checking it out.)

ETA: And, re: "why this sudden jump?" I don't even get the question. Before we started worshipping at the altar of the almighty BMI, and obsessing over children's weight, I saw kids get a little thicker, then sprout up, then get a little thicker, and then sprout up, then get a little thicker, and then sprout up - over and over and over. If we'd been tracking those children's BMIs, I'm very sure we'd have seen a lot of sudden spurts, which resolved themselves equally suddenly. This is very, very common, ime...and I'd be very wary of a ped who thought "blood tests for thyroid" before he/she thought "wait and see if she outgrows it". Of course, that's if I thought the girl in those pictures had a problem in the first place, which I don't.