DD (5yo) is in the 97th percentile for BMI...doc says she's in the obese category - Page 3

[rubidoux]

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.

Are you saying that you are a pediatrician?  If so, I'm curious if this is the advice you'd give if a child built like OP's dd came in.  

Originally Posted by 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?

That is really disturbing all the way around  --  that they weren't the least bit concerned about 90/5'3" (though I do see why you aren't worried) and that they have different concerns depending on the parent who brings her.  Ugh.  Makes me wonder if it's because they assume that a fat parent would feed her badly or that she's got fat genes, probably both I guess.  Either way, though, horrifying.  And I cannot believe they have these conversations with you in front of her!  That is just so unbelievable to me.  It must be unthinkably terrible for a young girl to be told that she's fat by a professional.  OP, did they have the convo with you in front of your dd, too?

My boys are both super short, like 5-7th percentile.  My 8 year old has always been very delicately built.  I have always worried a little about the possibility of him being under weight, but he has always been around the 40th percentile for BMI, oddly enough.  He almost never wants to eat, but when he does eat, it's usually for about three days straight.  He loves treats, but he'll eat a half a pack of m&m's and tell me he's had enough.  I do my best to stay out of it and let him self-regulate, except that I do make him eat b'fast because he goes to school and doesn't have another chance to eat until lunch.  My little one, though, was born a pound heavier and just blew up.  He was a big rolly polly baby.  He was what I had always thought a healthy baby looked like until I had my first and he was so petite.  But I worried about Aug being big just because it was so different from his brother.  Then when he was old enough to be walking around he didn't look fat to me at all, but I would say stocky and solid with a belly.  It worried me because of all the fear mongering going on in the media now (which I think is SO unfortunate and misguided).  And he doesn't self-regulate like Milo.  He wants nothing but carbs and if he has something yummy in front of him he'll eat too much of it.  So, when I took him in, guess what, he was in the 7th percentile for BMI!!!  I don't get it at all.  Everyone who looks at my two kids agrees that Milo is petite and delicate and Augie is more stocky.  I think it must be as previous poster's are saying  --  there was an error in measurement of math or something.  Or BMI is truly meaningless.  

I think your dd is the picture of health, OP!

[jenrose]

My now 18-year-old was HUGE as a baby. 24 pounds at 6 months old. Her rolls of fat had rolls of fat. I didn't worry about her being 99th for weight, because it was all breastmilk. 

And what do you know... at 1 year, she was 26 pounds. 

And about 3 weeks before she turned 2, she was 27 pounds.

Then at her 2 year well check, she was 30 pounds and only 50th percentile for height, and our idiot family practice doc (long since fired) tried to lecture me about how she was obese. I said, "She put on 3 pounds in the past 3 weeks after barely gaining for an entire year. I'm pretty sure we're looking at a growth spurt."

Sure enough, boom, a couple weeks later, she put on a couple inches. 

And gosh... at 18 years old, she's now 5 foot 4 and about 140 pounds, and as she has had her entire life, she has a wide frame, strong bone structure (at her very, very leanest she is too skinny when she's 130 pounds, because she has wide hips and shoulders and big bones), and she's not the least bit fat or overweight, has the healthiest food habits in the family, and is relentlessly normal in size. 

She managed to not gain a pound or an inch in 2 years somewhere in grade school... then one month she pudged a little bit, then grew an inch overnight. Literally woke up and said, "Mom, my feet are farther away." She put on 6 or 7 inches in a few months. 

There is nothing linear about growth for a lot of kids.

My younger daughter won't grow at all if she doesn't have a little fat pad on her, it's a metabolic thing, I think, part of her chromosome disorder. Also, both kids have long torsos, and thus tend to run heavier for their height than kids with long legs. Shiny, especially, is that way... she outgrew her car seat rated to 65 pounds 7 inches early because her torso is just that long. And torso is HEAVY compared to legs for a lot of kids.

As for the OP, she's a lovely little girl, and looks like she has a great bone structure and just the right amount of padding for a kid getting ready to grow. Before anyone gets on her case about her weight, they better darned well watch for a few months and see what happens growth-wise, and if they're still concerned, actually MEASURE her body fat, rather than make blanket statements based on idiotic height/weight-based analysis from a single doctor visit.

When K (my oldest) was in preschool, she wasn't at all fat, but she was wider than the kids around her, and it was all about bone structure. She's still got Great Dane puppy hands and feet compared to her height... her bones really ARE bigger and wider for their length than the kids around her. 

   Age six .

12-ish?

And just before senior year

[meemee]

Originally Posted by Storm Bride 

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.

StormBride would u really dump the ped? even after the OPs second post about the ped? would u not give the ped a second chance? just coz its weight? body images and wigged out ideas? 

it seems the ped has supported the mama all this while. could we not give her the benefit of the doubt? could she have been whigged by a recent case and freaking out? i mean if it was growth spurt she should have already seen this trend shouldnt she in her well baby visits? dd does the same thing. goes rounder and then suddenly almost overnight shoots up. since i've noticed since 4 dd had done the same thing for the last 5 years. if the ped has been seeing her she should see this pattern shouldnt she? of course provided she saw her at the same time. i mean it just blows my mind that a ped of all persons did not factor in growth spurt. 

i understand where you are coming from - where everyone is coming from but dump the ped over this? just coz its a body issue - i dont think so. 

if the world thinks OPs dd is fat they are going to let her know pretty soon. dd is tall and broad and stocky. and in the same category as OPs dd. however dd looks it. she has a tummy, she is 4'9" and a 100 pounds. and guess what? she is the same as her father and uncle when they were that age plus she has a mother who has 'heavy bones' (how i have always 'looked' and what my weight said has always been different). the world has been calling her fat since she was 5 years old. including her own father. i've had to counter that a lot to make sure dd doesnt get a complex. i guess so far she hasnt since she chose a bikini for a swim suit. 

i would give the ped one more chance instead of dropping her like the plague. plus i am curious what else she asked and discussed. 

did she bring up growth spurt, family genes...? 

looking at OPs dd there is no way i would call her fat. 

[karne]

OP, however you decide to follow up/not follow up on this, I just wanted to share as the mom of a tall teen dd (97th percentile).  My dd is lower in weight percentiles right now than height, prob 75th, but that's because at a certain point in puberty, kids just shoot up.  As in, 6 plus inches in a year!  I think that it is extremely important to tread very carefully, esp. at such a young age, around issues of weight, BMI, etc.  It can become such a loaded issue for girls-I wouldn't emphasize it at all except for healthy portion sizes and plenty of exercise-but these are things that seem like they are already part of your family.

I wonder why your pedi isn't waiting for another visit to watch for a trend vs. concern at a one time visit?

[wishin'&hopin']

I was a solid kid, who became an overweight/obese teen and then a solid adult.  I REMEMBER feeling "fat" at age 5--comparing myself to more petite classmates.  Now, I look back at those photos of little five year old me and realize that I was FINE--just a sturdy and strong little girl.  I wish my parents had encouraged my athleticism and helped me to love myself as me, rather than feeding into my notion that I was "fat".  For me, it became a self fulfilling prophecy--I became embarassed to run and play, since I was bored I ate mindlessly, since I ate mindlessly I became overweight, because I was overweight I was uncomfortable running and playing.   So, you see where this train went.  Even now, my mom desperately wants to know what I weight--so she can compare my weight to her own, to my sisters, to her sister etc.  She tells me the height and weight of my niece (who she is raising) and all in all has a bizarre way of comparing/affirming our bodies.  I don't feed into this--it's actually the reason I never asked for/recorded my weight in pregnancy, that way, when mom asked I could say "I don't know".

That said, I've worked with preadolescents/teens that have expressed that they are "fat"--and regardless of body type and actual numbers, my response has always been "Does your body do all the things that you want it to do?  Can you run, play, dance, sing?  Can you ride your bike and enjoy hikes?  Than stop worrying, your body is beautiful and strong!"  

BMI is a tool, but when you use a sledge hammer when the finesse of a screw driver is needed you'll just destroy what you're trying to create...

[ameliabedelia]

I think the pediatrician is concerned because of the sudden jump in BMI....not the numbers themselves.  She's probably looking at the bigger picture of America where a lot of children (especially girls) start to be become overweight or obese around the time they hit school age.  I agree that blood tests and nutritionist is a bit much, it would make more sense to keep an eye on it and see what happens.   Yes, it could just be due to a growth spurt.  But, many children do start to become obese around that age .  This is just from my own observation (so I don't have any data), but one thing I have observed is that as kids (especially girls) get older, the percentage of children that are obese increases.  In other words, I personally feel like I have observed more obese 10 years olds than obese 7 year olds, and more obese 7 year olds than obese 5 year olds, and more obese 5 year olds than obese 3 year olds, etc.

[serenbat]

I would not hesitate to do the blood work and I would not dump the ped-I would wait to see the results and talk them over and see what really did cause the jump. If it is a growth spurt so be it. Why not rule the chance that there is another issue out?

Waiting another year and IF there really is a problem the ped would be attacked for not acting sooner.

Mostly healthy foods and a jump does not always equal a grow spurt, it can be there also can be much more going own.

Do the blood work and go from there.

Looking healthy and being healthy are two different things.

Edited by serenbat - 9/28/11 at 6:25am

[Alyantavid]

Originally Posted by Storm Bride 

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.

Yes to all of that.  I totally understand why a ped could be concerned with a big jump like that.  But a good ped would want to see her again in a few months, not rush to blood tests and a nutritionist.  Blood tests would not be my first step in this case.   

[serenbat]

What exactly is this BIG harm in having a blood work done?  yes there is a problem or no there isn't

or just keep waiting and find out later you really have a problem and live with knowing that you did nothing when it was presented to you-I would not want to live with that

And where is it that after the results are back the ped won't want to meet with the child? I read what the OP wrote and I did not get that the dr was not going to follow up.

Most doctors DO NOT set follow up apts until the results are back-why is this somehow different?

[Alyantavid]

Originally Posted by serenbat 

What exactly is this BIG harm in having a blood work done?  yes there is a problem or no there isn't

or just keep waiting and find out later you really have a problem and live with knowing that you did nothing when it was presented to you-I would not want to live with that

And where is it that after the results are back the ped won't want to meet with the child? I read what the OP wrote and I did not get that the dr was not going to follow up.

Most doctors DO NOT set follow up apts until the results are back-why is this somehow different?

I'm just imagining how traumatic a blood draw would be for my 5 year old.  And waiting a few months to see if it's something as simple as a growth spurt is not doing nothing. 

[choli]

Originally Posted by Alyantavid 

I'm just imagining how traumatic a blood draw would be for my 5 year old.  And waiting a few months to see if it's something as simple as a growth spurt is not doing nothing. 

Well, I would prefer a minute long trama over a blood draw than to ignore a potential problem for "a few months".

[beenmum]

Your Ped is a moron. She is perfect.

[serenbat]

Well, I would prefer a minute long trama over a blood draw than to ignore a potential problem for "a few months".

totally agree---ignoring a simple draw - what happens if (AND THIS IS NOT SAYING IT IS THE CASE HERE!) that there is a problem- such as diabetes or thyroid or something else and the child needs to start having regular blood draws? I don't know the family history here- the dr may suspect something - why not error on the side of caution?

another thing they also needs to be considered (if the OP has insurance-even state plans) insurance plans simply will not cover waiting a few months and doing another "well visit" - one per year unless there is a problem- the Dr is being proactive and addressing a increase and requesting blood work to see if another visit is warranted  

what happens if there is no hight increase and the child continues to gain weight- is it only at that time it is an issue?

[choli]

Originally Posted by serenbat 

totally agree---ignoring a simple draw - what happens if (AND THIS IS NOT SAYING IT IS THE CASE HERE!) that there is a problem- such as diabetes or thyroid or something else and the child needs to start having regular blood draws? I don't know the family history here- the dr may suspect something - why not error on the side of caution?

another thing they also needs to be considered (if the OP has insurance-even state plans) insurance plans simply will not cover waiting a few months and doing another "well visit" - one per year unless there is a problem- the Dr is being proactive and addressing a increase and requesting blood work to see if another visit is warranted  

what happens if there is no hight increase and the child continues to gain weight- is it only at that time it is an issue?

I guess I am a little touchy about this right now. A good friend of mine's DD was feeling a bit unwell for a few weeks. The Ped eventually suggested a CT scan, which my friend wanted to refuse, as she was concerned about the radiation. In the end, though, she did take her DD for the scan. They found a cancerous tumor, and her DD is now undergoing chemo. Her chances of recovery are much higher than they would have been had my friend decided to wait and see for a few months.

[serenbat]

Originally Posted by serenbat 

totally agree---ignoring a simple draw - what happens if (AND THIS IS NOT SAYING IT IS THE CASE HERE!) that there is a problem- such as diabetes or thyroid or something else and the child needs to start having regular blood draws? I don't know the family history here- the dr may suspect something - why not error on the side of caution?

another thing they also needs to be considered (if the OP has insurance-even state plans) insurance plans simply will not cover waiting a few months and doing another "well visit" - one per year unless there is a problem- the Dr is being proactive and addressing a increase and requesting blood work to see if another visit is warranted  

what happens if there is no hight increase and the child continues to gain weight- is it only at that time it is an issue?

I guess I am a little touchy about this right now. A good friend of mine's DD was feeling a bit unwell for a few weeks. The Ped eventually suggested a CT scan, which my friend wanted to refuse, as she was concerned about the radiation. In the end, though, she did take her DD for the scan. They found a cancerous tumor, and her DD is now undergoing chemo. Her chances of recovery are much higher than they would have been had my friend decided to wait and see for a few months.

I also know. Many people don't have to feel unwell to have a problem.

[nextcommercial]

I am always the one who thinks if the doctor says she's obese, then she probably is.  Too many people are being ignorant to what's happening to their kids.

Last night, I met a friend at the gym.  She brought her two sons.  The youngest (almost 3 yrs old) had a stack of bologna in his hand.  He was downright obese.  So, after the kids were in the playplace, we were talking and she said her doctor wants something done for the 3 yr old asap because he's Obese.  She was highly offended, and thinks he's fine.  I asked her how much he weighs.  She said "He's 69lbs".  I said "That is morbidly obese, and he was eating at least five pieces of bologna...no child needs to eat five slices of anything for a snack".

My daughter was considered possibly too thin when she was in grade school.   She was going to turn six in September, and she weighed 49 lbs.  The doctor was giving me ideas on how to put more weight on her.  He said she was in the 20th% for her height.   (He was really adamant about it too)

But, your daughter isn't that much heavier than my daughter was at that same age.  The only difference is there's 15 years between them.  Maybe the charts have changed?  

I think if you are not letting her snack the entire day, and she plays outside, then she looks perfect and beautiful to me.  You can be watchful, and consider what she eats and how often, but other than that, I wouldn't think of her as overweight at all.   I would have no problem saying she needs to thin out a bit if I thought she did.  But, I think the charts are wrong this time.

[nextcommercial]

Originally Posted by mamatoablessing 

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. 

This would concern me too though.  I think the doctor is just doing his job.  

I would try to cut down on portion sizes, and maybe cut back on the treats.  

But, I still think she's absolutely beautiful and perfect. 

[funkymamajoy]

I really wish pedis would look at the child, not just the numbers. I have the same problem regarding my oldest. He's got a 6-pack and you see the muscles in his back at 6 years old but the pedi says he's obese.   Your DD looks fine and I'm guessing she'll shoot up in height fairly soon.

[rubidoux]

Originally Posted by serenbat 

What exactly is this BIG harm in having a blood work done?  yes there is a problem or no there isn't

If there's a good reason to do one, then it's worthwhile, but I don't think the trauma it would cause most five year olds is anything to scoff at.

Originally Posted by serenbat 

totally agree---ignoring a simple draw - what happens if (AND THIS IS NOT SAYING IT IS THE CASE HERE!) that there is a problem- such as diabetes or thyroid or something else and the child needs to start having regular blood draws? I don't know the family history here- the dr may suspect something - why not error on the side of caution?

another thing they also needs to be considered (if the OP has insurance-even state plans) insurance plans simply will not cover waiting a few months and doing another "well visit" - one per year unless there is a problem- the Dr is being proactive and addressing a increase and requesting blood work to see if another visit is warranted  

what happens if there is no hight increase and the child continues to gain weight- is it only at that time it is an issue?

If I were the parent here, I'd be willing to wait and see if she continues to gain.  Why not?  We act, in this culture, like gaining a little weight is about the worst possible thing that could happen, but we're talking about a little girl who is healthy and feeling good and happens to have some whacked out BMI number that doesn't seem to correspond with how she's looking or feeling.  The *only* issue here is a BMI number.  I feel like it's quite common of kids that age to have a little extra padding that they grow out of (not saying that OP's dd looks padded) and my guess is that she's not on her way to being overweight but on her way to getting taller.  Why not wait and see?

Also, if there was a reason for this ped to think OP's daughter has a real medical problem, she should have told her what it was.  I can't believe that the BMI alone is reason to jump to that conclusion.  

There is also an issue that doing testing can uncover benign transient variations from normal that lead to worry and further invasive testing and treatment.  I don't know a lot about this, but apparently there is an accepted belief amongst scientists/doctors that most of us go in and out of disease states without ever knowing it.  If you're symptomatic it probably means your body is having a hard time and needs help, but if you do random testing when there aren't symptoms, then you may end up testing/treating/worrying about something that would have resolved on its own.  I think it's true (maybe someone else will know more about this?) that the vast majority of cancers come and go without ever being detected, leaving our bodies no worse for wear.  I think people who find those benign/transient variations and pursue them (because once you know about them, how could you not?) can experience real trauma from it.

 

Originally Posted by choli 

I guess I am a little touchy about this right now. A good friend of mine's DD was feeling a bit unwell for a few weeks. The Ped eventually suggested a CT scan, which my friend wanted to refuse, as she was concerned about the radiation. In the end, though, she did take her DD for the scan. They found a cancerous tumor, and her DD is now undergoing chemo. Her chances of recovery are much higher than they would have been had my friend decided to wait and see for a few months.

That's so scary and terrible.  I'm happy she caught it early.   
 

[insidevoice]

She looks quite healthy to me.

I say that however, as a woman who will ALWAYS have a very high BMI.  I have a huge amount of muscle for a woman (and I tend to follow genetics in my family and carry some weight over it as well!  Egad- horror of horrors!!) It took me a lot of years of an eating disorder as a teen and young adult to make peace with my body shape because I was convinced I was 'fat'. I was held hostage as I tried to achieve the 'right' numbers on a scale, and that wasn't what was right for my body. 

I finally made peace with my body when I survived a cancer that was diagnosed as terminal.  At that point, I realized that simply being aware of what I was eating and trying to live an active lifestyle was a lot more important than praying to the almighty scale and trying to hit the right BMI.  My body is strong, and I am very happy with it as it is- even the squishy bits. :)

My kids are all over the place.  My oldest is FINALLY over 70 lbs- she's gained about 20 lbs in a year as she hit puberty, and she's beginning to develop breasts and hips.  For the first eight years of her life we had to fight to get her to gain weight at all.  My middle child is about 40lbs now- at age three and has been close to that weight for about a year now.  He was a very rolly poly little one, and not very physically active.  Now he's tall and solid, and while one month he will look chubby, the next he will look quite lean- all hinging on growth spurts.  My youngest is almost 30 lbs, and two years old. He's never looked terribly chubby, but looks quite 'average' all the time.  In reality though, he is the child who carries the most body fat. Numbers on a scale can be misleading. 

Maybe we need to focus on health as a family issue- instead of looking to make weight the individual issue as we currently are.  Yes, there is a major problem with obesity in this country, but shaming children and parents isn't going to be the cure.  Enabling access to healthy foods at reasonable cost, ensuring that people can afford to exercise when the weather outside isn't good, educating people about how to build healthy habits and quick meals- with healthy foods, and finding a way to make this a priority as a country without the outcry from people screaming 'entitlement programs!!' - THESE might actually make a difference.  Telling someone that their healthy and active child is overweight because she doesn't fit into the perfect chart position is a knee-jerk reaction that just supports finger pointing and blame instead of collaborative effort to make health and wellness a priority for everyone.