@ Pediatricians and BMI

[yogapants]

We recently took my 7yo daughter to her pediatrician for her well-child visit. Her pediatrician tracks height and weight on a chart at every check-up. Currently, my daughter is at ~54%ile in height and ~77%ile in weight. Her BMI is apparently 91%ile.

I'm her mom, so I acknowledge that I'm not unbiased here, but I don't think my daughter would be perceived as fat. She's pretty average in size, wears size 6 or 7 clothing, etc. She is bigger than some of her friends, though. At this age, I think there's a lot of variation in size between kids.

Her pediatrician made a point of bringing up her BMI with us in her presence at her well-child visit. I could tell that she was trying to be low-key about it, and the conversation we had was about making healthy food and activity choices, not about my daughter being overweight. However, I felt very unhappy that the pediatrician was addressing my daughter's weight in her presence.

I am overweight, so I may be oversensitive in this regard. I don't think BMI is a great indicator of health. I absolutely do not want my 7 year old daughter believing she is fat and internalizing all the shitty things that society says about people who are overweight. On the other hand, I can acknowledge the purpose of having some kind of standardized scale to help guide parents and kids toward making healthier choices before there are lasting health impacts.

I don't have a great sense of whether this is typical for pediatricians to discuss at well-child visits, or how they tend to discuss it. My initial reaction is to want to look for a new pediatrician for my kids. But I'm curious to hear from other parents: How does your child's doctor talk about weight? What, if anything, would you do in this situation?

[waverly]

Our pediatricians have never mentioned BMI, and we have had 2 doctors due to moving. My kids are on the tall side too like 90th percentile for height etc. They look proportioned to me. I think a lot of people are moving away from BMI as a measurement. My daughter is 5 almost 6 and is in size 8 to put it in perspective for you.

If it something that really bothers you I would find a new doctor. Once I am unhappy with a doctor I know it is time to switch, and some doctors I stayed with way too long and regretted not switching sooner. I think that it is something that some doctors will discuss, and I think some doctors don't go there unless there are medical symptoms.

[whitemerlot]

My kids' pediatrician brought it up at both of my children's well check visits. At my son's appointment, she went on and on about sugar consumption. For perspective, both of my kids are around the 25th percentile for BMI and in the low 20s for weight. My 9 year old weighs 56.5 lbs and swims 3+ hours a week.

[fivechickens]

Our pediatrician has never mentiones BMI to us. My kids are 50% or lower on height and weight consistently which is all their Dr is concerned about (consistency).

There was a short period of time around 6-12 months old where my DD2 was being tube fed and was considered overweight and no one mentioned her BMI to me (Pedi, GI Dr, or her nutritionist) then either.

[eddy]

We have had BMI talks before with our pediatrician. She always remarks that his measurements are consistent. There was a time that DS1 was up in upper 90% for weight and height. We had a more in depth talk that time. . She gauged what sort of activity he was doing and what he was eating. Eventually he shot up in height and the weight part of the BMI when down. But BMI is at least something the doctor remarks on each time for both of my boys. Mostly a “well he is staying on the consistent curve and that is what I am always look for.” THye are less worried with the percentage and more about the data over time.

I guess from the Peds perspective, it is hard. It is their duty to talk about health concerns and gauge how families are practicing healthy habits. Pediatricians are often the front line of making sure safe practices are happening. Think about all the times you have talked about carseat safety, sleeping habits etc with your Ped. Growth should be a similar conversation. As far as your daughter in the room, that is tough. But what is the alternative? Send her to the waiting room on her own? Not talk about it?

I understand why you felt sensitive to your daughter hearing the conversation. But  I also don’t really think the pediatrician was doing anything wrong.

[erbear]

I think BMI is bullshit for kids. Both of mine are in the 0-10%, and they are normal and healthy little girls.

I think most parents know when your kid is actually unhealthily overweight, and I don't think it needs to be brought up when kids are kids unless a parent is oblivious. I get that pedis have to talk about weight in some instances, but I think there is a better measure.

[keyslover]

At DD2's 7 year old well check, the pediatrician said nothing about her weight. I get the paperwork and it due her BMI it said Obese.
DD2 is a sturdier kid, she has muscle, oh and she is also 7! I was/am upset that is in her chart now, but am happy the doc didn't say anything. I *think* was automatically put in due to numbers.

And for those that say to switch docs, it is not that easy. Our nice little pediatricians office is now part of the Children's Hospital Network, we lost a lot of the small office feel we sought out over 10 years ago.

My 2 cents- BMI is a horrible indicator of health. Talk to DD about being happy with who she is, everyone is built different and that is what makes her her and she is awesome.

[Susie]

My DD is only 3, but we have only discussed her height and weight in percentile terms, not BMI.  She was most recently 23rd% for weight and 76th% for height.  She has at various points been <3rd% for weight, and definitely clinically underweight.

I don't have an inherent problem with BMI.  It's an objectively measured index, not a subjective judgment or commentary.  It's less dependent on population trends than percentiles.  I'm short, fairly athletic, and not at all fine-boned, and am always near the border (or over the line) of having an "overweight" BMI.  I think use of the BMI scale might be improved just by dropping the labels -- you can have a BMI of 25.1 or whatever and just leave it at that; the same medical end is achieved without the label.  But ultimately it's not something I've given a lot of thought.

As far as my kid is concerned, I am not sure it's doing kids a favor by never discussing weight (or BMI, or whatever measure is at hand) in front of them.  When they're old enough to start making their own food choices (at 3 we are not so much there yet but 7 would be) I think it's important to start understanding and getting reference points, and consciously developing good habits.  I would not be upset about the FACT of a discussion of BMI or weight, I think it's healthy to get an understanding of.  If there was judgment, criticism, or body shaming with a current measurement, that is a different story -- that I would switch over.

[mrssandro]

Eddy worded it well.

I get the weight talk all the time about my kid. DD slipped under 10% again but she is long and skinny. So of course I get a conversation about her weight and what she eats and how much. It always feels like I have to be defensive because in the moment I feel that she it criticizing me as mother. I have to take a step back and realize she is just trying to educate and looking out for the best interest of my kid. Healthy eating habits are always mentioned also with my typical child. I feel this is generally how these checks go.

[trissie18]

Our pediatrician has brought up both DS1 and DS2's BMI at their last three well child visits. It always annoys me because our children are far from being considered fat when you look at them yet she is always telling us to make sure they are eating healthy and being active because she is concerned. If our children were anymore active they would never come in the house or sleep hence why they have very muscular body types like DH.

[dontlook]

We discuss BMI in terms of if they are following their normal trend or not.

I wouldn’t be upset about the food discussion. Our pedi talks about it at every appointment. She asks what kind of foods the kids love and then talks about making sure they eat fruits and veggies and less candy/junk food. They also receive a $10 gift card for our local grocery store to be used on fruits and veggies.

[Deleted]

Ditto eddy.

If your kid is maxing out at one end or the other, isn't it the pediatrician's job to bring it to your attention? I mean, she's not going to force you to put your kid on a diet and exercise regimen. If you think your daughter is fine and healthy, you're going to do what you want regardless. The pedi knows this. But it's her job to say, "Hey, you know, that arm is totally broken. I know you don't want to, but you should get it set and in a cast ASAP."

And with the converse, if the pedi never said anything and your kid ballooned up or dropped down to an unhealthy standard, we'd say, "Well, you didn't TELL ME my kid was severely underweight and we should do things like go to whole milk and add in high-fat, healthy foods."

[yogapants]

Dec 12, 2018 14:31:41 GMT -5 eddy said:

We have had BMI talks before with our pediatrician. She always remarks that his measurements are consistent. There was a time that DS1 was up in upper 90% for weight and height. We had a more in depth talk that time. . She gauged what sort of activity he was doing and what he was eating. Eventually he shot up in height and the weight part of the BMI when down. But BMI is at least something the doctor remarks on each time for both of my boys. Mostly a “well he is staying on the consistent curve and that is what I am always look for.” THye are less worried with the percentage and more about the data over time.

Our pediatrician generally says something similar: "I just want to be sure they're trending along the same line." This has come up before, 2 or 3 years ago, at a time when I felt like my daughter probably couldn't understand what the pediatrician was talking about. Then, the following check-up, her height and weight had stabilized a bit, and it was a non-issue.  But my kid is smart, and she's going to catch on sooner or later if the doctor makes an issue of her weight.

All that said, of COURSE we could do more to incorporate more veggies and activity into her diet, and I plan to try to follow those recommendations.

[InBetweenDays]

DD (12) is 25th %ile for height and <3rd %ile for weight, so she is <1% BMI. Which comes with it's own complex body image issues. At every appointment her doctor states her weight and height, says DD is on her own curve and the doctor isn't concerned. For her to just keep making good food and activity choices. So in my experience it is completely normal for the doctor to discuss height and weight as part of the yearly exam.

Personally I don't want weight to be a taboo subject. We certainly don't focus on the numbers, but I think not discussing weight at all can amplify the idea that certain weights are "good" and others are "bad". So weight isn't something to hide from or be embarrassed about, and we reinforce with our kids that healthy comes in all shapes and sizes.

[hermione]

My DD has been off the charts for height and weight since her 2 week well visit. Every visit they ask me about sugar consumption and physical activity. They make sure she is eating vegetables. It's their job to ask these questions, I know, so I don't let it bother me. Even the pediatrician concluded last time that "well, someone has to be to be at the top of the charts."

If this thread goes like the many other threads on this topic, it is only a matter of time before someone or several someones chime in here talking about the childhood obesity epidemic in this country and "nicely" implying you should be doing more. Unless you believe you are being lax when it comes to healthy food and physical activity, ignore them.

[kath16]

I mean... I don't like it for myself, if I'm being honest, but it's important.

I would assume that your doctor is careful about avoiding words like "fat" or even "overweight" in front of your daughter who might not have a great perspective.

[Deleted]

I have two kids that have been on both sides of the weight. Our pedi mentions weight and says she likes to see them follow “their” curve and talks to both kids about eatinng vegetables/fruits/protein and exercising/playing enough. It’s just part of her appointments with them. I do think it’s important doctors discuss it because it can be a health issue.

If you’re uncomfortable talking about it in front of her, I’d bring it up with her doctor and see if it’s something you can discuss elsewhere if need be.

[scorpio72]

Weight has never been discussed at any of my kids ped appointments.  I only see the BMI % when they give me the sheet with the kids' stats for the appointment.  My oldest went through a chunky stage where her weight and BMI were pretty high.  She's thinned out since then but it was never brought up once by the doctor.  I'm thinking her BMI was in the 80-90% but she was not particularly fat.  She was well within normal limits.  She's built like her father with muscular legs and thicker build.  

She does (or used to-my kids are now teens) talk about healthy food choices but that's the extent of the weight/food discussion.  I would not be discussing BMI with my kids.  They do not need to be concerned with it at all.  

[penguingrrl]

My pediatrician is matter of fact about it at well visits. She tells us what the BMI is and what range it falls in without any commentary or judgement (and over the years my kids have been basically all over the place on BMI, and always very high on height). She also discusses the importance of healthy eating and exercise regardless of where you fall on the chart (because the truth is, everyone needs to eat well as exercise a lot, size is irrelevant to that). I don’t consider any of it fat shaming, I consider it a very small piece of a large puzzle that helps determine overall health, and I do think it’s in her purview to discuss it.

[cabbagecabbage]

I went back to read the OP and, no, I don't think you're describing anything outright inappropriate or unkind. That said, everyone is so quick to point out that pediatricians are doing their job. I agree. However, nobody has mentioned that doctors bring their own biases and are entirely human and studies show that overweight patients are treated differently and poorly and its entirely possible that the doctor approaches your daughter differently than a child with the exact same BMI but with, say, slim parents. If you felt judged or shamed, I'm guessing it was both your own feelings and the subtle attitudes of the doctor at play. Our generation feels so much emotion tied to weight and size but must our children? I really don't know the answer. Is it possible to discuss a kid's weight and for them to feel neutral in their presence? I don't know the answer to that either. I think this interaction is so fraught with tension and emotion that I really don't know what a good version or a best version would look like but I wanted to validate that this isn't a cut and dry thing even when everyone has the best of intentions and I'm sure I'd have lots of huge feelings.

[ginandtonic]

My DD is a gymnast and I actually switched from a male doctor to a female within the same practice because of this.

She's on the short end, but also muscular and solid, so her BMI is high. It's always been brought up, but several years ago, I felt like he wasn't hearing "she's at the gym 10+ hours a week..." Our switch brought us to a female, who happened to have a grown daughter who was a competitive gymnast as well. So she gets it. We still talk about healthy choices, etc. But, physical activity is not a concern (she also swims with a competitive team when she has the time).

She'll be 11 in a couple of weeks and won't have a yearly appointment until at least February (because I'm a slacker), but she's actually barely gained this year, while growing a little taller, so I'm looking forward to BMI being off the radar a little. She's in such a body conscious sport, she doesn't need it any more than she already gets it.

[jinkies]

I just had my daughter's 7-year appointment this morning. She is very big for her age-- 98% for height, 99% for weight.

The doctor did ask about her activity level, and eating habits. She specifically talked about drinking water, and limiting but not eliminating sweets.

I actually thought she handled it pretty well. DD has always been in the upper 90s percentiles, and the doctor has always said that they are more concerned with whether she is moving along a curve, vs. the actual height/weight numbers. This is the first time that her weight has deviated above the curve, so we did have more of a talk but it wasn't presented in a way that I thought was damaging for DD to hear.

I don't think it is bad for the doctor to have this conversation with you and your DD. BUT only you know exactly how the conversation went/what the doctor's tone was. There are definitely good ways and bad ways for doctors to have the conversation.

[formerlyak]

DS in similar percentiles as your DD in height, weight and BMI. Our doctor only cares that he grows on the same curve - a big jump in weight percentile, for example, with no jump in height percentile, would cause concern to him. I did ask about it once and was told that unless they see big jumps or the child is clinically obese, they don't put a ton of stock in BMI. I asked why and the doctor said it is because BMI is determined by a height and weight taken on a given day and there are way more factors than that in determining health. The example he gave was some kids bulk up right before they grow taller - and if you happen to take the height and weight after the bulk up but before growth spurt, of course the kid will have a higher BMI. That is why he cares more about the growth curve over a period of years and that the kid falls within the same band on the growth chart. Every well child visit has included a discussion about physical activity and healthy eating, along with other, age-appropriate taking care of your body information. Last time, the doctor talked a lot about the importance of skincare and sunscreen since DS is a golfer and golfers apparently have one of the highest rates of skin cancer and sun-related skin damage.

[starburst604]

So my DD is only 3.5 but yes her BMI has come up at her last 3 well checks. She's like 60th percentile for height and 97th percentile for weight and has been pretty much since her 18 month checkup. Her BMI shows up as obese and we have "the talk" about diet and activity. I do bristle a bit at the discussion, though I know the doctor is just mentioning it because it's right there on the screen when we are going over her height and weight measurements. I also get that it's her job to discuss it with us because she has no way of knowing if her size is just the way she is, or if she's getting a steady diet of junk food at home. Just as they don't know if kids on the low end of normal weight are eating normally. DH is very tall (6'5") and I'm fairly tall, we both have athletic muscular frames, so chances are DD isn't destined to be petite. My own BMI has always been high normal.

DD is not only very active but she LOVES to be active. Given a choice of anything to do, it's going to be outside either riding her bike or just running. She takes gymnastics and swim lessons and is in FT preschool/daycare with lots of outdoor playtime. Her diet is probably a typical toddler diet - I notice she's more hungry during growth spurts, then there are days where it felt like she barely ate a thing. Some days she loves the healthy offerings, some days she won't touch them. All this to say that I consider myself educated enough about health and nutrition to not worry about her weight at this point, and the doctor agreed that it's likely she will "even out" a bit as she grows taller.

However, if it continues to be a discussion a few years from now, I don't want it discussed in front of DD. I think what I would do is message the doctor through the portal in advance of the appointment and say that I'm happy to discuss her weight/diet if she has concerns, but prefer that she call me after the appointment, at her convenience. I have strong feelings about her overhearing that convo and pulling the wrong things from it. I can remember my pedi talking about things in front of my mom that I probably didn't need to hear or worry about - like I was very slow to hit puberty and he mentioned something about hormone shots which freaked me right the fuck out and caused me to be anxious for months. I ended up growing just fine and it wasn't even necessary.

[revolution]

BMI is talked about at my kids well childs. It's a matter of fact discussion as we go through the whole list of things - height, weight, BMI, sleep, seatbelts, caffeine, eating habits.

While BMI isn't a super great measurment of health, it is a starting point and a talking point about health. My kids are on the low end of the BMI scale, and we still chat about healthy choices and fruits and vegetable habits.

[Leeham Rimes]

We get “the talk” with both boys. X has always been 98th % since he’s been 4 weeks old. He’s super active, never met a sport he didn’t like—I just tell them we eat in moderation and are active.

With Wes he’s a damn stick figure, but that’s just his build. I explain that he’s just picky but eats all the time and is also very active.

Anyway, all that to say our doctors do bring it up in the exam room with them in it but I’ve never felt it was in a negative way, they ask those questions along with “do you own guns, do they go to school, are they doing well, “you’re not drinking full fat milk right?”

Their school does BMI checks as well, so I know I’ll get a note home for x. His is a stocky build. Always has been.

[nessness]

What do you mean that he made a point of addressing it in her presence? Do you typically send your kid elsewhere for part of her appointments?

I get that weight is a sensitive topic for both kids and parents, and that a lot of doctors handle it poorly, but I don't see anything inappropriate about anything the pediatrician said.

[yogapants]

Dec 12, 2018 15:08:18 GMT -5 cabbagecabbage said:

I went back to read the OP and, no, I don't think you're describing anything outright inappropriate or unkind. That said, everyone is so quick to point out that pediatricians are doing their job. I agree. However, nobody has mentioned that doctors bring their own biases and are entirely human and studies show that overweight patients are treated differently and poorly and its entirely possible that the doctor approaches your daughter differently than a child with the exact same BMI but with, say, slim parents. If you felt judged or shamed, I'm guessing it was both your own feelings and the subtle attitudes of the doctor at play. Our generation feels so much emotion tied to weight and size but must our children? I really don't know the answer. Is it possible to discuss a kid's weight and for them to feel neutral in their presence? I don't know the answer to that either. I think this interaction is so fraught with tension and emotion that I really don't know what a good version or a best version would look like but I wanted to validate that this isn't a cut and dry thing even when everyone has the best of intentions and I'm sure I'd have lots of huge feelings.

I'm circling back around to let you know that I really appreciate this response. The interaction is SO fraught for me. I'm working hard to try both to teach my kids healthy and intuitive eating habits and not to teach them that society's idea of beauty is more important than who they are and what they have to offer the world.

[isabel]

Our pediatrician mentioned BMI to us at DS1's last appointment. He made a point to talk about his concerns that his BMI was high. My son sounds pretty similar to your daughter in terms of percentiles. I think he's low 60s for height and mid 70s for weight.

Like you, I do not think my son is overweight. He wears 3T and is moving toward 4T now (he turns 4 in April), so his clothing seems to be age appropriate. I do think he still has a toddler belly, but his arms, legs, and face all look slim and he looks pretty similar to all his peers.

It bothers me that he brought this up and I am trying really hard to be objective. But I am concerned. We focus on talking about which foods are healthy and help us grow vs the ones that don't. That treats are treats because you don't get them everyday. That kind of thing.

This has actually been on my mind because I really don't want him to bring it up in front of DS1 again when it's time for his next well visit. I think at 4 he will be much more aware and, like you, do not want him getting that message directly. I would be bothered by your doctor bringing it up in front of your daughter as well. I wouldn't hesitate to let her know that if she needs to discuss weight/BMI, she needs to ask her to step in the hall or step out with you. That said, if she's just talking about making healthy choices, I think that's fine. It's hard to tell from your post how detailed things got about her BMI.

[cleo29]

My doctor has only mentioned she would be concerned if the height and weight were really out of proportion, so let's say 30th percentile for height and 80th for weight. both of my girls are in the higher end for both, especially K. but i had GD when I was carrying her, so she started out bigger than average, especially in her tummy.

I think this is always a tough subject. and i don't even think healthy habits that we are trying to teach kids now is always about how the world values beauty. Good habits are good habits and eventually, as we age and our metabolisms slow down, having those good habits ingrained in us can only be a good thing. I say that from knowing my own bad habits. Taking the how we look part out and make it about keeping our working body healthy; heart, lungs, joints, etc.