Author: Belinda Martin, Accredited Practising Dietitian | PAEDIATRIC NUTRITION
My son is 4 years and 9 months old and he is at kindy. For illustrative purposes, his weight is 23 kg and his height is 116.5 cm. This means his BMI (body mass index; which is weight in kilograms divided by height in centimetres squared) is 16.9 kg/m2. This puts him in the 86th percentile for BMI and in the overweight category for his age. Mmm, well I can assure you he is not overweight – I mean look at him. And interestingly if I measured him just a little bit incorrectly and put his height as 113.5 cm (it is so easy to measure young kids heights incorrectly. Do they ever stand still!), then bam he would have a BMI in the 95% percentile and be in the obese category. Do you see a problem with this scenario?
If you’ve got a kindy kid like me, your child may have had a visit to the school health nurse at school recently and had their BMI checked or weight for height checked. You may have even received a phone call saying that your child has an elevated BMI which puts them in the overweight and/or obese category. The school health nurse might have even discussed strategies with you regarding this. If this has happened to you, how did you feel about it? Well I’d be pretty upset. But hey, don’t shoot the messenger. The school health nurse is just doing her job.
This is one of the governments strategies of tackling overweight and obesity in this country. As a paediatric dietitian, I think this is a terrible approach to this global issue. Yes, we know one in four kids are overweight or obese and Australia is right up there with having the highest obesity rates in the world. There are even studies that show that we can’t recognise when kids are overweight or obese just by looking at them anymore as it is so common. The same studies have shown that even health professionals are unable to recognise an overweight child when they see one. So, I see the need to take drastic measures in tacking this issue but really – BMI screening at school at the age of 4 years? I don’t think so.
There are so many problems with this. A one-off measure does not indicate growth. In fact to assess growth you need at least 3 measurements of weight and height plotted on the growth chart before you come to any conclusions. We also know that growth is not linear. Growth goes up and down. Every child is unique and grows and develops in different ways. Some kids get their weight before their height, or alternatively they shoot up in height, look skinny for a while and then even out. Kids have growth spurts and times of when they aren’t really growing. Taking a one off measure is an inaccurate weight to assess growth, overweight and obesity. Children who are naturally taller than other kids like my 4 year old may also come out as being overweight or obese when they are just in proportion for their size.
We also need to remember that weight is only one aspect of health. You can be healthy at any size. My main concern however is the psychological effect this will have on our young ones and their families. If not handled correctly, we could be creating a bigger problem than what was initially intended. Lets try to tackle overweight and obesity in more of a positive way. Leave measurements and discussions around weight out of the classroom. Growth assessments and discussions regarding a child’s size should happen in a sensitive way with the doctor, paediatric dietitian and other trained health professionals. Try to remember that our beautiful little 4 year olds are always listening and need not to worry about these things. Providing healthy food choices full of variety and colour and giving our kids lots of outside play is what we should be aiming for to encourage a healthy weight.
If you are at all concerned about your child’s growth, come and see us. This is what we are experienced in and we can work with you and your child in a positive way.
About the Author
Belinda Martin is a Perth Dietitian specialising in paediatric nutrition, infant nutrition, allergies and pregnancy nutrition. She is the co-founder of Advanced Dietitians Group and loves working with people and families. She has been a dietitian for 20 years. She has worked as a Senior Dietitian and Paediatric Dietitian in various teaching hospitals in Western Australia and the United Kingdom. When she is not working, she is trying to tame a 4-year-old and a 2-year-old (and a 40+ year old) at home.
About Advanced Dietitians Group
Advanced Dietitians Group was founded in 2014 by Belinda Martin and Ingrid Roche, Perth dietitians with a combination of over 40 years’ experience in the industry. Both dietitians have a range of experience across the lifespan but specialise in paediatric nutrition, pregnancy nutrition, infant nutrition and allergies. They provide up to date evidence-based nutrition advice. This coupled with their wealth of experience in dietetics ensures you get the best possible nutrition service. They get a buzz out of helping their clients and their families.