Are many kindergarteners already on the road to obesity? That's what a study published in the December issue of Pediatrics finds. Nearly 40 percent of kindergarteners have a body mass index (BMI) in the 75th percentile or above.
According to the Center for Disease Control, childhood obesity rates have tripled over the past three decades, and most people blame our kids' growing girth on a host of sources including eating out, junk food and inactivity. But I have identified a hidden culprit: pediatricians.
Before you get upset, I want to make it perfectly clear that I admire and respect pediatricians, and I think most of them are brilliant and well meaning. And I don't think pediatricians are actively encouraging parents to feed their toddlers high-calorie, junk food. Actually, some of them are, but I'll get to that in a minute.
As a sociologist who helps parents teach their children to eat right, it is clear to me that one of the primary panic points for parents of toddlers is whether their children are consuming enough of the "right" nutrients. Pediatricians unwittingly feed this fear.
The average check-up goes something like this: pediatricians chart height and weight and then ask parents if their toddlers are taking in enough milk, enough fruits, enough protein. In short, when pediatricians talk nutrition, the emphasis is on consumption.
This nutrition mindset prompts parents to push ever more food into their young kids' mouths. In pursuit of target goals that they can't quite pinpoint, the parents I know are never satisfied that their toddlers have consumed enough calcium, enough protein or even enough calories.
The result? Parents are constantly urging their toddlers to eat "two more bites." In fact, "two more bites" is probably the most popular parental mantra out there.
Pediatricians play a more direct role in encouraging overeating when toddlers are underweight. Here are some examples:
Under Par
Even when there are no signs of illness or that a child is failing to thrive, some pediatricians automatically become concerned when a toddler falls into the 5th percentile for weight, even though 5 percent of the population naturally charts in that part of the normal distribution. These pediatricians urge parents to "beef them up."
One client I worked with began feeding her slight toddler ice cream three times per day because her pediatrician had told her to do whatever it took to get more calories into her kid. He didn't care what the food was.
Fare Trade
To treat low-weight children, some pediatricians urge parents to replace foods (even healthy ones) with higher calorie fare.
Another one of my clients, whose low-weight toddler prefers a diet most parents can only dream about -- fruits, vegetables, hummus and water -- was urged by her pediatrician to replace these foods with higher calorie fare. She resisted trading "up" but began feeding her toddler every 30 minutes.
Medical Magic
Some pediatricians prescribe appetite-enhancing medication. And it works. But when parents spend the first few years of their children's lives trying to get their kids to eat more, it's not a coincidence that they have to spend the rest of their kids' lives trying to get them to eat less. Habits learned early in life tend to stick around.
That's what another client found out when her low weight toddler turned into an overeater. Could the appetite enhancing medication her pediatrician prescribed be to blame? Who knows, but five years later this mother continues to wonder.
To be fair to pediatricians, they are steeped in the nutrition culture as much as parents are, and let's face it, part of checking up on a child's development requires pediatricians to enquire about nutrition. There are children whose low weight is an indication of a bigger problem, and feeding interventions are sometimes required.
Still, encouraging parents -- however inadvertently -- to "get nutrients" into their toddlers is misguided. According to the Center for Disease Control, obesity now affects 17 percent of all children and adolescents in the United States. That's close to 1 in 5. Young children are particularly susceptible to being overweight. As the Pediatrics study shows, a lot of young children are dangerously close to the 85th percentile cut-off for being overweight. In light of these statistics we should be cautious about sending the message to feed kids more.
Pediatricians can't solve the obesity problem on their own, but there's one thing they could do that would really help: they could encourage parents to consider habits as much as they consider nutrients.
But habits don't just dictate how toddlers will eat in the long-term. Habits also shape how toddlers eat today. The nutrition approach produces a vicious cycle: parents tolerate the high levels of sugar, salt and fat found in the basic "child-friendly" diet in exchange for getting a few "good" nutrients into their kids. This kind of diet, however, makes kids less tolerant of fruits and vegetables; the foods parents really want their kids to eat. As a consequence, parents resort to a host of techniques to get a few more bites of the good stuff into their kids. The begging, bribing and bartering that ensues, though, also backfires because it teaches kids that vegetables are necessary but yucky.
Parents wouldn't have to resort to the "two more bites" tactic if they thought their toddlers were eating well. Ironically, it's the emphasis on nutrition that produces the problem. It's time to consider the habits we're teaching instead.
© 2011 Dina R. Rose author of the blog "It's Not About Nutrition." Changing the conversation from nutrition to habits.
Thanks for sharing your story.
Dina
I applaud your low sugar approach though - that is great to hear.
I know each kid is different, but I just hope that new moms out there realize that that is probably a bit late to start eating solids.
3catwoman3: I like your decision not to tell parents which percentile for weight their children fall into, but I wonder how parents take it. It sounds like you have a wonderfully sane approach. Sadly, though, I hear all the time from parents whose pediatricians are overly focused on weight gain. Sigh.
Dina
I personally do not approve of telling parents about which percentiles a child is in, as I find it causes undue concern. I think people often confuse percentile with per cent. If you are taking a math test, of course you want a 95 per cent. When it comes to height and/or weight, what matters is overall steady progress for the long term - not occasional little blips on the radar. It is neither necessary nor even important for the height and weight percentiles to match one another, as long as each one progresses in a reasonably stable pattern.
Serving sizes for children over a year of age are quite small - a tablespoon per year of age for each item being served. Young children will often eat well at breakfast, 50/50 for lunch, and by supper time, not interested. Or, a child will devour anything not nailed down all day for one day, and then eat very little for the next several days. Some kids mix up this pattern.
Once kids can get food into their own mouths, the parental job switches from putting the food into the child's motuth to putting small servings of healthy foods on the child's plate, and then standing back and zipping your lip. Don't run mom and dad's made to order restaurant.
However, she's happy and active, and she eats as much as she wants of whatever we put in front of her. I think she's just a slender toddler, and I wonder if the problems with childhood obesity are causing charts to shift. What percentile would she have been a few decades ago?
Much more important than percentile for weight is the trend. If a baby starts out at 35th percentile and stays there, then that's not a problem. If they started at 70 percent and at each visit their percentile drops until they are at 35, then it might indicate a problem.