As a parent or caregiver, you’re not alone if you are wondering how to approach the topic of weight with your child. You may worry about finding a balance where you address issues but don’t create more of them in this sensitive area of health. To get some tips on supporting your child in a path of healthy growth, we spoke with Dr. Cynthia Cohen of Orangetown Pediatrics.
If you see a note about your child’s weight, or if someone mentions it, don’t panic. According to Dr. Cohen, it is meant to be taken as a screening flag, not a judgment or diagnosis. “The word is automatically generated when the chart compares your child's height and weight to other kids the same age and sex, and it tells me one thing: it's worth a closer look. It does not tell me your child is unhealthy, and it does not tell me you did anything wrong,” she says.
Dr. Cohen says that weight is shaped by many factors, including genetics, sleep, stress, family history, what food is accessible, how much time the family has to cook, and time spent sitting. Insufficient sleep is tied to weight changes in kids, so make sure they are getting enough and have a regular bedtime. She says that screen time is important too and affects things in a few ways. It often replaces active play, is paired with snacking, and for older kids, it can cut into sleep. “None of these is the single cause. They stack. When a family wants somewhere practical to start, sleep and screens are often easiest to adjust.”
She adds that “The American Academy of Pediatrics (AAP) recognizes obesity as a complex chronic condition with strong genetic and physiologic contributors. I say this to families often because parents tend to carry guilt about their child's weight, and a lot of that guilt is misplaced. Genetics play a role. It doesn't mean nothing can change. It means we work with the child's biology instead of pretending it isn't there.” She says the best first step is a conversation with your child’s pediatrician about the whole picture.
BMI, or body mass index, is one way your child’s doctor may look at their weight. It is calculated using height and weight to estimate body fat. For adults, BMI is a fixed set of numbers; in children, it’s more about percentiles, says Dr. Cohen. BMI doesn't measure body fat directly, and it can't tell muscle from fat, so a strong, athletic kid can land at a high percentile and be perfectly healthy. That's why a percentile is a starting point, not a conclusion. She emphasizes that it’s more about a pattern over time.
The best way to broach the topic with your child is carefully, and by speaking about health rather than weight. Dr. Cohen advises framing everything around the whole family building healthy habits together, rather than fixing a problem or weight specifically. You can say something like, “We are going to cook more dinners at home” or “How do you feel about a walk together in the evenings?”
Dr. Cohen says: “With kids, I keep the focus on a number of items: how their body feels and works, sleep, energy, and strength, rather than a number on a scale. I'm specific with parents about what not to do, because it matters. Research is clear that weight talk, teasing, and pressure to diet can backfire and raise the risk of disordered eating, and I would never want a visit meant to help a child to end up hurting them.”
Talk with your child about being strong, rested, and energized in their body. Try to avoid trigger words like “fat” or “diet.” Don’t encourage restriction. Try to frame any intervention as encouraging an overall healthy lifestyle. Also, be mindful of how you speak about your own body, as kids pick up on those messages.
Finally, don’t hesitate to reach out to your child’s pediatrician with any questions or concerns. As Dr. Cohen says, “If you're worried, that's exactly what we're here for. Bring it to us, and we'll figure out the right next step together, based on your child and your family.”