Conversations about weight: A focus on overall health

Contributing Authors:

Kelsee L Halpin, MD, MPH – Pediatric Endocrinology

Talking about your child’s weight may feel uncomfortable or challenging to bring up for a variety of reasons. But what if “weight” wasn’t the main focus of the conversation? While weight and height are important numbers to measure as your child grows, there are many factors that contribute to overall health. As a parent, you can be your child’s greatest advocate and help them form healthy habits at an early age.

What are some reasons kids gain or lose weight?

Changes in weight can result from an imbalance between the energy your child consumes (food) and the energy your child expends (activity or exercise). Energy imbalance can also be impacted by the way the body absorbs food, hormone changes or metabolism (when the body converts food and drink into energy).

However, diet and exercise only explain about half of all weight gain. The other half could be a combination of genetics, the environment and other unknown factors.

When should parents talk about weight with their child?

First and foremost, conversations should be framed around health – not a number on a scale. Start young! Talking to your child about overall health as early as toddlerhood can encourage them to live a healthy lifestyle and have a healthy view of weight.

Don’t ignore a weight concern or assume it will just go away. The younger a child is, the easier it is to establish essential habits that promote healthy weight into adulthood.

When should parents talk about weight with a pediatrician?

It’s important to discuss growth and weight at every well-child visit from infancy through adolescence. Rapid or slow weight gain or weight loss can happen at any age. This is usually reflected by changes in percentiles on a growth chart (how your child’s height and weight compare to other children at their age). Your pediatrician can point out if there’s a concern and help come up with a plan if needed.

Body mass index (BMI) is another measure used to categorize weight as underweight, normal, overweight or obese. BMI tracking begins at 2 years of age. We know that preschoolers who are in the overweight or obese category are 5 times more likely to become obese adults compared to healthy weight children at the same age, so early discussions about weight are important.

Does the conversation change as kids get older?

Young children are naturally happy with their bodies, but as kids grow older, they become more aware of their bodies in relation to others. Children may begin to point out how their body is different, which can present insecurities or body image issues. This is especially relevant during puberty when kids and adolescents begin going through changes at different times. Promoting positive body image and a healthy lifestyle should be an essential part of the conversation as kids grow up.

Discussions about health may also take on a more concrete meaning as kids begin to understand more about health problems that can result from excessive weight gain or weight loss, like diabetes, high blood pressure or eating disorders. At this point, kids may be able to better understand why a healthy weight is so important.

How can parents tactfully approach the conversation?

Parents and families should be a united front and never single out a family member. You might say, “we’re making healthy choices as a family,” instead of drawing attention to a child that is experiencing weight gain or weight loss.

Make sure to avoid terms like “chubby,” “skinny,” “husky” or “scrawny,” which can negatively impact body image. Instead, focus on positive lifestyle changes to promote health, strength, energy, mood boosts and confidence.

What factors contribute to a healthy lifestyle?

There are several factors that contribute to a healthy lifestyle, but here are a few that rise to the top when thinking about overall health. Some of these may also impact each other. For example, if your child didn’t get a good night’s rest, they might have low energy the next day and little interest in being active.

Encourage a healthy intake. Make sure your child is eating “real food” on a regular basis (foods like fruits, vegetables, whole grains, lean meats and cheeses that are not highly processed).
Limit packaged foods and sugary drinks. Kids have plenty of opportunities for exceptions, like birthday or class parties, so try to set a healthy routine at home. Reserve sugary drinks (fruit juice, sports drinks, soda) for treats so kids don’t get used to having them whenever they want.
Pay attention to serving sizes. Think about healthy portions as you serve your family. There’s usually no need to count calories or be excessively restrictive, but pay attention to nutrition labels and follow serving sizes, buy smaller kid-appropriate plates and bowls, use snack bags to prepackage their favorite snacks, avoid children eating straight out of the package (such as a box of cereal or bag of veggie straws).
More activity, less screen time. This might look like bringing your child with you to the grocery store to get them up and moving, taking a 15-minute walk as a family after dinner instead of relaxing on the couch, or establishing a “no electronics” time like during meals or right before bed.
Set a consistent bedtime routine. Practice good sleep hygiene with a consistent bed and wake up time. Avoid electronics at least 1 hour before bedtime. Avoid televisions/phones in the room where your child sleeps. It’s hard for anyone to make healthy choices when they’re tired!
Don’t forget your child’s emotional wellbeing. When your child is stressed or bothered, it is hard to make other positive lifestyle choices. For younger children, setting limits is key. This is not a punishment, but actually provides them with security and knowledge of what they can and cannot do. Be intentional in talking about feelings and emotions with your children to build emotional understanding. As children get older, particularly as they enter puberty, they are under additional stresses and pressures, so make sure you have open communication and treat them with empathy and respect.
Be healthy together. Suggest family walks, hikes, bike rides, a new recipe to try soon, or consider a family garden that children can help plant and pick. As much as possible, eat at the table as a family with no electronics.

How can parents encourage kids to have a healthy mindset when it comes to weight?

Be a role model for your child by modeling a positive relationship with yourself. Avoid making negative comments about how you or other people look. You can also build your child’s confidence by complementing them without focusing on weight – “I love your new hairstyle!” Parents can also place positive reinforcement around health, wellbeing and day-to-day improvements. Finally, there should be zero tolerance for teasing or bullying from anyone in your child’s life.

What is your advice for parents?

Don't be afraid to have these conversations. There’s no scientific evidence that talking about weight with children as a matter of health, in a supportive way, causes any sort of harm (like poor body image or eating issues). Think about weight like you would asthma, or ADHD – these are things you would discuss to ensure your child is healthy. Abnormal weight gain or weight loss is just as important!

Parents can always reach out to their child’s pediatrician to share any concerns. You can even schedule a specific visit to discuss weight and overall health. From there, your pediatrician can determine if other specialists might be needed.

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