Labeling overweight children as obese

by Ellyn Satter, Registered Dietitian and Family Therapist

Don’t let your child be labeled overweight or obese. Childhood overweight/obese designations have become even more harmful than before: Over 85th percentile is “overweight.” Over 95th percentile is “obese.” Parents often refuse to accept these labels for their children. From the Satter Feeding Dynamics Model (fdSatter) perspective, their reluctance is well-founded, as many large children’s size is simply normal. However, if a child’s weight shows abnormal acceleration at any percentile level, there is a potential problem that needs to be addressed. 

BMI cutoffs are misused

This slippage grew out of a January, 2007 Committee Statement and recommendation¹ and was made official by a National Health Statistics report.² To its credit, NHS authors temporize about the legitimacy of such designations. Less than half of ”obese” children (those with BMI ≥ 95) have a high percentage of body fat. Moreover, the consensus in the literature is that it is difficult to come up with any definition of child overweight or obesity.² The problem arises from the manner in which those terms – and definitions – are used. However the BMI levels are labeled, they are statistical cutoff points established for the purpose of population-wide evaluation. As such, they are not appropriate for diagnosis of individual children. Despite the shortcomings of the definition, that is exactly the way they are used. Little wonder that parents are unwilling to accept and act on a weight-related diagnosis for their child.³

The real problem is weight acceleration 

Labeling children overweight or obese makes them feel flawed: not smart, not physically capable, and not good about themselves.

To remind you, fdSatter says that the issue with weight not high weight per se, but weight acceleration: Abnormal upward weight divergence for the individual child. Such divergence gives a clue to distortions in feeding. Those distortions can be corrected by instituting a division of responsibility and feeding optimally throughout the child’s growing-up years.⁴ The whole issue of whether or not the child is overweight can responsibly be side-stepped – it really isn’t important. What is important is helping parents do a good job with feeding and letting the child grow up to be the weight that is right for him or her.

Labels harm children and parents

• Children who are labeled overweight feel flawed in every way: not smart, not physically capable and not good about themselves.⁵ How much worse is it for children labeled obese?
• Parents who are concerned about child overweight or have anti-fat attitudes are likely to restrict children’s food intake.⁶ Parental feeding restriction is associated with increased child food intake and higher child body weight.⁷  How much greater will parental tendencies and child weight gain be if children are labeled obese?
• Controlling for child weight, increased child BMI z scores over several years correlate strongly with parents’ concern about child weight and perceived child overweight.⁸ How much more will BMIs accelerate if children are labeled obese?
• Children whose food has been restricted have an increased likelihood of restricting themselves as they get older. Currently, at least two-thirds of adolescent boys and girls restrict their food intake to lose weight.⁹ How many more adolescents will diet if they are labeled obese in earlier life?
• Such dieting is as counterproductive for adolescents as for younger children. Controlling for beginning weight, adolescents who diet by either healthful or unhealthful means are heavier five years later than adolescents who do not diet.¹⁰ What would those adolescents have weighed if they had been fed well, given opportunities to be active, and allowed to develop—and value—the bodies that nature intended for them?