Growing Big: When Health and Self Esteem Collide

When I was growing up, I was big. I'm not sure where exactly I fell in relation to other kids my age, because I rarely went to the doctor. That's what happens when you don't play sports and move every couple years, and thus don't have a good relationship with a doctor. But, I was definitely bigger than most kids. And I got teased for it. Throughout high school, I wore a giant, baggy jacket, because I was so ashamed about my body. As a sophomore in high school, I was asked by another student if I was pregnant. One of my friends desperately wanted me to go to the homecoming dance as a freshman so that I could have a Cinderella moment.

Point being, I know what it's like to have a low self-esteem.

But, as a doctor, I also know the harms of childhood obesity. I've talked about it before. So, I want young girls to get healthy and be at a healthy weight.

Problem is, weight is a very sensitive subject for adolescent girls. I saw a girl in clinic who completely shut down on me, to the point where we got a social worker to come talk to her, because I mentioned she was heavier than was healthy. It's not an easy subject to discuss, and I hate bringing it up, but I do it because it's in their best interest.

Well, a recent study has come out that may affect how I bring up the topic. This study took a group of girls and asked if someone had ever called them 'too fat'. They specifically asked about family members, teachers, and peers. Girls who were labeled as such at age 10 were significantly more likely to be obese at age 19 than those who were not, independent of what weight they started at.

Makes you wonder about all that media that girls consume now, doesn't it? How they are comparing themselves to the size 0 models in magazines, or worse, real women who are photoshopped to be unrealistic in proportions. Or how Ursula and the Queen of Hearts underwent a makeover to make them skinnier.

Yes, obesity is a problem.

But you know what? I was at my healthiest weight when I felt great about myself. It took me a long time to get there--years of affirmation by someone I loved. But I became happier with myself, accepting of myself, and started to walk around with confidence. And those extra pounds melted off.

So maybe the focus should be on body image, and not weight. After all, there is also such a thing as being too skinny.

Growing Big: The Issue of Childhood Obesity

Yes, it's time we talk about that sticky topic: obesity. It's a concern across all of American society, but we as pediatricians are specifically looking to curb childhood obesity, as it increases your chance of being obese as an adult and has its own health risks. Obese children are more likely to have early heart disease than those who are not obese. They are at risk of having bone and joint problems (due both to being obese and due to lack of exercise), and are much more likely to develop type 2 diabetes, a disease that used to be considered an adult-only disease. Obesity can also affect school performance, not only because of the psychological impacts of being obese (teasing, bullying, etc), but also because it can result in sleep apnea, a condition where you stop breathing periodically throughout the night, which can impact the ability to concentrate in school.

Clearly, there are many effects of obesity on health, which is why we care so much about it. But how bad of a problem is obesity, really?

First, let's start by defining obesity.

In adults, it's pretty straight-forward. We take a ratio of your height and your weight, a number referred to as your BMI, and compare it to what we've established as normals. Essentially, under 20 is considered 'underweight', between 20 and 25 is a healthy weight, between 25 and 30 is overweight, and greater than 30 is obese (with greater than 35 being considered morbidly obese). This tool is used because it allows a better comparison between a thin, short woman, to a heavy-set, tall man. However, it's not perfect. Muscle weighs more than fat, so someone could have a favorable body fat percentage, but have an elevated BMI. Still, it is one of the easiest measures we have of body fat, so it is the one used most frequently.

In children, though, the normals are understandably different. A baby is going to have a higher amount of body fat than a teenager should, because they use it for warmth. Also, when kids go through puberty, a lot of things about their body changes, often including their BMI. Kids also often grow taller faster than they grow fatter, so often have BMIs in what we would consider underweight in adults.

So, we use growth charts to help us out. If you've ever seen a pediatrician, you've probably seen these at least once. We have a chart for length (height in standing kids), one for weight, and one for length-vs-weight or BMI, depending on the age (BMI is used for children older than 2). There are growth charts available for children with different disorders, such as Turner's syndrome, Down Syndrome, PKU, etc, that allows us to track a child's growth compared to other children his age.

Thus, when we say a child is obese, we are using a slightly different set of criteria. We use these growth charts and define obesity as anything over the 95th percentile, meaning children who have a higher BMI than 95% of their peers are considered obese. Overweight is defined as a BMI between the 85th and 95th percentiles.

Back to how bad of a problem this really is. In 2011, approximately 8.1% of kids aged 0 to 2 are obese; the rate is higher among girls (11.4% vs 5%). We are, thankfully, seeing a decrease in obesity rates in children under age 2 compared to 2003, but that doesn't mean we are out of the woods yet. Approximately 31.8% of kids aged 2 to 19 were either overweight or obese. That means that 1 in 3 kids is bigger than they should be.

This is better than the adult numbers, where upwards of 60% of adults are overweight or obese, but realistically, I see it as only a matter of time before kids enter that trend, which is why it's so important to establish good habits early in life.