At my beautiful five year old daughter's check-up, I was informed that her BMI was in the 95th percentile, and that we should see a nutritionist (together). I asked if I go go alone, and they told me that she needs to be there. I'm not sure what to do.
I know a good deal about nutrition. We eat a healthy diet. My daughter doesn't drink juice, doesn't eat processed food beyond the occasional oreo cookie in her lunchbox, and eats a well-balanced diet -- fruits and vegetables, whole grains, poultry and fish. She is definitely active, running around like crazy at the playground and doing organized activities (gymnastics, soccer, and swimming) on the weekends. She has a pot belly and isn't a skinny kid, but does not appear fat -- she's just heavier than she is tall. Her older sister is on the opposite end of the weight charts, and I can't help feeling that the baby just got the wrong end of the genetic stick. My husband was a skinny kid, I was not, and while we are both at a healthy weight as adults, one child takes after each of us.
I thought I would go to the nutritionist just to have a check-in, but friends have counseled me that having a little girl see a nutritionist -- a little girl who is not super skinny -- is just a straight ticket for an eating disorder.
What do you suggest? I feel like we are caught up in the childhood obesity epidemic, and I want to do what is right for my family -- now and in the long term.
From: Alice, Cambridge, MA
Point #1: Let's be clear what we're talking about here. If an overweight child is in the 95 percentile it means she weighs more than 95 percent of children her age. That's a big deal. It's also the cutoff for health practitioners in identifying someone whose trajectory puts them at risk. In other words, she's not at risk now, but, put bluntly, this child could face dramatic medical problems, from heart disease to a shortened life span, not to mention dealing with the social stigma our culture attaches to over-weight children.
Which brings me to Point #2. Knowing about point #1, how could any friend urge you away from any potential help? What kind of friends do you have, anyway? (And why do they have such a negative opinion of nutritionists?)
I asked Michael Leidig, Clinical Director of the Center for Youth Wellness at Floating Hospital For Children at Tufts Medical Center, for his take on your email. He said it's not as if a nutritionist is going to put a 5-year-old on a restrictive diet or make her feel as if she has a problem. "That is," he added, "not if you go to a pediatric nutritionist," a point he stressed in our conversation.
He agreed with your practitioner that you have lots to gain by meeting with a pediatric nutritionist. "Even though it seems like this mom is recounting a relatively healthy diet and that this child is active, maybe there are some things the mom thinks are healthy that aren't. Or maybe the mom needs help with portion size," he said. "This is also not just about one child's eating habits, it's about the family's habits," he said. Especially with young children, the solution is not a regimen that gets foisted on any one individual. It needs to be embraced by everyone in the family.
Leidig is not sure why your practitioner is so adamant that your daughter go with you to the nutritionist. At his Center, a parent often comes alone initially.
"If the child does go," he said, "you want to know beforehand that the focus will be not on the child's weight but on how the family can learn to eat more healthy. And that's exactly how I would bill this to the child before the appointment: 'I want to learn how we can eat the healthiest food possible as a family. You can help me.'"
Since you are questioning your doctor's insistence that your daughter accompany you to the appointment, the best thing to do is pick up the phone and ask him, "Why is this so important?"