Year R weighing and measuring

[AbbyR1973]

Dear All,

So the results are in at our house for the weighing and measuring exercise that takes place in reception year. My letter has measured DS's BMI on the 94th centile and I am told that he is therefore overweight. Actually DS isn't overweight at all, he is of mixed-race white/ Caribbean origin and has very little subcutaneous fat, he h a very muscular body type so you can see every muscle on him.
As a health professional I know not to be worried and to just carry on with our healthy lifestyle consisting of plenty of activity and balanced diet. There are however some parents who would worry about this a great deal and mistakenly believe the result did reflect a genuine overweight picture. As a health professional I am however concerned that letters like these coming out to children with a healthy body habitués make a mockery of a very real issue which is the massively expanding population of obese children in this country which is of very real concern.
I believe that as well as measuring height and weight and calculating BMI we should be measuring waist circumference to provide a more accurate picture for parents. Has anyone else fallen foul of this?

[AuntieStella]

The weighing and measuring programme has been running since the 1940s, and has provided an invaluable data set for health planners.

They use the UK90 BMI reference, and are concerned with overall population. It's only recently that parents were given results, and signposted to where they can get more help if they wish.

[AuntieStella]

Here's an example of the type of report that emerges for the national measuring programme.

[lljkk]

Do different ethnic backgrounds really have such different physiques?

It's got to be a simple screening tool, and even sophisticated ones would generate controversy.

I thought DS was a bit fat but he came home as only 85th percentile BMI. I still think he was a bit fat & did a lot of little steps to redress that. We're white btw, not that I think that's germane. he was just a bit fat. I think I should have been more worried than the letter might have suggested. Is that what you meant?

[NeverKnowinglyUnderstood]

I remember seeing a super channel 4 doc a few years ago, showing the variety of normal healthy shapes and sizes for children. And TBH very few of them aged 5 had spare flesh. heights changed stature etc but level of wobble was more consistent.
It does suprise me when people I know with chubbier children say ah it is just puppy fat, when the child is clearly over weight.

I have no idea what the answer is to be able to get the message to these parents that their window to educate the child about a healthy balance is quite small.

FWIW I was annoyed that no one was interested in talking to me about DS2's weight, he is significantly under weight. and this doesn't seem to be note worthy and yet to me it is just as much of an issue.

[MajaBiene]

Being mixed race doesn't make you weigh more.

I am surprised that a child of 5 would be so muscular that it makes them present as overweight.

[janek]

a child i know went from 'overweight' to 'normal' simply by getting a bit older...

[AbbyR1973]

I agree that the weighing and measuring programme is important and that parents should be given the results so that they can take necessary action including adjusting risky lifestyle factors. As a paediatrician I know this data has contributed to developing British specific growth data.
However I think it is beholden upon us to provide accurate information to parents about their child's weight status and concurrent risks. It clearly makes no difference in our case because I have a level of knowledge but sending out inaccurate information to parents in general risks making a joke of what is in fact a very important exercise. I would favour using a combination of BMI and waist circumference to inform parents.

[AbbyR1973]

DS1 takes after his father. He has a waist circumference below 10th centile despite height 75th centile. His body fat percentage is 5 (measured on bio impedance scales)
I am saying that measuring a combination of factors would give greater accuracy and avoid anomalies like DS.

[AuntieStella]

lljkk

"Do different ethnic backgrounds really have such different physiques?"

Look in the report I linked (pages 17-19): yes, there are differences by ethnicity (something which would not be known if this survey did not exist and have such high participation rates).

[lljkk]

DS had a pretty big tummy, so probably would have finally nudged over into the fat category after all.
But if you had screening that insisted that child must be labeled fat according to both BMI & tummy circumf to be flagged up, then DS wouldn't have been flagged, although he was pretty obviously fat to me (no ribs on view etc).

So I humbly submit that no system would be perfect. Not unless we're all trained to use them bio impedance scales.

[AbbyR1973]

Lijkk- exactly BMI as a pure measure is not ideal.

What we are attempting is do is guesstimate body fat percentage which is the actual risk factor and using BMI as a proxy measure for this. On its own its not ideal in both ways. It will miss some children with a higher body fat percentage and wrongly identify some children with a healthy body fat percentage. No single measure is ideal.

There was an interesting article a year or so ago with a picture of 3 children children which parents were asked to identify by looking which child had the healthy weight. One child was a healthy weight, one child mildly overweight and the other child was overweight. Most parents wrongly identified the mildly overweight child as being a healthy weight because our perception of healthy has changed as children's body fatwas slowly increased across the population as a result of our lifestyles.

Every year there is another newspaper article about a child that has been wrongly labelled as overweight by the weights and measures programme- it risks belittling a very real and very serious problem that I deal with every week in my clinic.

[mrz]

Interestingly the letter will be from another health professional

[Bakingtins]

I don't think they way the information is presented is very helpful. I have a science degree and have done some statistics and find BMI percentage a bit difficult to get my head round, so I imagine many parents are flummoxed by it. It can't be hard for a computer to produce " your child is x cm tall. The healthy weight range for that height is y-z kilos. Your child weighed __ and is therefore underweight/healthy weight/overweight/obese.
I'd be very interested to know how many families where a child is identified as overweight/obese actually do anything about it after receiving a letter?

[AuntieStella]

Informing parents began only in the early 00s as a "value adding" measure, and I don't know why the particular verbiage. Before that, parents simply weren't told.

[lljkk]

How much more confused would average parent be if the information was combined with waist circumference (or any other measure), and they had to process another bit of information to try to understand what it all meant.
Maybe the sensationalistic news coverage is really about numpty parents who can't shrug it off or who like to take offence.

Doesn't the letter state to get in touch with your GP if you need more explanation?

[RaisinBoys]

You can opt out of being notified like 80% of our class did at the time.

Do not know what the state says about my child's weight and height.

Do not care what the state thinks about my child's weight and height.

Social Services have not come knocking so I guess we passed whatever arbitrary measure of normality is employed at present.

[lljkk]

I am sure that the letter says "Your child is heavier than 95% of children the same height and age, therefore we think your child is at high risk of obesity."

Is that really so ill-informed, confusing and patronising?

[stressyBessy22]

MY DDs are both competitive gymnasts training at least 3 times a week plus daily conditioning at home.They are both very muscular but well below 50th centile for BMI.