Do We Need to Measure Body Fat in Children?

Children 3Because I am a member of the Academy of Nutrition and Dietetics (AND) as well as the Weight Management Practice Group, I receive regular emails and updates from them, many very informative. But this week I was floored by one that advertised this: “Join us for our November Pediatric Weight Management Webinar: Measuring adiposity in children – what’s the best method? 

Really? OK, is it me, or is this crazy? Am I missing something? To make it clear, I am not referring to evaluating body fat to determine level of malnutrition. I was fortunate to receive training from the hospital where I work in diagnosing malnutrition based on different criteria. It is the thought of using various methods to determine body fat in children that you already know you are going to treat for “obesity”. Yes, I get it, those people who equate perfect weight with perfect health. The whole “obesity epidemic” and those who worry about kids health because of this (as if weight alone or even body fat is the cause of disease, it is not). When I worked full time at an outpatient children’s hospital, yes, there were children with pre-diabetes and hyperinsulinemia or Nonalcoholic steatohepatitis (NASH) who had gained too much weight (according to their individual growth charts, they had veered off which was not normal for them). But focusing on the body composition of a child like this does nothing but continue to label and villainize the poor child even more. The problem is inevitably not the weight, it is the lifestyle change that led to the abnormal (key word=abnormal) weight gain. You cannot, I repeat cannot know if a child’s weight is “normal” or not just by looking at them. Or weighing them.You absolutely need to see their growth chart.

I have ranted on and on about reasons I am not a fan of BMI (Body Mass Index, determined by calculating out a number based on weight and height). Just as a reminder, this number is meaningless when it comes to measuring muscle mass verses fat mass or even water weight so that athletes who tend to be heavier due to all that muscle often have BMI’s in the “obese” range. I am sure I have told the story that always sticks in my mind of the little boy who was about 10 years old and referred to us for “obesity”. How I went to the waiting room to find a very fit looking young man with a very worried look on his face. How when I asked his mom what brought them here, he blurted out “I have obesity. Am I going to die?!” It absolutely broke my heart. I just came out and told him (after looking at his growth chart and seeing that he had been plotting along a certain percentile for weight and height since he was an infant) that his doctor made a mistake. “Your doctor must have forgotten to look at your growth chart! You are fine!” Phew. He literally wiped his forehead as if he just escaped a close call. Come to find out, he was an athlete and very competitive in more than one sport, and he was as healthy as any kid could be. BMI, obesity, see why I hate the terms?

Anyway, after looking into the research a bit, it seems we are more obsessed with getting the “numbers” right instead of figuring out how to actually help people. I was trained decades ago to use the triceps skin-fold method of determining body fat. I hated it because I never felt I could get it right (“am I pulling out muscle or skin or fat? this doesn’t feel right”). Maybe it is just me, but I just never felt confident in it (and have never used it). There are other methods to determine body fat, and I am guessing many people have seen (or own) those scales that supposedly can tell your body fat in addition to the force of gravity on your body. I remember my son telling me back when he was a high school athlete that he was 80 percent fat because his friend’s mother’s scale said so. I just laughed and thankfully he just shrugged it off because it was blatantly inaccurate. But still, I am imagining a lot of people believe those scales and are thrown into a self-deprecating tizzy every morning. But according to that upcoming webinar, we dietitian’s and other health care professionals should be not only paying attention to body fat but learning the best way to measure it.

So now all I can imagine is adding one more invasive scary thing to an already traumatized and singled out chubby kid. It is bad enough to be openly labeled by your trusted pediatrician but then to have someone pulling and squeezing calipers on your body, or measuring your waist or running a weak electric current through you to see how fat you are because we don’t already know by your weight or BMI we just figured out, no,we need to do a few more things to your poor innocent body to see just how horrible you really are. Oh, and at the end of your visit, don’t you feel like going home and eating your vegetables?

OK, I get it, and we all know that a certain kind of body fat is more dangerous. And it is not the fat on our thighs…. for a good explanation as to why experts are concerned, see this article Body fat Types. While we can’t ignore the fact that increasing visceral fat does affect our health, I just don’t get why we need to measure it because in the end, aren’t we still going to have to figure out how to help people? Does it really help to tell someone what percentage body fat they have? And when it comes to children, why on earth do we need to subject them to anything like this? If we are talking about your otherwise healthy child going to the pediatrician’s office for a yearly visit, if BMI is useless, why would this add anything helpful at all? In the end, it boils down to what kind of lifestyle a parent is able to provide for their child. Right? I understand time is very limited at the doctor’s office, and they really need to cover a lot. I have heard the stories, and that is what affects my opinion. From what I hear from parents, most doctors really don’t have time to get the details of what their barriers are as far as achieving a healthy lifestyle. So they just have to resort to handing out the typical advice: Don’t buy soda. Limit juice to once a day. Limit screen time to 2 hours or less. Get 60 minutes of physical activity. Make half your plate vegetables and fruit. Eat at the table. Have family meals. Well, that is great if you have the means and ways to achieve these goals. But lots of families I know just can’t do this. They may not have the income to afford those veggies and fruits and that giant jar of chip/Cheetos/pretzel mix for a few dollars at Walmart will feed your 3 children for longer than 3 apples. Maybe grandma is watching your children after school in a neighborhood where you can’t safely go for a 60 minute walk, and so video games really come in handy. Does your pediatrician ask about these things? The good news, at least in Connecticut, is that some pediatricians are hiring dietitians who actually do have the time to find out all the details of a family’s life and who then can help with the barriers. Yes, these doctors must understand that achieving a healthy lifestyle is more complicated that the healthcare experts think. We are not all created equal and our lives and resources are not the same.

That is why I keep hoping the madness will stop. We will eventually get it that focusing on BMI is not helpful at all. Did I get it wrong, or didn’t the American Academy of Pediatrics just come out with the paper on focusing on health and NOT weight loss? I shared it a few posts ago. I was happy. So then why am I getting these emails about measuring body fat in children? Even if we figured out a way to accurately and in a noninvasive way know what a child’s body fat was….would it change our intervention? Aren’t we supposed to just be focusing on promoting health? Then how can this help?

Frankly, I don’t care what someone’s body fat is. I want to help people be healthier. Whether someone has a lot of the dangerous kind of fat, or the other kind of fat, or no concerns about fat at all. I think we all could benefit from doing all the things we can to be healthier. More sleep, less screen time, less stress, more family meals, more fruits and vegetables, less McDonald’s, more water, more fun movement…..more sanity.

I won’t be attending that webinar. No offense, dietitians, I know the intentions are good. I know the goal is not to humiliate children, and we all say we need to focus on families and parenting, but from my experience, kids are smarter than you think. If you talk about their BMI and then start pinching their arms with calipers, they will get the message, no matter what you say or how you say it. Is it really necessary?

I say no. How about handing out free hula hoops? Now that sounds like progress….compared to calipers.

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