Sudden Weight Gain

Dear Doc, I have noticed sudden weight gain in my daughter who will soon turn 8. Abnormal weight gain started about 2 yrs back and has accelerated over last 12-18 months at the most. Her weight gain was consistent till she was about 6 years of age:
Birth weight 3.45 kilos
At 1 year 9 kilos
At 2 yrs 10 mo. 12.3 kilos
At 3 years 13.3 kilos
At 4 years 15 kilos
At 5 years 17.5 kilos
At 6 years 22 kilos

She is currently 7 years & 9 months old. Her weight is 33 kilos and she is 4 feet 3 inches tall. Though she is chubby overall, her concentrated weight gain is on her belly.

Her appetite I would say is normal for a growing child.

Activity:

She not very active; not into developing sport or playing any active games. However, she goes to dance classes twice a week and does Kathak (Indian classical dance) for couple of hours each day. She also attends gym twice a week.

Doc what you think is the problem; please advise!

Information added by the expert, Ren Chats

Interpretation of given data

33 kg for an 8 years old girl is overweight by all standards.
From the information given by you, following are my observations –

• Predominant Truncal Obesity.

• The weight gain has started sometime after 5 years of age.
The graph on growth chart shows child’s weight gain curve crossing over two major percentile lines and almost touching the 90th percentile at present value. However, the corresponding height is just below 75th percentile.

This indicates discrepancy between weight gain and height gain that demands evaluation if the pattern persists over 12 months.

• BMI:
Her Present BMI dependent on the values submitted is 19.8, which you may be considering to be normal when judged by adult values; but it is not. Please note that children’s BMI need to be plotted on a graph.

Your daughter's BMI of 19.8 when plotted on the graph falls at 93rd percentile for age and sex, which is the highest limit of “overweight”.

BMI percentile of 95 and above is documented as obesity.

You did not upload any growth chart of the child, so I presume that you are not maintaining growth charts. I cannot over emphasis the importance of growth charts in evaluation of child’s growth pattern.

What could be the reason for this sudden weight gain in a child?

There are many reasons for overweight in children.
Click here to read the detailed explaination on whys of childhood obesity.
Here, I will limit myself to your daughter’s case under the limitations of the submitted data.

Activity

The two activities that your daughter is doing though good, are indoors and most probably enforced by you because of her weight gain. Believe me; she takes them as punishment for No fault of hers; they contribute to her poor body image and lower her self-esteem.

Indeed, encourage children to learn new art, but only for fun - you will see better results and not bruise their personality development.

Gym for an 8 years old?
As I understand: It screams your worry for the child's weight gain but is corrosive for child's self-esteem and self-concept: "Her parent does not like her looks!" Remember how depressed Ugly Duckling was?

How about putting on music at home and you dancing with her. - say Bollywood Dances: They are fun, modern, full of activity, easy to manipulate; and an activity that complies with the psyche of a 8 years old girl.

You could even invite her friends intermittently to join the fun and later date organize a little "Bollywood Dance Competition"

Lastly, indoor activities can never substitute for outdoor activities:
It is crucial to develop outdoor sports; they are an asset for life.
Read here to know the Usual barriers to outdoor exercise and how they influence weight gain in children.

What should you do?

• Maintain dietary recall diary for next 6 months:
Each day’s 24-hour dietary recall of each item eaten including fruits, vegetables, and water.

• I will strongly recommend that from now you plot your daughter's monthly weight and height on the growth chart religiously.

Also maintain regular BMI graph. I have uploaded BMI and growth charts on which I evaluated your submitted data for you.

Furthermore, keep a monthly record of her waist size.

• Encourage outdoor games.
Do not ask her to go and play; if parents go out to play, child will naturally follow.

• Minimize television viewing.

• Avoid secondhand tobacco smoke and pollution.

• Minimize medications; only if possible.

• Avoid eating out: Follow healthy eating and healthy meal times
Home cooked food with whole family eating together helps
children's psychological development, diminishes stress, improves communicability with adults in their environment and diminishes chances of excessive weight gain.

• Visit child’s school:
Discuss with teachers and other personnel to find out if there could be any cause for depression or stress in the child.

• Visit your Doctor once now and again after 6 months with all this information:
While fixing appointment make sure that your Doc gives you enough time; if need be book 3 slots.

You will be armed with all the evaluation data, which will help your doctor to take necessary steps.

• Many blood tests may be required: Only after Pediatric consultation
Laboratory testing is guided by detailed history and physical examination findings.
Usual Blood Tests asked in such cases:

i.) Fasting plasma glucose

ii.) Lipid profile

iii.) Blood cholesterol

iv.) Liver function tests

v.) Hormone evaluation as per clinical examination and results of above tests.

• In event of any abnormal findings or any uncertainty, you may be required to consult a Pediatric Endocrinologist.

• To be well equipped before you meet your doctor do read the full article on "Childhood Obesity: Doctor What Could The Reason Be?"

Hope that this helps your daughter and millions of other children and parents around the world suffering from similar dilemma but are hesitant to ask.

If you have any comment or more questions, post them under the "comments". However, I am hoping to soon start a paid portal where one could consult under complete secrecy.

Best wishes!

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