An Australian obesity expert has slammed the current fixation with “ideal” weight ranges, which he warns is driving poor advice that includes putting children – and even babies – on diets.
Obesity expert Dr Nick Fuller said he’s seen parents with children as young as six months old being told to restrict their baby’s food intake because they are too high on weight-for-age charts.
“Unfortunately, healthcare professionals are often getting it wrong when it comes to our children’s weight,” said Fuller, of the University of Sydney’s Charles Perkins Centre.
“They rely too heavily on weight-for-age charts. And when a child is not falling within the ideal weight-for-age range, they’re prescribing diets and advising food restriction. This is incorrect and damaging advice.”
In fact, he told Sydney Morning Herald, such advice may be contributing to the increasing number of children he sees in clinic with obesity, as well as type 2 diabetes and other metabolic disorders.
Though obesity, nutrition and weight management are complex sciences, few healthcare professionals have adequate training in these areas.
“It’s a very small part of their tertiary education, but it’s such an important part of shaping a child’s trajectory when it comes to health and weight,” he said.
“For decades, we’ve been brainwashed to think that if we’re not in a healthy weight range, we must restrict and diet. It’s doing nothing more than contributing to the problem it proclaims to solve.”
Weight will come down when energy intake is restricted, but as the body’s systems slow to try to conserve energy, there is “a cascade of physiological responses” and the body rebounds to its former size.
Restriction and diets also mess around with children’s innate ability to regulate their appetite, Fuller said.
Dr Terri-Lynne South, chair of obesity management for the Royal Australian College of General Practitioners, agreed, saying “we’re far too focused on healthy weight ranges”, and that the “additional dangers” of a restrictive dieting mentality include a lifetime of poor body image and eating behaviours.
She said children grow and develop at different rates, that some may carry extra fat before a growth spurt, and that youngsters can be petite or bigger and still healthy, despite sitting at opposite ends of the graph. She uses the analogy that humans are different shapes and sizes, just like different dog breeds.
“So you’ve got your little chihuahuas, you’ve got your bull mastiffs; you’ve got your Great Danes, you’ve got whippets,” she said.
“You can’t help your genetics. It’s really about being the healthiest Great Dane or the healthiest chihuahua or the healthiest whippet you can be.”
Professor Louise Baur, a paediatrician and child obesity expert, said monitoring a child’s weight can detect failure to thrive and is an indicator of health, but interpretation is important.
“It’s not the actual value that’s important, it’s the trajectory over time,” she pointed out. “You want to see children following percentile lines.”
Parents are often told to restrict fruit, as well as dairy and carbohydrates because they’ve been told they are fattening, said Fuller, whose new book, Healthy Parents, Healthy Kids, debunks nutrition myths and provides six foundations for raising healthy children.
“It’s madness…If they want to eat six mandarins, that’s perfectly fine. They have naturally occurring sugars, and fruit is full of fibre and nutrients that fill them up.”
And, provided parents offer mostly whole foods, including fruit, dairy and carbohydrates, children are extremely good at regulating their appetite.
“Some days they’re going to have huge amounts of food and the next day they’ll eat a small amount to compensate,” he said, adding that there is no need to restrict their food intake, although not eating for an hour or two before a main meal was a good rule of thumb.
If, however, parents provide mostly ultra-processed foods which are hyper-palatable but have very little fibre and nutritional value, then the child’s hedonic pathway overrides their brain’s ability to regulate appetite.
A quarter of Australian children are overweight and almost one in eight are obese. Most children who are overweight or obese will continue to be so in adulthood.
If a child continually tracks in the overweight or obesity range, then the habits in the home need to re-evaluated.
“But we should never be focusing on a child’s weight,” Fuller said. “That should never be the goal.”
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