July 19, 2006
FAMILY MEALS FOCUS #14
Interpreting the news and research about feeding and eating

Current research raises alarms about infant antecedents of overweight and puts pressure on health professionals and parents to impose early restriction. FMF #13 discussed taking action without doing harm. This issue explains the meaning of the data from the perspective of normal growth and weight patterns.

Fast-growing infants tend to be big adults Just over 5% of almost 28,000 infants plot at or above the 95th percentile by age 7. Those who grow rapidly as infants are about 1.5 times likelier to reach the 95th percentile.¹ Infants who grow faster during the first week and the first four months tend to be above average in size (>BMI 25) as adults.^2,3

Children of bigger mothers tend to be bigger Until age 2 years, with respect to size, fatness and growth velocities, there are no differences between infants of high-BMI (>30) and low-BMI (<20) mothers. The infants of high-BMI mothers may have eaten more enthusiastically,their sucks per minute were higher.⁴ Children's relatively large size emerges when they are between 3.5 and 6 years of age, when 15% reach BMIs at or above the 85th percentile.⁵

Studies brilliantly describe normal growth As outlined in FMF #11, BMI measures body density, which tracks, not body fat, which doesn't.⁶ Five percent of children normally plot at the 95th percentile and above, 15% at the 85th percentile and above.⁷ Children's growth adjusts over about the first 7 years,large infants of small parents gradually become smaller, and vice versa.⁸ BMI 25 is statistically average for the adult population, BMI 30 is between the 75th and 85th percentile.⁹

Normal growth is defined as abnormal These instructive observations about normal size become ominous when relatively large size is labeled, in accordance with health policy, as overweight or obese and children of relatively large parents are labeled as at risk of obesity (see FMF #11). This pathologizing leaves parents vulnerable to patterns that have been clearly demonstrated to make children fatter: perceiving their child as overweight, being concerned about it, and restricting their child's food intake.^10,11

Some children's weight accelerated rapidly One of the studies broke new ground in following the children's growth longitudinally and identifying a subgroup of four children whose weight rapidly accelerated.⁵ An additional study could examine those four children in detail to determine what disrupted their growth. Evidence-based clinical observations show that leading causes of weight acceleration are food restriction precipitated by misinterpretation of normal growth.

The feeding dynamics approach To avoid misinterpreting normal growth as overweight, the feeding dynamics approach defines normal growth as consistent longitudinal growth at any percentile. To support that consistent growth, the feeding dynamics approach is to optimize feeding from birth and target for clinical intervention only those children whose weight shows abnormal acceleration.

For more information for parents about normal growth and protecting themselves against interference, see Your Child's Weight: Helping Without Harming .

References

1. Stettler N, Zemel BS, Kumanyika S, Stallings VA. Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics. 2002;109:194-199.

2. Stettler N, Kumanyika SK, Katz SH, Zemel BS, Stallings VA. Rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans. Am J Clin Nutr. 2003;77:1374.

3. Stettler N, Stallings VA, Troxel AB, et al. Weight Gain in the First Week of Life and Overweight in Adulthood: A Cohort Study of European American Subjects Fed Infant Formula. Circulation. 2005;111:1897-1903.

4. Stunkard AJ, Berkowitz RI, Schoeller D, Maislin G, Stallings VA. Predictors of body size in the first 2 y of life: a high-risk study of human obesity. Int J Obes Relat Metab Disord. 2004;28:503-13.

5. Berkowitz RI, Stallings VA, Maislin G, Stunkard AJ. Growth of children at high risk of obesity during the first 6 y of life: implications for prevention. Am J Clin Nutr. 2005;81:140-146.

6. Wright CM, Parker L, Lamont D, Craft AW. Implications of childhood obesity for adult health: findings from thousand families cohort study. British Medical Journal. 2001;323(7324):1280-1284.

7. Satter EM; Chapter 10, Understand Your Child's Growth. Your Child's Weight: Helping Without Harming . Madison, WI: Kelcy Press; 2005:323-380 .

8. Falkner F, Tanner JM, Editors; Human Growth. Tanner JM. Growth As a Target-Seeking Function: Catch-Up and Catch-Down Growth in Man. Second Edition ed. New York and London: Plenum; 1986:167-179.

9. Najjar MF, Rowland M; Anthropometric reference data and prevalence of overweight, United States, 1976-80. Vital and Health Statistics, National Center for Health Statistics. Washington, D.C.: U.S. Government Printing Office; 1987;Series 11: No. 238; DHHS Pub. No. (PHS) 87-1688.

10. Faith MS, Berkowitz RI, Stallings VA, Kerns J, Storey M, Stunkard AJ. Parental Feeding Attitudes and Styles and Child Body Mass Index: Prospective Analysis of a Gene-Environment Interaction. Pediatrics. 2004;114:e429-436.

11. Faith MS, Scanlon KS, Birch LL, Francis LA, Sherry B. Parent-Child Feeding Strategies and Their Relationships to Child Eating and Weight Status. Obes Res. 2004;12:1711-1722.

Family Meals Focus by Ellyn Satter, MS, RD, LCSW, BCD. discusses trends, research and clinical issues in eating and feeding and interprets other research from a feeding-dynamics, eating-competence perspective. For past issues of Family Meals Focus, click http://www.ellynsatter.com/$spindb.query.mailinglist.kelcy2 where you'll find an easy sign-up form.