DEAR DOCTOR,

My three-year-old is quite chubby and my relatives say she’s at risk of becoming overweight and getting diseases like diabetes. What can I do to limit this risk? Are there steps we can take to ensure she stays healthy?

PAM

DEAR PAM, 

Has your baby been overweight since birth or just recently gained a lot of weight? Is she active as per her age, is she achieving age related mile stones in time? 

A child may be chubby as a baby, but starts to lose "puppy fat” by the age of 12 months or so. This happens because the growth rate of the body is slightly slowed down at this time, as compared to a small baby. 

Bigger babies are also considered to be healthier, stronger and less vulnerable to infections. A seemingly obese toddler may not necessarily become an obese adult.  Recent studies also suggest that after growing up, bigger babies may lead longer, more disease free life.  Just looking chubby does not mean that a child is overweight. Her body mass index (BMI) needs to be worked up, which depends on age, gender, height and weight.  More precisely, as per World Health Organization, if a child’s BMI percentile falls between 5 to 85 they are considered healthy. At 85th percentile or more, the child is overweight. At 95th percentile, she is definitely obese.   

There are multiple reasons for a child to be obese; genetic factors, lack of any physical activity, hormonal disorders like diabetes, adrenal gland or thyroid disorders, drugs like steroids, lack of receiving breast feeds in infancy, and eating junk (high calorie) foods. But once any of these existing disorders is corrected, the growing child can revert to normal weight. Even a small child who is genetically prone to obesity may maintain a normal body weight during growing years.  Even as an adult, if she follows correct diet and is active physically, she may not become obese.  

If your child is taking feeds regularly, sleeps well, is not irritable, not lethargic, is active physically, as per her age, she is healthy. Therefore, there is nothing to worry about. As she grows older, she will shed the extra fat and look slimmer. However, if she persistently gains weight, becomes too large, seems lethargic and is not very active, she should be taken to a paediatrician.

To prevent obesity, give the child more fresh vegetables, fruits, whole grains and healthy meat products. Avoid junk foods, ready to eat fast foods, white sugar, and sugary snacks. Discourage snacking between meals, encourage her to take healthy low calorie snacks. Also encourage the child to be active physically. 

Dr. Rachna Pande is a specialist in internal medicine

rachna212002@yahoo.co.uk