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My Adolescent is in the 98th Percentile.
Should I Be Worried?

Your visit with the pediatrician goes well, and at the end you are told, somewhat offhandedly, that your child is in the 98th percentile for weight. Suddenly, your mind starts racing.

Should I be worried?

Do they need to lose weight?

And at what point do we sign up for a weight management program?

Am I a bad parent for this?

If you thought about this, then let me tell you, you are not alone. At most well-child visits, parents often leave feeling anxious and wondering what to do next. Fortunately, in the grander scheme of your child’s health story, a growth chart percentile is really only a piece of information among much more critical data, and in fact usually does not tell the whole story.

What does the 98th percentile mean?

Growth charts compare a child’s growth to the growth of other same-age and sex children.
For example, if your teen is in the 98th percentile for weight, that means they weigh or are as tall than 98% of their peers. What it doesn’t mean is that your child has health problems.

What A Growth Chart Fails to Mention:

Genetics
Muscle mass
Eating habits
Physical activity
Sleep quality
Mental health
Body image
Family history
Clinical markers (lab values and other health data)

Kids, much like all human beings come in different shapes and sizes, and many kids grow along higher percentiles throughout childhood and adolescence.

Do not think about this number only, but rather take things to a larger scale.

Weight Is Just One Piece of Health

The 1st percentile or even the 10th percentile is a number, not a thing of worth but when parents hear it their focus quickly becomes weight focused. However, health is affected by numerous factors beyond body size and the percentile on that chart.

There are a few questions that need further evaluation, for example:

Is my child getting three square meals a day and snacks?
Are they sleeping well?
Are they energetic enough for all the school, sports and activities?
Are they moving in a way they have fun?
What are their lab values and blood pressure like?
In what state is their mental health?

The relationship of a teen with their emotional health and food often reveals much more than a number on a chart.

A Preoccupation with Weight Is a Danger

Almost all parents want the very best for their children. But conversations that are weight-focused can cause honest harm.

Studies indicate that teasing about weight, the promotion of efforts to lose weight and an emphasis on body size are all related with:

Lower self-esteem
Increased body dissatisfaction
Anxiety and depression
Disordered eating behaviors
Binge eating
Chronic dieting

The specifics of the language we use to talk about weight are important.

FIVE THINGS PARENTS SHOULD NEVER SAY ABOUT WEIGHT:

1. "You have to be careful in what you eat."

Although it is usually well-meaning, this often translates to children as, “My body and food intake is wrong in some way.”

Instead, focus on behaviours and fuel.

Try: “Eating a variety of balanced food gives us energy and makes us feel full!”

2. "Do you really need seconds?"

In fact, comments like these can teach children that they cannot trust their hunger.

Kids and teens are growing quickly and are very active that they often need more fuel than adults think they might.

Try: “How hungry do you feel? What is your body telling you?”

3. "If you lose weight, you will be so pretty."

It is a message that links both self-worth and desirability to body size.

They need to hear that they are worth something, no matter what their weight is.

Try to compliment traits like kindness, creativity, grit and determination, leadership and resilience.

4. "I'm worried you'll end up like me."

Parents are often struggling with their own food and body image baggage and pond this on kids desire intentions being good.

Make an effort not to transfer those fears onto your child.

Try to concentrate on building confidence and healthy habits.

5. "Let's put you on a diet."

Dieting in their adolescence increases the risk of disordered eating and potentially inhibits normal growth and development.

Most teens don’t need a diet. They require guidance and accurate information to establish a healthy relationship with food and their body.

When Do Parents Need Professional Help?

If your child is:

Constantly discussing weight or calories
Skipping meals
Avoiding entire food groups
Binge eating
Derogatory about their body
Avoiding going out to socialize because of how they look

Then maybe it’s time to talk to someone.

Partnering with an eating disorder-informed registered dietitian can help families navigate nutrition issues while safeguarding a child’s relationship with food and their body.

A dietitian with training in the pediatric and eating disorder field is able to evaluate growth patterns, eating habits, relevant medical issues and emotional health, enabling them to make specific recommendations
tailored to the individual in a way that promotes long-term well-being.