Many mothers with obese children have a distorted perception of their child’s body size, recent studies have shown. 1 Researchers say this phenomenon is most prevalent among low-income women and Hispanic mothers who often desire their children to be larger still. 2 

But it seems that whenever I discuss biometrics with my patients — whether it be height and weight, height for weight or BMI — everyone argues with me, regardless of their race/ethnicity or socioeconomic background.

This happens so often, that I find myself asking, “Is obese the new normal?” And I’m not the only one. The Institute of Medicine has proposed that the obesity epidemic is eroding the general impression of what healthy looks like, Reuters reports.3

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Many parents I see comment that their normal weight 4 or 5 year old is “so thin!” I then have to explain that a BMI of 15 is healthy for this age group, but may seem thin compared with what they are used to seeing.

In 2011, 17% of children in the U.S. were obese, and even more were overweight. This change has taken place during the past 30 years, a time-period that most childbearing women have lived through, so it is no surprise these patients have a distorted sense of normal.

It may take another 30 years to reverse the obesity epidemic, but if we focus on prevention, we can change this trend. And there is no better time to start than now.

In fact the importance of starting early, cannot be overstated. Did you know that infants who are exclusively breastfed and are at the top of the growth chart for weight have a lower risk for obesity later in childhood, whereas those who are fed formula, or “los dos” (fed with both breast milk and formula as a supplement), are at increased risk for obesity later in childhood?

Overweight or obese toddlers are likely to be overweight children, and overweight children are more likely to be overweight adults.

Self-regulation of hunger and understanding satiety is the most important thing parents and caretakers can teach their children. This concept is one of the advantages of breastfeeding. Have you ever tried to get a baby to nurse who is full and doesn’t want to? It’s difficult.

On the other hand, most infants will swallow the milk that flows easily from a bottle rather than choke on it. They quickly learn that their own feelings of fullness do not matter, and that the feeding only stops when the bottle leaves. 

Teach your patients who are new parents to watch carefully for cues that their infants and toddlers are full. This will help them enable their children to take charge of this important self-regulatory function early in life.

Yes, there is more to combating the obesity problem than starting early, but if an infant’s only cue to eat is that food is present, he or she is already losing the battle for a healthy weight and future.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.


  1. Hager E et al. “Maternal perceptions of toddler body size: Accuracy and satisfaction differ by toddler weight status.” Arch Pediatr Adolesc Med. 2012;166(5):417.
  2. Woroby J, Lopez MI. “Perceptions and preferences for infant body size by low-income mothers.” J Reprod Infant Psychol. 2006; 23(4): 303-308.
  3. Begley, Sharon. “Obesity fight must shift personal blame – U.S. Panel.” Reuters. Thompson Reuters, 8 May 2012.
  4. Centers for Disease Control and Prevention. NCHS Data on Obesity – Fact Sheets.