What counts as overweight in children?

What is overweight in children?

Overweight in children is a classification on the BMI scale between normal weight and obesity in children. In Swedish paediatric healthcare, iso-BMI — an age- and sex-adjusted BMI measure according to Cole 2000 — is used to determine where a child lies. Overweight is defined as iso-BMI 25–29.9, corresponding to the same threshold as adult BMI 25, translated to the child's age.

A single measurement tells less than the trend in the growth chart. A child whose BMI curve follows their usual centile line is usually healthy, even if the value is in the upper part of the range. What clinicians react to is when the curve breaks its trend and begins to rise more steeply.

How big is the difference compared to obesity?

Overweight and obesity are not the same thing — neither clinically nor in how they are treated. See the difference between overweight and obesity in children for a deeper comparison, but in brief:

• Overweight (iso-BMI 25–30): often manageable with small changes in the family's daily routine, and with support from BVC or the school health service.
• Obesity (iso-BMI 30+): classified as a chronic disease and requires medical care via a paediatric outpatient clinic, BUMM (paediatric and adolescent medical clinic) or specialised obesity units.

Approximately 20–25% of Swedish school-aged children have overweight, and a further ~6–7% have obesity, according to Folkhälsomyndigheten (the Public Health Agency of Sweden).

How do healthcare services assess whether my child has overweight?

At BVC (ages 0–6) and within the school health service, height and weight are routinely measured in preschool class, year 4, year 7–8, and in upper secondary school. Iso-BMI is calculated automatically from the child's height, weight, age and sex. If the value crosses the threshold for overweight, or if the curve starts to rise more steeply than normal, the family is usually contacted for a discussion.

You can obtain an initial estimate yourself using our BMI calculator for children or iso-BMI calculator. The value does not replace a clinical assessment, but provides a reliable indication.

What do you do about overweight in children?

Most important of all: never talk to the child about weight, appearance or "losing weight". Research shows that comments from parents regarding weight and appearance increase the risk of eating disorders and low self-esteem, without improving weight outcomes. Treatment of overweight is directed at the whole family and focuses on routines, not on the individual child's body.

Concrete steps that help most families:

• Regular meals — breakfast, lunch, snack, dinner, evening snack — at roughly the same times every day.
• Water as the primary drink — soft drinks, squash and juice are restricted to weekends or special occasions.
• Capped screen time — particularly sedentary leisure screen time; approximately 1–2 hours per day is a reasonable guideline for school-age children.
• Movement the child actually enjoys — football, dancing, cycling, swimming — at least 60 minutes a day in total.
• Sleep — 9–11 hours for school children; insufficient sleep is an independent risk factor for weight gain.

When should you seek help?

Contact BVC, the school health service or a health centre (vårdcentral) if:

• The BMI curve rises more steeply than before.
• Iso-BMI exceeds 25 and everyday changes are not sufficient.
• Iso-BMI exceeds 30 — this is classified as obesity and the child should be assessed within healthcare.
• There is a family history of obesity, type 2 diabetes or cardiovascular disease.
• You, as a parent or guardian, are worried and would like support.

If an assessment at a BUMM or paediatric outpatient clinic is needed, a referral is made from there. See the pathway through an assessment at BUMM to learn how it works.

Mind your language — for the child's sake

Never tell a child that they are "too fat", "need to lose weight" or need to "go on a diet". Such messages increase the risk of eating disorders and an unhealthy relationship with food and body image — without having any positive effect on weight. Focus on the whole family's habits: the joy of movement, regular meals, sleep. That is where change happens.

Related questions

• What is the difference between overweight and obesity in children?Overweight and obesity are not the same thing — here are the cut-offs, and why the difference matters.
• What should I do if my child is overweight?Is your child overweight? How it is assessed and which practical steps help most families.
• What is childhood obesity?Childhood obesity is an iso-BMI of 30 or higher — a chronic disease that should be treated within healthcare.
• Elevhälsan has called us in about my child's weight — what now?The school nurse has called you in — now what? Here is what the consultation looks like and how to talk to your child about it.

See all questions and answers →