Your fifteen-year-old has asked you about a weight medication. A friend's older sister is on one, or it came up on a phone, and now she has said it out loud and is watching to see what your face does. You are on a site that offers a household plan, which is why the two options in front of you are these: book her own doctor, or start an evaluation here.
Two things are worth separating before you answer her. Whether fifteen is old enough for this to be a real question, and who is equipped to answer it. Settle those two and you can make the booking and tell her why you made it.
Book her own doctor. Fifteen is not too young for the question — the national recommendation for a young person with a high body mass index opens years earlier than that. What her pediatrician holds and nobody else does is her height and weight plotted since she was small, and at her age one measurement on one day says very little without it.
Whether fifteen is old enough for the question
Fifteen is old enough, and the question opens well before it. Body mass index at her age is not the adult number: it is read as a percentile against other children of her sex and age on the CDC growth charts, and the categories are drawn on that percentile rather than on the figure itself. It is a screening measure rather than a diagnosis, which is worth saying to her before the visit and worth remembering yourself afterwards.
| BMI-for-age percentile | The category it falls in |
|---|---|
| Below the 5th | Underweight |
| 5th to below the 85th | Healthy weight |
| 85th to below the 95th | Overweight |
| 95th or above | Obesity |
Those names describe a band on a chart rather than a person, and it is worth using them that way out loud, because she will take up whichever version she hears from you.
The recommendation built on that percentile is a referral rather than a prescription. The US Preventive Services Task Force advises clinicians to provide or refer children and adolescents six years or older with a high body mass index to comprehensive, intensive behavioral interventions of at least 26 contact hours, and puts about 19.7% of US children and adolescents aged 2 to 19 at or above that percentile. On medicines for this age the same task force found the evidence inadequate to weigh the benefits, which is a gap in the research rather than a finding against them. For a young person 12 or older with obesity, asking a health care professional about the other treatment options is a reasonable thing for a parent to do, and medicines for ages 12 and up are among them.
Her own doctor, or an evaluation online
Her own doctor, because of what the evaluation has to read. Working out whether a young person weighs too much takes in her age, weight, height and BMI-for-age percentile, her overall health, how fast she is growing, whether anything weight-related has already shown up such as high blood pressure or high cholesterol, and the family history of obesity and related conditions.
Two items on that list are the reason the appointment is in person. How fast she is growing is a line across years rather than a number on a day, and it exists only where somebody has been measuring her. Whether her blood pressure or her cholesterol has moved is a cuff and a blood draw. The rest of the list you could type into a form this evening; those two you could not.
The treatment behind that recommendation is also a program rather than a product. Twenty-six contact hours is something a clinician refers her into and a family then keeps turning up to, so it is worth asking who arranges it and what is available near you.
What the first appointment covers
The first appointment covers measurement, history and a conversation. Her height and weight go onto the chart she has been on since she was a baby, and the percentile comes out of that comparison rather than off the scale. The history takes in how she has been growing, what has already shown up in her blood pressure and her cholesterol, and what runs in the family.
Ask who else is involved, because it is rarely one person: a nurse practitioner, a registered dietitian or a weight-control specialist may each be part of what follows. That is also the appointment where the options for a young person 12 or older get named out loud, which is better done with her in the room than reported to her afterwards.
What you tell her beforehand decides whether she goes willingly. The visit is measuring and asking; the number that comes out of it is a screening result rather than a verdict; and she can ask her own questions while she is there.
Telling this apart from an eating disorder starting
Some of what looks like a teenager taking her health seriously is a sign of an eating disorder starting — and if the history in question is your own rather than hers, that is a separate conversation with her doctor and with yours. The signs of bulimia in particular are specific — eating large amounts of food in secret, buying large amounts of food that then disappear right away, going to the bathroom regularly right after meals, and spending a great deal of time exercising — and they are one disorder's signs rather than the whole set, so a daughter who matches none of them is not thereby ruled out. The printed instruction is to contact a health care provider for an appointment if you or your child has symptoms of an eating disorder.
If she is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988, or chat at 988lifeline.org. In a life-threatening situation, call 911.
The booking, and what to tell her
- Book whoever has been measuring her since she was small, and say at the booking that the appointment is about weight, so there is time on the schedule for it.
- Ask for her BMI-for-age percentile and how it has moved over the years, rather than for a number on its own.
- Ask what comprehensive, intensive behavioral treatment is available near you and who makes the referral.
- Ask what her blood pressure and her cholesterol are doing, and what the family history means for her.
- Tell her what the visit involves before she goes, and that she can ask her own questions in it.
- Where any of the eating signs above are already there, say so when you book rather than waiting for the appointment to surface them.
You are not deciding whether she takes anything. You are deciding which door she goes through first, and the pediatrician holding her chart, her growth curve and her examination is the one who can weigh all three. That person can also say no to the whole idea — and a no from someone who has watched her grow is worth more than a yes from anyone who has not. Booking the appointment commits her to nothing. It commits you to finding out.
