Pre-schoolers are being wrongly labelled as overweight and obese, which could be setting them up for a fatter future.
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New research published today in the New Zealand Medical Journal criticised the use of the Body Mass Index in Before School Checks as inaccurate and potentially harmful.
Before School Checks are designed to pick up any problems before children start school, but dietician Lucy Carey's research suggested it could be doing more harm than good in one respect.
Studies have shown the Body Mass Index (BMI) can be hugely inaccurate for individual children, wrongly classifying them as overweight, or obese.
"When parents are concerned a child is overweight, they're more likely to restrict food for that child," she said.
"You probably know, if you've ever been on a restrictive diet yourself, that you feel deprived and you seek out food more, and you almost become obsessed with food.
"And it's likely something like that is happening in children. It's actually causing them to gain more weight over time."
Ms Carey said BMI is even more problematic for some ethnicities, in that it doesn't take different body shapes into consideration.
"Māori and Pasifika populations tend to be taller, and have more muscle. It's quite flawed in that if you're too tall and have a higher muscle to fat ratio, it overestimates how fat you are."
Ms Carey wants to see BMI removed completely from the before school check.
In its place, she wants a more nuanced approach, such as talking with parents about the importance of adequate sleep, monitoring screen time, and home cooked meals.
Paediatrician Dr Yvonne Anderson says BMI - while imperfect - is probably still the best measure available, and because of the country's high levels of child obesity, early intervention and weight measuring shouldn't be removed.
Dr Yvonne Anderson Photo: Supplied
"We have to balance the fact that we have slightly imperfect measures, with the absolute importance of identifying these children," she said.
"And addressing their weight-related health issues, and also trying to start that korero around healthy lifestyle change."
But she agreed the conversation around it needs to change.
"The talk about healthy lifestyle change and how to make that persistent, and actually stopping using words like obesity, diet, and weight loss.
"Because I think they're simply not helping in that korero around healthy lifestyle change," Dr Anderson said.
Plunket's Clinical Services Manager Sophie Woodger said they are already trying to have such discussions.
"Our staff receive extensive training on how to use that conversation in a way that is easy to understand for the family," she said.
"And it's more about communicating what we're going to do going forward, rather than affixing labels."
But mother of two, Jo Caudwell, said her friend had one such experience.
"They've suggested maybe that their child was looking slightly overweight. She took quite a lot of offence to that and thought it was ridiculous."
New Zealand has the second highest rate of child obesity among OECD countries after the United States.
The Well Child Tamariki Ora programme, including the Before School Check, is currently under review, which will include a focus on dealing with obesity.