Skim or whole? Milk and weight mythbusting and recommendations

A client recently called to check in about weaning her one-year-old onto milk. (Her child's pediatrician gave what she felt was inadequate and confusing advice about weaning from formula to milk, nor did the doctor address her nutrition and feeding questions. Remember docs often don't have the time or training...)Her pediatrician recommended skim milk. The child's BMI was 70% (stable, steady growth).Another friend who's child is at the 25% was also advised to start on skim mil at 12 months.Both pediatricians stated that skim milk would lessen the chance of developing obesity. Both were wrong, and with possibly dangerous consequences. (Neither asked follow-up questions about intake and feeding otherwise.) Both are following new recommendations to recommend skim milk to children "at risk" for overweight, which some groups include having one overweight parent, regardless of the weight status and health of the child. Seems like some assume that everyone is now "at risk" for getting overweight and are recommending skim milk for all.  Skim milk is not to be recommended willy-nilly. Here's why.

• toddlers need 30-40% calories from fat (Kostyak , National Academy of Science)

• low-fat diets, with skim milk being a primary means to an end, fail nutritionally for small children (Skinner 1997 ADA and Satter 2007)

Little ones are growing. Fat is critical for certain vitamin absorption, brain and nerve development and more...More data on milk and weight: (Hint, the assumption that putting young children on skim milk for BMI reduction doesn't hold up.)

• NHANES: 2006: Cross-sectional analysis of 2-5 yo children reported that neither quantity nor type of milk consumed was associated with BMI.

• Prospective Association between Milk Intake and Adiposity in Preschool-Aged Children Huh S, Rifas-Shiman S, ADA 2010 110 (4) 563-570 conclusion: Neither consuming more dairy products nor switching from whole milk to reduced-fat milk at age 2 years, appears likely to prevent OW (overweight) in early childhood.In fact, the children who drank whole milk had the highest calorie intake and had the lowest BMI!

So, what to do? What did I recommend for my client? Start with whole milk unless there is a VERY compelling reason not to. Then, after about age two, assuming the child has stable growth, a pretty varied intake including sources of fats and protein, let the child transition to drinking the milk you like to drink as a family. I recommend at least 1% milk to include some fat for satiety and nutrient absorption. And remember to include milk into the regular schedule of meals and snacks and water in between. (I liked the milk-boxes for snacks away from home. At 2% fat, they were nice when M wouldn't eat much which was more likely to happen when distracted away from home.)What have you heard from your child's doctor on this?