Assessing%20Child%20Growth%20Using%20Body%20Mass%20Index%20(BMI)%20

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Using the Body Mass Index (BMI)-for-age Growth
Charts A Training for Health Care Provider
Assistants
Adapted by the CHDP Bay Area Nutrition
Subcommittee (BANS) from Centers for Disease
Control and Prevention National Center for
Chronic Disease Prevention and Health
Promotion Division of Nutrition and Physical
Activity Maternal and Child Nutrition Branch
January 2006
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Training Objectives

• Understand BMI and its importance for health care
  providers
• Learn how to plot BMI on the BMI-for-age growth
  charts

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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014 1519
2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 25
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How many?
Nine Million Kids are Overweight
2005

• 2000

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Pediatric Nutrition Surveillance System (PedNSS)
Growth Statistics forCity and County of San
Francisco 2004BMI for age gt 95 for Children 2-4
Years
All Races 17.90
not enough data
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Pediatric Nutrition Surveillance System (PedNSS)
Growth Statistics forCity and County of San
Francisco 2004BMI for age gt 95 for Children
5-19 Years
All Races 19.20
White 17.90
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What is BMI?

• A number that compares a childs weight to her
  height
• Body Mass Index (BMI)
• Weight (kg) / Height (m)²
• BMI is an effective SCREENING test to check for
  possible overweight but alone it is not a
  diagnostic tool

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BMI is Only an Indirect Measure of Body Fat
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BMI is Not the Same for Adults and Children

• Adult BMI is evaluated by use of cut-off numbers
  for example BMI gt30 is indicative of adult
  obesity
• The BMI for children is useful only when it is
  plotted on the BMI-for-age Growth Chart

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For Children, BMI Changes with Age
BMI
BMI
Example 95th percentile tracking Age
BMI 2 yrs 19.3 4 yrs 17.8 9 yrs
21.0 13 yrs 25.1
Boys 2 to 20 years
BMI
BMI
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Importance of Using BMI-for-age

• Associated with clinical risk factors for chronic
  disease including hyperlipidemia, elevated
  insulin, and high blood pressure

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CDC Standardized Growth Chart
Formula to calculate BMI
Percentiles (5th,10th,25th, 50th,
75th,85th,90th,95th)
Published May 30, 2000
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What is a Percentile?
50th Percentile
85th
5th
95th
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Using BMI-for-age Percentiles to Assess Risk

• gt 95th percentile Overweight
• 85th to lt 95th Risk of percentile overweight
• lt 5th percentile Underweight

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Steps to Plot BMI-for-age

1. Obtain accurate weight and height measurements
2. Select the appropriate growth chart
3. Record the data
4. Calculate BMI
5. Plot measurements

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• Obtain Accurate Weight and Height Measurements
• Accurate Measurements are Critical

5 year old boy Weight 43.5 lb Height 43
in BMI 16.5 BMI-for-age
75-84th tile Inaccurate height measurement 42.5
in BMI17 BMI-for-age 85-94th tile
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2. Select the Appropriate Growth Chart

• For ages birth to 36 months old
• Length-for-age, and Weight-for-age
• Weight-for-length, and Head Circumference-for-a
  ge
• For ages 2 to 20 years
• Weight-for-age, and Stature-for-age
• Body Mass Index BMI-for-age

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3. Record Data
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4. Calculate BMI
English Wt (lbs.) Ht (in.) Ht (in.) x
703 Metric Wt (kg.) Ht (cm.) Ht (cm.) x
10,000
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4. Calculate BMI

• Use a Pediatric BMI Wheel

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5. Plot Measurements
95th
85th
75th
50th
BMI
5th
Age
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Practice using BMI-for-age Growth Chart
Liz (4 y)
Pete (3 y)
Gabriella (4 y)
Photos from UC Berkeley Longitudinal Study, 1973
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Please Plot Pete Perfectly
Measurements for Pete Age 3 y 3 wks Weight 41
lbs (18.6 kg) Height 39.7 in (100.8 cm) Find
BMI and plot. BMI Wt ( lbs) Ht (in) Ht (in)
x 703
Photo from UC Berkeley Longitudinal Study, 1973
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Answers Petes BMI-for-age
BMI18.3
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Lets Look at Liz
Liz
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Lizs - BMI
17.7
Liz
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2-3-02
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Graph Gabriellas Growth
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Gabriellas BMI
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(No Transcript)
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Please visit www.cdc.gov/growthcharts/

• For additional training materials related to the
  growth charts
• For tools related to the growth charts
• To download the growth charts

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References

• Guidelines for Overweight in Adolescent
  Preventive Services (Am J Clin Nutr
  199459307-316)
• Obesity Evaluation and Treatment Expert
  Committee Recommendations (Pediatrics 1998
  Sept(102)3e 29)
• Assessment of Childhood and Adolescent Obesity
  International Obesity Task Force (Am J Clin Nutr
  1999, 70,suppl)
• Centers for Disease Control and Prevention
  Website (www.cdc.gov/growthcharts)
• American Academy of Pediatrics Policy Statement
  Prevention of Pediatric Overweight and Obesity
  (Pediatrics 2003 Aug (112)2 424-430)