The Pediatric BMI

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The NHLBI Guidelines for adult weight loss of 1 to 2 lb per week with a goal of 10% weight loss over 6 months are clear [50]: create a caloric deficit of 300 to 500 calories per day (unless the patient is extremely obese), monitor either weekly or monthly weight loss, and plot the patient's progress towards the 10% goal. In reality, the process is much more difficult. Pediatric treatment for overweight and obese children and adolescents is even more difficult than treating adults. There are no randomized controlled trials to give specific advice regarding total weight

CDC Growth Charts: United States

Body mass index-for-age percentiles

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kg/m2

kg/m2

Age (years)

Boys 2 to 20 years

Age (years)

Boys 2 to 20 years

Figure 5.2. Boys' BMI chart. BMI equals weight in kilograms divided by the square of the height in meters, or weight in pounds times 703 and divided by the square of the height in inches. (Reprinted from the Centers for Disease Control and Prevention website [7].)

loss over a period of time or suggestions for a daily caloric deficit or weekly weight loss. Because of the tremendous developmental and growth changes children and adolescents experience, the specific guidance that can apply to almost every adult may never be forthcoming for the pediatric population.

The one obesity tool that does consider the uniqueness of growth and development is the pediatric BMI plotted against gender- and age-specific charts (Figures 5.2 and 5.3). Calculation of pediatric BMI is the same as for adults. Take the patient's weight in pounds divided twice by the height in inches and multiply

CDC Growth Charts: United States

Age (years)

Girls 2 to 20 years

Figure 5.3. Girls' BMI chart. (Reprinted from the Centers for Disease Control and Prevention website [7].)

Age (years)

Girls 2 to 20 years

Figure 5.3. Girls' BMI chart. (Reprinted from the Centers for Disease Control and Prevention website [7].)

that value by 703. For adults, normal, overweight, or obese are defined by the BMI. In contrast, for children the weight category is defined by plotting the BMI against the 95th percentile for gender and age. For example, for an adult a BMI of 22 indicates a normal weight. This is not the case for children when plotting a 22 on the pediatric BMI growth chart. For example, an 8-year-old boy with a BMI of 22 is obese. At age 11 with the same BMI he would still be overweight, but at age 15 a BMI of 22 is normal for his age and gender.

Understanding that a child's BMI can remain the same while the child goes from being obese to overweight to normal weight reflects how developing children can grow into their weight over time. Using the BMI chart, the physician can show parents that the goal over time is to maintain the child's current BMI through the different growth spurts. This approach helps to discourage parents who want their child to lose weight at a time in their physical development when they naturally will increase in physical size. This approach is helpful when dealing with overweight pre-adolescent children. The physician should show the parents where their child is on the chart and how their child's weight should be tracking moving into adolescence. During this time the physician can introduce to the parents the AAP recommendations of promoting structured and unstructured physical activity, eating more fruits and vegetables, and limiting sedentary activity. Partnering with the parents, the patient's BMI can be used semiannually as a way for the physician to reinforce positive health behavior changes for both the child and for the parents who are role models who still have significant control over the child's dietary and physical activity choices.

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