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Assessing Child Growth Using Body Mass Index (BMI) –for-Age Growth by yah17499

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									       Assessing Child Growth Using the
        Body Mass Index (BMI)-for-age
               Growth Charts:

     A Training for Health Care Providers

 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
                         March 2006
BMI-for-age Growth Chart is:
    considered standard practice by the
     American Academy of Pediatrics.
    now required as part of the well-child
     exam for children ages 2 through 19
     by the Child Health and Disability
     Prevention (CHDP) Program.
           Training Objectives
   Understand BMI and how it is useful to
    screen for normal growth

   Learn how to plot BMI on the BMI-for-age
    growth charts

   Learn how to assess a child’s growth using
    BMI-for-age growth charts for early
    identification of childhood overweight
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1985
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1986
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1987
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1988
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1989
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1990
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1991
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1992
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1993
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1994
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1995
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1996
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1997
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%   ≥20


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1998
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%   ≥20


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 1999
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%   ≥20


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 2000
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




    No Data         <10%            10%–14%            15%–19%   ≥20


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity Trends* Among U.S. Adults
                  BRFSS, 2001
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




   No Data          <10%        10%–14%           15%–19%   20%–24%    ≥25%


Source: Behavioral Risk Factor Surveillance System, CDC.
             Obesity Trends* Among U.S. Adults
                        BRFSS, 2002
                           (*BMI 30, or ~ 30 lbs overweight person)
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’4” for 5’ 4” person)




   No Data         <10%          10%–14%           15%–19%       20%–24%         ≥25%


Source: Behavioral Risk Factor Surveillance System, CDC.
       Obesity* Trends Among U.S. Adults
                  BRFSS, 2003
                      (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




   No Data        <10%          10%–14%           15%–19%   20%–24%     ≥25%


Source: Behavioral Risk Factor Surveillance System, CDC.
Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics for
                 City and County of San Francisco 2004
              BMI for age > 95% for Children 2-4 Years

50%
                                                                   Hispanic
                                                                   Asian/PI
40%                                                                Black
                                                                   White
30%                                                                All Races

20%

                                        not enough data
           Hispanic
           22.50%                                           All
10%                             Black                      Races
                      Asian/PI 15.60%                     17.90%
                      11.90%

 0%
Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics for
                 City and County of San Francisco 2004
              BMI for age > 95% for Children 5-19 Years

50%
                                                            Hispanic
40%                                                         Asian/PI
                                                            Black
                                                            White
30%
                                                            All Races
20%        Hispanic
                                  Black
           26.60%
                                 24.90%              All
                                           White
                                                    Races
10%                                       17.90%
                                                   19.20%
                      Asian/PI
                      11.40%

 0%
          What is BMI?

   A number that compares a child’s
    weight to her height

   Body Mass Index (BMI) =
    Weight (kg) / Height (m)²

   BMI is an effective SCREENING
    tool; alone it is not a diagnostic tool
      BMI is Not the Same for
       Adults and Children
   Adult BMI is evaluated by use of cut-off
    numbers; for example BMI >30 is indicative
    of adult obesity

   There are no BMI cut-off numbers for
    children. The BMI number must be plotted on
    the BMI-for-age growth chart

   The BMI for children is useful only when it is
    plotted on the “BMI-for-age Growth Chart”
For Children, BMI Changes with Age
  BMI                         BMI



        Boys: 2 to 20 years
                                    Example:
                                    95th percentile
                                    tracking

                                    Age      BMI
                                    2 yrs    19.3
                                    4 yrs    17.8
                                    9 yrs    21.0
                                    13 yrs   25.1


  BMI                         BMI
Importance of Using BMI-for-age
     Tracking tool for body size starting
      at age 2 years through adulthood

     Only indicator that examines
      weight, stature AND age for a child
      on a single growth chart

     Correlates with clinical risk factors
      for chronic disease including
      hyperlipidemia, elevated insulin,
      and high blood pressure
BMI is Only an Indirect
 Measure of Body Fat
   Using BMI-for-age
Percentiles to Assess Risk
 > 95th percentile   Overweight

 85th to < 95th      Risk of
 percentile          overweight

 < 5th percentile    Underweight
What is a Percentile?

        50th Percentile

                      85th
5th

                             95th
CDC
Standardized
Growth Chart
  Formula to
  calculate
  BMI


  Percentiles
  (5th,10th,25th, 50th,
  75th,85th,90th,95th)



  Published
  May 30, 2000
   Using BMI-for-age
Percentiles to Assess Risk
 > 95th percentile      Overweight?

 85th to < 95th         Risk of
 percentile             overweight?

 < 5th percentile       Underweight?

 Growth acceleration or deceleration
 across 2 percentile lines
What is “Adiposity” Rebound (AR)?

                •A rebound or increase in
                BMI that occurs after it
                reaches its lowest point,
                usually between ages 4 to 6.
                • Normal pattern of growth

BMI
                • An early "adiposity"
                rebound, occurring before
                ages 4 to 6, is associated
                with obesity in adulthood.
Normal “Adiposity”         Early “Adiposity”
    Rebound                    Rebound




BMI                  BMI
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
 6.   Interpret plotted
      measurements
  1. Obtain Accurate Weight and Height
              Measurements
       Accurate Measurements are Critical
BMI                         BMI


                                  5 year old boy
      Boys: 2 to 20 years
                                  Weight: 43.5 lb
                                  Height: 43 in
                                  BMI= 16.5
                                  BMI-for-age =
                                  75-84th %tile
                                  Inaccurate height
                                  measurement: 42.5 in
                                  BMI=17
                                  BMI-for-age =
BMI                         BMI
                                  85-94th %tile
    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-age”

   For ages 2 to 20 years:
     “Weight-for-age,”and “Stature-for-age”
     Body Mass Index “BMI-for-age”
3. Record Data
           4. Calculate BMI

English:
Wt (lbs.) ÷Ht (in.) ÷ Ht (in.) x 703


Metric:
Wt (kg.) ÷Ht (cm.) ÷ Ht (cm.) x 10,000
            4. Calculate BMI
   Use a Pediatric BMI Wheel
      5. Plot Measurements
                   95th

                          85th

                          75th

                          50th


BMI                       5th




             Age
6. Interpret the BMI-for-age Chart

      Need a series of BMI plots to
       determine the growth trend

      If growth deviates from
       expected growth pattern,
       further assessment may be
       needed
             Practice using
      “BMI-for-age” Growth Chart




Pete (3 y)                          Gabriella (4 y)   Liz (4 y)
Photos from UC Berkeley Longitudinal Study,
1973
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, plot, & interpret growth
                                             trend

                                             BMI= Wt ( lbs) ÷ Ht (in) ÷ Ht (in) x 703




Photo from UC Berkeley Longitudinal Study,
1973
Answers: Pete’s “BMI-for-age”
BMI                         BMI
                                  BMI=18.3
      Boys: 2 to 20 years
                                  Interpretation:
                                  • BMI-for-age =
                                  >95th percentile
                                  • Overweight
                                  • Of 100 boys the
                                  same age, more
                                  than 95 have a
                                  lower BMI-for-age
BMI                         BMI
Let’s Look at Liz




         Liz
Liz’s - BMI


              17.7




      Liz
2-3-02
Graph Gabriella’s Growth
Gabriella’s BMI
Please Identify Overweight Children
             on PM160


                     Put comments here
                    ex: overweight,
                    > 95th % BMI
                References
Guidelines for Overweight in Adolescent Preventive
Services (Am J Clin Nutr 1994;59:307-316)

Obesity Evaluation and Treatment: Expert Committee
Recommendations (Pediatrics 1998 Sept;(102)3:e 29)

 Assessment of Childhood and Adolescent Obesity:
International Obesity Task Force (Am J Clin Nutr 1999,
70,suppl)

Centersfor 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)
          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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