Transcript Using the Body Mass Index (BMI)-for-age Growth Charts: Provider Assistants

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
Training Objectives

Understand BMI and its importance
for health care providers

Learn how to plot BMI on the
BMI-for-age growth charts
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%
Source: Behavioral Risk Factor Surveillance System, CDC.
≥20
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%
Source: Behavioral Risk Factor Surveillance System, CDC.
≥20
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%
Source: Behavioral Risk Factor Surveillance System, CDC.
≥20
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%
Source: Behavioral Risk Factor Surveillance System, CDC.
≥20
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%
Source: Behavioral Risk Factor Surveillance System, CDC.
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI(*BMI
≥30,
oror~
30lbs
lbs
overweight
5’ 4” person)
30,
~ 30
overweight
for 5’4” for
person)
No Data
<10%
10%–14%
15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
20%–24%
≥25%
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%
Source: Behavioral Risk Factor Surveillance System, CDC.
20%–24%
≥25%
How many…?
Nine Million Kids
are Overweight
2000
2005
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
Black
White
All Races
40%
30%
10%
0%
Hispanic
22.50%
Black
Asian/PI 15.60%
11.90%
not enough data
20%
All
Races
17.90%
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
Asian/PI
Black
White
All Races
40%
30%
20%
10%
0%
Hispanic
26.60%
Black
24.90%
White
17.90%
Asian/PI
11.40%
All
Races
19.20%
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 test
to check for possible overweight; but
alone it is not a diagnostic tool
BMI is Only an Indirect
Measure of Body Fat
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
 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
Example:
95th percentile
tracking
Boys: 2 to 20 years
Age
2 yrs
4 yrs
9 yrs
13 yrs
BMI
BMI
BMI
19.3
17.8
21.0
25.1
Importance of Using
BMI-for-age

Associated with clinical risk factors
for chronic disease including
hyperlipidemia, elevated insulin,
and high blood pressure
CDC
Standardized
Growth Chart
Formula to
calculate
BMI
Percentiles
(5th,10th,25th, 50th,
75th,85th,90th,95th)
Published
May 30, 2000
What is a Percentile?
50th Percentile
85th
5th
95th
Using BMI-for-age
Percentiles to Assess Risk
> 95th percentile
Overweight
85th to < 95th
percentile
Risk of
overweight
< 5th percentile
Underweight
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
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
BMI
BMI-for-age =
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
Practice using
“BMI-for-age” Growth Chart
Pete (3 y)
Gabriella (4 y)
Photos from UC Berkeley Longitudinal Study,
1973
Liz (4 y)
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
Answers: Pete’s “BMI-for-age”
BMI
BMI
Boys: 2 to 20 years
BMI=18.3
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 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
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)

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)