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

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

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

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  1. 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

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

  3. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  4. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  5. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  6. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  7. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  8. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  9. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  10. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  11. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  12. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  13. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  14. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  15. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  16. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  17. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  18. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  19. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  20. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) (*BMI 30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  21. Obesity* Trends Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  22. How many…? Nine Million Kids are Overweight 2000 2005

  23. Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forCity and County of San Francisco 2004BMI for age > 95% for Children 2-4 Years All Races 17.90% not enough data

  24. Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forCity and County of San Francisco 2004BMI for age > 95% for Children 5-19 Years All Races 19.20% White 17.90%

  25. 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 nota diagnostic tool

  26. BMI is Only an Indirect Measure of Body Fat

  27. 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”

  28. 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

  29. Importance of Using BMI-for-age • Associated with clinical risk factors for chronic disease including hyperlipidemia, elevated insulin, and high blood pressure

  30. CDC Standardized Growth Chart Formula to calculate BMI Percentiles (5th,10th,25th, 50th, 75th,85th,90th,95th) Published May 30, 2000

  31. What is a Percentile? 50th Percentile 85th 5th 95th

  32. Using BMI-for-age Percentiles to Assess Risk > 95th percentile Overweight 85th to < 95thRisk of percentile overweight < 5th percentile Underweight

  33. Steps to Plot BMI-for-age • Obtain accurate weight and height measurements • Select the appropriate growth chart • Record the data • Calculate BMI • Plot measurements

  34. BMI BMI Boys: 2 to 20 years BMI BMI • 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 BMI=17 BMI-for-age = 85-94th %tile

  35. 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”

  36. 3. Record Data

  37. 4. Calculate BMI English: Wt (lbs.) ÷Ht (in.) ÷ Ht (in.) x 703 Metric: Wt (kg.) ÷Ht (cm.) ÷ Ht (cm.) x 10,000

  38. 4. Calculate BMI • Use a Pediatric BMI Wheel

  39. 5. Plot Measurements 95th 85th 75th 50th BMI 5th Age

  40. Practice using “BMI-for-age” Growth Chart Pete (3 y) Gabriella (4 y) Liz (4 y) Photos from UC Berkeley Longitudinal Study, 1973

  41. 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

  42. BMI BMI Boys: 2 to 20 years BMI BMI Answers: Pete’s “BMI-for-age” BMI=18.3

  43. Let’s Look at Liz Liz

  44. Liz’s - BMI 17.7 Liz

  45. 2-3-02

  46. Graph Gabriella’s Growth

  47. Gabriella’s BMI

  48. 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

  49. 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)

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