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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

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Slide1 l.jpg

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 l.jpg
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.


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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 l.jpg

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1986 l.jpg

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1987 l.jpg

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1988 l.jpg

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1989 l.jpg

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1990 l.jpg

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1991 l.jpg

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1992 l.jpg

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1993 l.jpg

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1994 l.jpg

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1995 l.jpg

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1996 l.jpg

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity trends among u s adults brfss 1997 l.jpg

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)


Obesity trends among u s adults brfss 1998 l.jpg

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)


Obesity trends among u s adults brfss 1999 l.jpg

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)


Obesity trends among u s adults brfss 2000 l.jpg

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)


Obesity trends among u s adults brfss 2001 l.jpg
Obesity Trends* Among U.S. Adults ≥20BRFSS, 2001

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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


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Obesity Trends* Among U.S. Adults ≥20BRFSS, 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%


Obesity trends among u s adults brfss 2003 l.jpg
Obesity* Trends Among U.S. Adults ≥20BRFSS, 2003

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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


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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


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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%


What is bmi l.jpg
What is BMI? Statistics for

  • 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 nota diagnostic tool


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BMI is Not the Same for Adults and Children Statistics for

  • 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”


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For Children, BMI Changes with Age Statistics for

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 Statistics for

  • 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



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Using BMI-for-age Percentiles to Assess Risk Statistics for

> 95th percentile Overweight

85th to < 95thRisk of percentile overweight

< 5th percentile Underweight


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What is a Percentile? Statistics for

50th Percentile

85th

5th

95th


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CDC Statistics forStandardized Growth Chart

Formula to calculate BMI

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

Published May 30, 2000


Slide33 l.jpg

Using BMI-for-age Percentiles to Assess Risk Statistics for

> 95th percentile Overweight?

85th to < 95thRisk of percentile overweight?

< 5th percentile Underweight?

Growth acceleration or deceleration across 2 percentile lines


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What is “Adiposity” Rebound (AR)? Statistics for

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

  • Normal pattern of growth

  • An early "adiposity" rebound, occurring before ages 4 to 6, is associated with obesity in adulthood.

BMI


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Normal “Adiposity” Rebound Statistics for

Early “Adiposity” Rebound

BMI

BMI


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Steps to Plot BMI-for-age Statistics for

  • Obtain accurate weight and height measurements

  • Select the appropriate growth chart

  • Record the data

  • Calculate BMI

  • Plot measurements

  • Interpret plotted measurements


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BMI Statistics for

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


2 select the appropriate growth chart l.jpg
2. Select the Appropriate Growth Chart Statistics for

  • 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 l.jpg
3. Record Data Statistics for


4 calculate bmi l.jpg
4. Calculate BMI Statistics for

English:

Wt (lbs.) ÷Ht (in.) ÷ Ht (in.) x 703

Metric:

Wt (kg.) ÷Ht (cm.) ÷ Ht (cm.) x 10,000


4 calculate bmi41 l.jpg
4. Calculate BMI Statistics for

  • Use a Pediatric BMI Wheel


5 plot measurements l.jpg
5. Plot Measurements Statistics for

95th

85th

75th

50th

BMI

5th

Age


6 interpret the bmi for age chart l.jpg
6. Interpret the BMI-for-age Chart Statistics for

  • 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 l.jpg
Practice using Statistics for“BMI-for-age” Growth Chart

Pete (3 y)

Gabriella (4 y)

Liz (4 y)

Photos from UC Berkeley Longitudinal Study, 1973


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Please Plot Pete Perfectly Statistics for

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


Slide46 l.jpg

BMI Statistics for

BMI

Boys: 2 to 20 years

BMI

BMI

Answers: Pete’s “BMI-for-age”

BMI=18.3

  • Interpretation:

  • BMI-for-age = >95th percentile

  • Overweight

  • Of 100 boys the same age, more than 95 have a lower BMI-for-age


Let s look at liz l.jpg
Let’s Look at Liz Statistics for

Liz


Liz s bmi l.jpg
Liz’s - BMI Statistics for

17.7

Liz


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2-3-02 Statistics for



Gabriella s bmi l.jpg
Gabriella’s BMI Statistics for


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Please Identify Overweight Children on PM160 Statistics for

Put comments here

ex: overweight, > 95th % BMI


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References Statistics for

  • 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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Please visit: Statistics for

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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