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School Tool? Understanding Body Mass Index (BMI)

BMI chart

The BMI (Body Mass Index) is a tool for understanding obesity and its use in children is growing.  If your pediatrician hasn’t used it at your child’s annual check-up, you may see it in the school setting soon.

The BMI is an assessment tool that calculates the combination of  weight and height to determine the appropriateness of  a person’s body weight for their current height.  Results of the BMI calculation may include:  underweight, healthy weight, overweight, or obese.

The BMI is a screening tool developed for populations to determine public health risk for chronic diseases such as heart disease and diabetes.  Its use in children over the age of two has increased due to the rising incidence of childhood obesity.  Most pediatricians are routinely assessing BMI at your child’s annual check-up.  However, less common is the use of BMI as a screening tool in schools.  The BMI as a screening tool for school-age children is gaining momentum–thirteen states are currently using BMI screening methods (as of 10/1/2009) to help pinpoint, prevent, and reverse the epidemic of childhood obesity.  Will this be effective?

One of the key elements to the reversal of any trend  is awareness.  BMI data can help build awareness in families, if it is presented in a responsible way.  Cultural sensitivity to parents’ perceptions of their child’s weight is important.  Evidence shows that some parents perceive overweight as healthier and better for their child.  Linking weight status to health risk is key to building awareness in these groups.  Also, many families have no idea that their child may be gaining too much weight –because when they look around at other children, their own child doesn’t look dissimilar.

Education about the BMI measurement and its limitations is crucial.  The BMI measurement provides a total body index and does not differentiate body frame size and muscle mass from fat stores.  In other words, you may have a large-framed child that is muscular who may be classified as overweight or obese.  Looking at the child as an individual…what they eat, how they eat, how physically active they are, parents’ frame size, etc. can aid in keeping the right perspective when it comes to your child’s weight and interpreting his BMI result.

Communication of the BMI data results require sensitive wording and resources for parents who want to seek further help for their child.  Presenting this data without resources can be confusing and concerning to a parent.  BMI result information should include local programs and providers who can assist with healthier eating and lifestyle enhancement.

And if you are told your child’s BMI is too high?  Consult with your pediatrician, registered dietitian, or other health care provider to gather information and education that is tailored to your child, family, and lifestyle.  An elevated BMI and the associated risks for chronic disease can be normalized and/or reversed with healthy eating, physical activity, and lifestyle changes.  For a BMI calculator tool, go to http://apps.nccd.cdc.gov/dnpabmi/.

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  1. Hi there I just found your site and enjoyed it! I must tell you how much I loved it. Will there be an update? I plan on bookmarking your page and definetly check back!

  2. Hi Jill, I have worked in private practice since 1999 – but rarely see bmi>85th percentile for age. My population of kids has spec needs: Autism, asthma, developmental delay, sensory integration disorder, learning/behavior/mood problems, or growth and feeding concerns. Here’s the thing: Peds do not refer these kids for nutrition care, even when BMI is below zero percentile – this is not unusual. Instead they are referred for growth hormone injections. Parents or OTs refer the kids. When we get them into nutrition care, well, they don’t need growth hormones – their pediatricians need a little education! The kids I do encounter who are actually overwt or even obese don’t get referred either. One child who was over 95th % BMI was actually refused a referral for nutrition care when the mom asked her pediatrician for one. Any thoughts on what is going on – ? I have heard for years that the pediatricians aren’t listening to the parents, who do have nutrition concerns and want to do the right thing, but can’t get the referrals.

    1. Judy, thanks for your pertinent point–yes, kids who fall into the Underweight category on the BMI tool are also in need of a registered dietitian’s input and help. These children typically are under-nourished in some fashion–either from not enough calories and protein, to inadequate vitamins and minerals. Pediatricians do their best at addressing nutrition problems in the child, but they have SO MANY other items to address when visiting with a family, that nutrition falls down the priority list. Also, there are FEW pediatric dietitians in the country who do what you (and I) do, which is see children in an out-patient setting–many pediatricians are just unaware that this type of service is available to their patients. Parents need to advocate for their child, and we need to continually get the word out that we are available for preventive and corrective nutrition services. Thanks for your post–and thanks for taking care of the children who fall into the Underweight BMI category!