BMI should be routinely measured in pediatric patients

by Emily P. Walker

Physicians should record body mass index (BMI) of their pediatric patients during routine offices visits, according to a sweeping new plan laid out by a White House task force on ways to shrink childhood obesity rates over the next 20 years.

The inter-agency President’s Task Force on Childhood Obesity was formed three months ago as part of the Let’s Move! initiative and was given 90 days to draft recommendations on how to curb the problem. The result is a report released Tuesday called “Solving the Problem of Childhood Obesity Within a Generation,” which outlines 70 specific recommendations for driving down obesity rates to 5% by 2030.

The last time the rate was that low was in the 1970s; the current rate is about 17%, according to data from the Centers for Disease Control and Prevention (CDC). Meanwhile, 32% of kids are classified in the broader category of being either overweight or obese.

The 124-page report to the president calls for actions that can be taken by the federal government, state and local governments, schools, and healthcare professionals, as well as the agricultural and food industries, but it does not call for any new funding or legislation.

Besides tracking changes in BMI, the report calls on doctors and other providers to share the information with parents, who often don’t accurately perceive the weight of their overweight or obese child, the task force said.

“It is critical that health providers engage in BMI measurement,” wrote the task force, which included members of 12 federal agencies including the Departments of Health and Human Services, Agriculture, Education, Transportation, and the Federal Trade Commission.

The report cites a survey of pediatricians that found nearly all respondents reported measuring height and weight at well-child visits, but only half calculated the BMI percentile for gender and age for kids over 2 years of age.

Several states have enacted legislation requiring schools to measure BMI and report the results to parents, which has proved a controversial undertaking because some parents don’t approve of what they dub “Fat Report Cards.”

Meanwhile, the scientific community is increasingly questioning the accuracy of using BMI as a surrogate for obesity. In one recent study, a researcher referred to the measure as the “baloney mass index.”

The obesity task force notes that BMI is one part of a screening process, and not a diagnostic tool on its own.

The task force also recommends that healthcare providers counsel parents and children on increasing fruit and vegetable intake and physical activity and on limiting consumption of junk food and sugary beverages.

Providers might also need training on how to communicate weight issues to patients, the report notes, “since the stigma often associated with obesity can sometimes prevent clinicians from feeling comfortable discussing the implications of a high BMI.”

The task force acknowledges that uninsured families won’t have the same type of access to well-child visits as insured families, but said the recently enacted Patient Protection and Affordable Care Act will expand coverage.

Aside from specific advice for the medical community, the task force focused on four priorities to reduce obesity: educating parents about healthy food and exercise, improving access to healthy, affordable foods, getting children to be more physically active, and providing healthy food in schools.

The report highlights major shortcomings in school lunch and breakfast programs. Only 6% to 7% of all schools met Department of Agriculture nutritional standards for the 2004-2005 school year, according to the report.

The report calls for reducing sugar intake, drastically increasing fruit and vegetable intake, promoting breast feeding, increasing physical activity, and limiting TV time.

Among the report’s other recommendations:

* Improve labeling on food and menus to deliver more useful information (The Patient Protection and Affordable Care Act requires chain restaurants to list nutrition information on menus starting in 2011.)
* Reduce marketing of unhealthy food to children.
* Improve federally-supported school lunches and breakfasts.
* Improve access to healthy, affordable food by eliminating “food deserts” in urban and rural areas
* Lower the relative price of healthy food
* Encourage physical activity through gym classes and by making it easier for kids to walk or bike to school

The report’s authors note that many of the recommendations would have to be undertaken at the federal level, and some would require congressional action.

Some are out of the purview of the government altogether, including a recommendation to reduce marketing of junk food to children, explained Federal Trade Commission Chairman Jon Leibowitz at a Tuesday morning event at the White House to discuss the report.

The FTC has no authority over food advertisements, but Leibowitz hopes to encourage food companies to curtail the ads they show to kids on their own, and if that doesn’t work, he said, he’s not against shaming companies who continue to promote unhealthy food products.

A $4 billion bill to reauthorize childhood nutrition programs is currently pending in Congress, although President Obama has proposed increasing the budget for school food programs to $10 billion.

Emily P. Walker is a MedPage Today Washington Correspondent

Originally published in MedPage Today. Visit MedPageToday.com for more pediatric news.

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  • family practitioner

    I dont get it.
    A BMI is just a number; most of the time you just need to look at the patient to realize there is a problem. Plus, we are giving an already self-conscious generation yet one more thing to obsess about.

    • CamJN

      Yes BMI is just a number, but then is it practical to do a water displacement test every-time a child sees a doctor? Or is it any more accurate to judge a child on whether they look overweight? A tool is a tool, and needs to be treated as such.

      And further if the public is self conscious it’s only because they KNOW that they aren’t healthy.

      • family practitioner

        If they know they are not healthy, then why do we have to calculate their BMI?

        • CamJN

          Because while they know it they are not facing it, and while they avoid this inconvenient truth they become worse off. Better to confront them and possibly elicit change than do nothing and get nothing in return.

  • jim

    Why are we forcing restaurants to make healthier food and why are we requiring them to list all nutrition information. Let the market work this out, it is possible that if Burger King went ahead and did all this on their own, people would begin choosing BK over Wendy’s, McD’s, etc. (If people even care about this stuff) If people care THAT much about what they’re eating, they won’t eat at restaurants that refuse to disclose their nutritional info. In the age of the internet where everyone has access, yes even poor people, it easy to find nutrition info online. If I’m forced to eat out, that’s how I make my decisions on where to eat. Why do we even have federal lunches and even breakfasts at our schools? Why do we have buses for students who live within 15, 20 min walking distance? Put the responsibility back on the parents. I can’t imagine what this country is going to look like in 20 years.

  • Anonymous

    Why not use waist / height ratio instead of BMI to detect obesity (waist measured at navel)? BMI obviously gives a false positive for obesity when a muscular lean athlete is measured; those who are muscular but not lean may be seen as obese by BMI, but it then comes back to a subjective judgment call to guess how much of the weight is muscle versus excess fat.

  • http://www.brightonyourhealth.com Mary Brighton

    BMI is just a tool and part of the whole picture to access a child’s nutritional/medical status.
    I am actually surprised that only half of the pediatricians measured BMI, even though I do agree also that it isn’t the gold standard.
    I recently went to the largest medical conference in Paris in March. One of the lectures was how the medical staff in the city of Paris was dealing with the increasing problem of childhood obesity.
    One point that the lecturer made was that BMI should be done at a child’s one year old mark and then redone at the two year old mark. If there is a rebound effect, meaning that if this child’s BMI, charted on a bell curve (as we see with height and weight charts) jumps two “lines” in the curve, this is a red light for obesity risk in this child. Thus, the pediatrician or general doctor must do something to stop this progression.
    By starting early with good education to the parents, you can slow down this risk. By that child’s 6 year old birthday…it is almost too late.

    Mary Brighton, MS, RD

  • http://www.extremedietpills.org Brian

    Sure it’s all well an good monitoring a child’s BMI, but the harder part is convincing the child’s parents not to feed them so much crap. A massive evaluation of the way nutrition is taught is required, but even if (as one commenter said) all restaurants and fast food outlets were required to publish nutritional data for their products, would it make a blind bit of difference? To my mind, allowing your child to become obese is a form of child abuse, storing up numerous problems for them in later life.