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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