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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 PreventionNational Center for Chronic Disease Prevention and Health
Promotion
Division of Nutrition and Physical Activity
Maternal and Child Nutrition BranchJanuary 2006
Training ObjectivesTraining Objectives
Understand BMI and its Understand BMI and its importance for health care importance for health care providers providers
Learn how to plot BMI on the Learn how to plot BMI on the BMI-for-age growth chartsBMI-for-age growth charts
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1985
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1986
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1987
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1988
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1989
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1990
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1991
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1992
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1993
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1994
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1995
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1996
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1997
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1998
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1999
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2001
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
Source: Behavioral Risk Factor Surveillance System, CDC.
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%
How many…?How many…?
20002000 20052005
Nine Million Kids Nine Million Kids are Overweightare Overweight
Hispanic 22.50%
Asian/PI 11.90%
Black15.60%
0%
10%
20%
30%
40%
50%HispanicAsian/PIBlackWhiteAll Races
All Races
17.90%
not
en
ough
dat
a
Pediatric Nutrition Surveillance System (PedNSS) Growth Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forStatistics for
City and County of San Francisco 2004City and County of San Francisco 2004BMI for age > 95% for Children 2-4 YearsBMI for age > 95% for Children 2-4 Years
Hispanic 26.60%
Asian/PI 11.40%
Black 24.90%
0%
10%
20%
30%
40%
50%HispanicAsian/PIBlackWhiteAll Races
All Races
19.20%
White 17.90%
Pediatric Nutrition Surveillance System (PedNSS) Growth Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forStatistics for
City and County of San Francisco 2004City and County of San Francisco 2004BMI for age > 95% for Children 5-19 YearsBMI for age > 95% for Children 5-19 Years
A number that compares a child’s A number that compares a child’s weight to her heightweight to her height
Body Mass Index (BMI) = Body Mass Index (BMI) =
Weight (kg) / Height (m)²Weight (kg) / Height (m)²
BMI is an effective BMI is an effective SCREENING test test to check for possible overweight; to check for possible overweight; but alone it is notbut alone it is not a diagnostic toola diagnostic tool
What is BMI?What is BMI?
BMI is Only an Indirect BMI is Only an Indirect Measure of Body FatMeasure of Body Fat
BMI is Not the Same for BMI is Not the Same for Adults and ChildrenAdults and Children
Adult BMI is evaluated by use of Adult BMI is evaluated by use of cut-off numbers; for example BMI cut-off numbers; for example BMI >30 is indicative of adult obesity>30 is indicative of adult obesity
The BMI for children is useful The BMI for children is useful only when it is plotted on the only when it is plotted on the “BMI-for-age Growth Chart”“BMI-for-age Growth Chart”
Example: 95th percentile tracking Age BMI 2 yrs 19.3 4 yrs 17.8 9 yrs 21.013 yrs 25.1
For Children, BMI Changes with Age
Boys: 2 to 20 years
BMI BMI
BMI BMI
Associated with clinical risk Associated with clinical risk factors for chronic disease factors for chronic disease including hyperlipidemia, including hyperlipidemia, elevated insulin, and high elevated insulin, and high blood pressureblood pressure
Importance of Using Importance of Using BMI-for-ageBMI-for-age
CDC CDC StandardizeStandardized d Growth Growth ChartChart
Formula to calculate BMI
Published May 30, 2000
Percentiles (5th,10th,25th, 50th, 75th,85th,90th,95th)
What is a What is a Percentile?Percentile?
95th
5th
50th Percentile
85th
> 95th percentile Overweight
85th to < 95th Risk of percentileoverweight
< 5th percentileUnderweight
Using BMI-for-age Percentiles to Assess Risk
Steps to Plot BMI-for-ageSteps to Plot BMI-for-age1.1. Obtain accurate weight and Obtain accurate weight and
height measurements height measurements
2.2. Select the appropriate Select the appropriate growth chartgrowth chart
3.3. Record the dataRecord the data
4.4. Calculate BMICalculate BMI
5.5. Plot measurementsPlot measurements
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
1. Obtain Accurate Weight and Height Measurements
Accurate Measurements are Critical
Boys: 2 to 20 years
BMI BMI
BMI BMI
2. Select the Appropriate 2. Select the Appropriate Growth ChartGrowth Chart
For ages birth to 36 months old:For ages birth to 36 months old:““Length-for-age,” and “Weight-for-age” Length-for-age,” and “Weight-for-age” ““Weight-for-length,” and “Head Weight-for-length,” and “Head
Circumference-for-age” Circumference-for-age”
For ages 2 to 20 years: For ages 2 to 20 years: ““Weight-for-age,” and “Stature-for-age”Weight-for-age,” and “Stature-for-age”Body Mass Index “BMI-for-age”Body Mass Index “BMI-for-age”
3. Record Data3. Record Data
4. Calculate BMI4. Calculate BMI
English:
Wt (lbs.) ÷Ht (in.) ÷ Ht (in.) x 703
Metric: Wt (kg.) ÷Ht (cm.) ÷ Ht (cm.) x 10,000
4. Calculate BMI4. Calculate BMI
Use a Pediatric BMI WheelUse a Pediatric BMI Wheel
5. Plot Measurements5. Plot Measurements
Age
BMI
50th
75th
85th
5th
95th
Practice using Practice using “BMI-for-age” Growth Chart“BMI-for-age” Growth Chart
Liz (4 y)Pete (3 y) Gabriella (4 y)Photos from UC Berkeley Longitudinal Study, 1973
Please Plot Pete Perfectly
Photo from UC Berkeley Longitudinal Study, 1973
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
BMI=18.3
Boys: 2 to 20 years
BMI BMI
BMI BMI
Answers: Pete’s “BMI-for-age”
Let’s Look at LizLet’s Look at Liz
Liz
Liz’s - BMILiz’s - BMI
Liz
17.7
2-3-02
Graph Gabriella’s Growth Graph Gabriella’s Growth
Gabriella’s BMI Gabriella’s BMI
• For additional training materials related to the growth charts
• For tools related to the growth charts
• To download the growth charts
Please visit:
www.cdc.gov/growthcharts/
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)
References