The Use of BMI in the Clinical Setting

University of Colorado Denver and Health Science Center, Department of Pediatrics, 13123 E 16th Ave, B065, Aurora, CO 80045, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2009; 124 Suppl 1(Supplement 1):S35-41. DOI: 10.1542/peds.2008-3586F
Source: PubMed


BMI has been recommended for evaluating overweight and obesity in children and adolescents in the clinical setting. Definitions of overweight and obesity are based on percentile cutoff points. There are both strengths and limitations of BMI for this use. The strengths include the fact that BMI is cheap and relatively easy to use. The weaknesses include the fact that BMI percentiles are not widely used, and categorization of BMI percentiles may not adequately define risk of comorbid conditions. In addition, percentiles are not optimal for stratifying children and adolescents with very high BMI. Alternatives to the use of BMI and BMI percentiles include waist circumference to evaluate regional fat deposition and replacement of percentiles with z scores. Despite limitations, BMI and BMI percentiles have great utility in the clinical setting and the potential to be even more useful as BMI is used more frequently and more appropriately by primary care providers. Additional research on alternatives or adjuncts to BMI is needed.

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    • "Previous research suggests that high BMI percentile is also a predictor of future adiposity and increased morbidity and mortality. BMI percentile has reasonable sensitivity for identifying children with the highest accumulation of fat, is easy to use, and is inexpensive (Daniels, 2009). The wording on this survey question allows for multiple answers and combines children and adolescents. "
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    ABSTRACT: Introduction School-based health centers (SBHCs) serve many overweight/obese children, yet little is known about provider adherence to obesity guidelines. The purpose of this descriptive study was to evaluate obesity care assessment practices of SBHC providers prior to completing training on obesity guidelines. Method Providers (n = 33) from SBHCs in six states (AZ, CO, NM, MI, NY, and NC) completed The International Life Science Institute Research Foundation Assessment of Overweight in Children and Adolescents Survey. Results Most providers reported using body mass index percentile (93.9%) to assess weight. In caring for overweight/obese children, providers reported screening for hypertension 100% of the time and cardiovascular disease 93.9% of the time, and approximately two thirds reported requesting total cholesterol and lipid profile laboratory assessments. Some assessment guidelines were not routinely followed. Discussion SBHCs serve a high-risk population, and providers in this study may benefit from additional training on assessment guidelines and quality improvement processes to improve adherence to current guidelines.
    Journal of Pediatric Health Care 11/2014; 28(6). DOI:10.1016/j.pedhc.2014.05.002 · 1.44 Impact Factor
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    • "Although adipose tissue is probably the component of overweight responsible for increasing disease risk, most studies of secular trends have focused solely on indices of weight and height (Freedman et al. 1997). However, some evidence suggests that skinfolds may be more sensitive than the body mass index for detecting excess adiposity (Marshall et al. 1991, Sardinha et al. 1999, Sarria et al. 2001, Daniels 2009, Bibiloni et al. 2013). This is to be expected because skinfolds are more directly associated to the presence of subcutaneous fat than the body mass index (Norgan 1991, Bedogni et al. 2003). "
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    ABSTRACT: Aim: To analyze the secular changes in body size and composition of two cohorts of children from La Plata City, Argentina, with a 35-year follow-up. subjects and methods: Cohort 1 (C1) was measured in 1969-1970 and included 1772 children (889 boys, 883 girls), and Cohort 2 (C2), measured in 2004-2005, included 1059 children (542 boys, 517 girls). Both cohorts were obtained from matching geographical areas and comprised children from 4 to 12 years. Body weight (W); Height (H); Upper arm circumference (UAC); Tricipital (TS) and Subscapular skinfolds (SS) were measured, and Body Mass Index (BMI) and muscle (UMA) and fat (AFA) brachial areas were calculated. Prevalence of overweight and obesity was estimated by IOTF. To compare C1-C2 we used a generalized linear model with log-transformed variables, and chi square test. Results: There were significant and positive differences between C2-C1 in W, UAC, SS, TS, and AFA. In contrast, H was not significantly different and UMA was significantly different but with negative values. The prevalence of overweight and obesity was 14.5% and 3.8% in C1, and 17.0% and 6.8% in C2. Differences between cohorts were significant for obesity. Conclusion: The shifts observed for soft tissues--positive trend for fat and negative for muscle area--occurring without changes in height lead us to suppose that in these three decades, La Plata's population has experienced deterioration in living conditions and important changes in their lifestyle, such as an increased consumption of energy-dense foods and sedentary habits.
    Anthropologischer Anzeiger 06/2014; 71(3). DOI:10.1127/0003-5548/2014/0364 · 0.54 Impact Factor
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    • "Nevertheless, it became clear that using IOTF or WHO references on the same dataset yielded widely different rates [2], [5]–[7]. Moreover, there are some limitations associated with the use of BMI as indicator of fatness, as follows: individuals with increased muscle mass may also have increased BMI; and also individuals with decreased lean body mass and increased adiposity may be misclassified by assessment with BMI; BMI fails to assess the accumulation of abdominal fat, which mainly increases the risk of diabetes, hypertension and cardiovascular diseases (CVD) risks; and BMI is relatively insensible to body composition changes [8]. "
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    ABSTRACT: Body mass index (BMI) shows several limitations as indicator of fatness. Using the International Obesity Task Force (IOTF) reference and the World Health Organization (WHO) standard 2007 on the same dataset yielded widely different rates. At higher levels, BMI and the BMI cut-offs may be help in informing a clinical judgement, but at levels near the norm additional criteria may be needed. This study compares the prevalence of overweight and obesity using IOTF and WHO-2007 references and interprets body composition by comparing measures of BMI and body fatness (fat mass index, FMI; and waist-to-height ratio, WHtR) among an adolescent population. A random sample (n = 1231) of adolescent population (12-17 years old) was interviewed. Weight, height, waist circumference, triceps and subscapular skinfolds were used to calculate BMI, FMI, and WHtR. The prevalence of overweight and obesity were 12.3% and 15.4% (WHO standards) and 18.6% and 6.1% (IOTF definition). Despite that IOTF cut-offs misclassified less often than WHO standards, BMI categories were combined with FMI and WHtR resulting in the Adiposity & Fat Distribution for adolescents (AFAD-A) classification, which identified the following groups normal-weight normal-fat (73.2%), normal-weight overfat (2.1%), overweight normal-fat (6.7%), overweight overfat (11.9%) and obesity (6.1%), and also classified overweight at risk and obese adolescents into type-I (9.5% and 1.3%, respectively) and type-II (2.3% and 4.9%, respectively) depending if they had or not abdominal fatness. There are differences between IOTF and WHO-2007 international references and there is a misclassification when adiposity is considered. The BMI limitations, especially for overweight identification, could be reduced by adding an estimate of both adiposity (FMI) and fat distribution (WHtR). The AFAD-A classification could be useful in clinical and population health to identify overfat adolescent and those who have greater risk of developing weight-related cardiovascular diseases according to the BMI category.
    PLoS ONE 02/2013; 8(2):e55849. DOI:10.1371/journal.pone.0055849 · 3.23 Impact Factor
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