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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    • "A child was identified as obese if their BMI percentile was N the 97.7th percentile for their age and sex as defined by the WHO growth curves. BMI is not always used for children less than 2 years of age, thus only the participants between the ages of 2–11 (n = 43,437) comprised the eligible sample (Daniels, 2009). An additional 5860 participants were excluded due to missing data. "
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    ABSTRACT: Parents play a critical role in their children's lifestyle habits. The objective was to assess the effect of parenting style on the risk of childhood obesity, and to determine whether poverty was a moderator of the association. Participants were from the 1994-2008 cross-sectional samples of the National Longitudinal Survey of Children and Youth (NLSCY), a nationally representative survey of Canadian youth. Factor and cluster analysis identified four parenting styles consistent with Baumrind's parenting style prototypes. Multivariable logistic regression assessed the risk of obesity based on parenting style after adjusting for covariates. Analyses were stratified by age (preschool: 2-5 years of age, n=19,026; school-age: 6-11 years of age, n=18,551) and the moderating effect of poverty (household income < low income cut-offs adjusted for household size and geographic region) was assessed. Analyses used sampling and bootstrap weights. In multivariable analyses, compared to authoritative parenting, preschool- and school-age children with authoritarian parents were 35% (95% CI: 1.2-1.5) and 41% (CI: 1.1-1.8) more likely to be obese, respectively. In preschool children, poverty moderated this association: authoritarian and negligent parenting was associated with 44% (CI: 1.3-1.7) and 26% (CI: 1.1-1.4) increased likelihood of obesity, respectively, but only among the children not living in poverty. In school-age children, poverty was not a moderator. Parenting style is associated with childhood obesity, but may be moderated by poverty. Successful strategies to combat childhood obesity should reflect the independent and interactive associations of sociodemographic and social-familial influences on health especially in early childhood. Copyright © 2015 American Health Foundation. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Mar 2015 · Preventive Medicine
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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.
    Full-text · Article · Nov 2014 · Journal of Pediatric Health Care
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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.
    Full-text · Article · Jun 2014 · Anthropologischer Anzeiger
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