Aug. 4, 2003 -- Forget about pounds, inches, and percentiles, parents may soon be hearing a lot more about their child's body mass index (BMI) from their pediatrician as part of a new effort to combat childhood obesity.
New recommendations from the American Academy of Pediatrics (AAP) call for pediatricians and parents to take more active roles in preventing and treating childhood obesity in ways that go beyond standard yearly height and weight measurements.
It's the first policy statement from the organization specifically to address the growing problem of obesity among children. It calls for using changes in a child's BMI over time as an indicator of the child's risk of becoming overweight or obese.
BMI as Prevention Tool
"We're trying to encourage them to not wait until children are already overweight, but to see trends that are concerning before they get to a problem point," says researcher Nancy Krebs, MD, chair of the nutrition committee of the AAP.
"Sometimes doctors think they can just look at a child and say whether or not they are overweight. The BMI provides us with a tool to see if child's weight gain is excessive or appropriate relative to their height gain."
BMI is a measurement of weight in relationship to height that is widely used to define overweight and obesity. A child with a BMI between the 85th and 95th percentile for age and sex is considered to be at risk of overweight, and a BMI above the 95th percentile is considered overweight or obese.
According to national statistics, the number of overweight and obese children and teens in the U.S. has doubled in the last 20 years, and more than 15% of children 6-19 years old are now considered overweight or obese.
Putting Child Obesity on the Radar Screen
Experts say many parents may not recognize or accept the potential risk of their child becoming overweight, and this new policy will help raise awareness of the issue.
"There are many parents of children who are overweight or at risk for overweight who don't necessarily see it as an issue," says obesity researcher Myles Faith, PhD, who works in the weight and eating disorders program at the University of Pennsylvania School of Medicine.
"Simply making families, physicians, and health-care professionals more aware won't solve the problem, but it does help put it on radar screen of some families."
Researchers say the health consequences of the obesity epidemic among American youth are serious. Overweight children are likely to become overweight and obese adults, and the medical problems associated with childhood obesity can affect adult health and increase the risk of heart disease and diabetes.
Stopping Obesity Before it Starts
The guidelines, which appear in the August issue of Pediatrics, emphasize recognizing and addressing the issue of a child's weight before it gets out of control.
Key recommendations include:
- Identify and track children at risk for becoming overweight due to a family history of obesity, birth weight, socioeconomic status, ethnicity, and other cultural and environmental factors.
- Calculate and plot BMI once a year in all children and adolescents according to CDC growth charts for age and sex.
- Use changes in BMI to identify excessive weight gain relative to growth.
- Encourage breast feeding. Studies have linked breast feeding to a decrease in obesity later in life.
- Encourage parents and caregivers to promote healthy eating patterns.
- Routinely promote physical activity, including unstructured play.
- Limit television and video time to a maximum of two hours per day.
Once at-risk children are identified, researchers say pediatricians should talk to parents about strategies to prevent childhood obesity.
"The good news is that for families who see a problem and are willing to get involved, family-based behavioral interventions can be effective for many overweight children," says Faith. "Many small changes have to be implemented, any one strategy by itself probably won't be as effective as multiple strategies."
Those strategies might include training parents about setting an example with healthy food choices, decreasing sedentary activities, and rewarding healthy food choices.
Creating a Healthy Home
Melinda Sothern, PhD, co-author of the book Trim Kids and director of the childhood obesity prevention laboratory at Louisiana State University, says parents can do little things to create a healthy environment and encourage physical activity at home. For example:
- Turn on the stereo instead of the TV when you get home.
- While watching TV, have children "do the commercial boogie" and get active during commercial breaks.
- Enact a 30-minute rule. Take a five-minute break after 30 minutes of sedentary activities like homework or sitting at the computer.
- Set up an imagination station in the living room or den filled inexpensive games that require movement, such as a Hula-Hoop, balloons, basketball-type hoop games, Twister, jump rope, small hand weights, and stretch bands.
"Anything is better than vegging out in front of the TV," says Sothern. "It doesn't have to be vigorous. If they are up on their feet, it's three times more calories being burned than when they're sitting in front of the TV."