Marilyn W. Edmunds, PhD, NP

Disclosures

July 29, 2002

Question

I would like to be able to show parents their child's ideal weight range to help convince some of them that their child is overweight. Traditional charts for children are often difficult to show to parents and are not easy to read. Where can I find a useful body mass index (BMI) chart for children?

Response from Marilyn W. Edmunds, PhD, NP

A simple search through any Internet search engine will turn up literally hundreds of sites devoted to the issue of obesity in children. You're right to be skeptical -- not all of this information is credible. The single best reference for this information is the Body Mass Index-for-Age for Children from the Centers for Disease Control (CDC).

The CDC site contains information on calculation of BMI with examples, downloadable charts for children between the ages of 2 years and 20 years, and an extensive list of references. A related site, Using the BMI-for-Age Growth Charts, provides a training module appropriate for educating nonprofessional office staff in use of this tool.

The CDC site also contains links to a number of related sites on nutrition and physical activity. Unfortunately, what it doesn't have are patient-friendly materials on diet and nutrition that are appropriate for providers to give to parents and children. Good information is hard to find because weight-control information for children must be individualized to meet their growth needs and family issues.

Clearly, a one-size-fits-all tool will never be appropriate for children. The importance of maintaining adequate growth coupled with weight maintenance or loss makes it imperative that each child is evaluated individually and a diet and exercise plan is crafted to fit the child's needs. Designing and implementing a plan is labor-intensive, time-consuming, often frustrating, and requires the involvement of the entire family. Again, there are dozens of resources available of varying quality. One of the best of these is Helping the Overweight Child, available through the Cleveland Clinic. This site includes information for healthcare providers as well as tools that can be downloaded and given to parents.

In addition, the United States Department of Agriculture Web site Using the Dietary Guidelines for Americans contains information on food guide pyramids and their use in children. This article discusses portion sizes, a huge problem for children who have been urged by the food service industry to "super size" their meals. Again, much of the information can be printed for parents.

Patients and families learn best when information is discussed by a provider and followed with written advice that can be taken home and referenced as needed. These sources provide very helpful information that can supplement your in-office discussions about weight. Diet should be included in any well-child discussion, beginning at the earliest ages. Calculating and plotting BMI, and sharing that information with parents, can point out trends before they become a problem. It's important to educate parents that fluctuations up and down within the normal range for a child's age are very common and should not be overinterpreted. This is particularly true for preadolescent girls, who frequently will experience their peak weight gain prior to beginning peak height gain.

By helping children and families learn good nutritional habits and how to make good choices, primary care nurse practitioners can be an invaluable resource in the treatment and prevention of obesity.

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