eLetters to:

SUPPLEMENT ARTICLES: Nancy F. Krebs, John H. Himes, Dawn Jacobson, Theresa A. Nicklas, Patricia Guilday, and Dennis Styne Assessment of Child and Adolescent Overweight and Obesity Pediatrics 2007; 120: S193-S228 [Abstract] [Full text] [PDF]

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eLetters published:

An Alternative Assessment Method for Overweight

Henry S. Kahn, Giuseppina Imperatore, Yiling J. Cheng   (19 March 2008)

Evaluating Impact of Treating Childhood Obesity

Joanne P. Ikeda   (16 July 2008)

An Alternative Assessment Method for Overweight 19 March 2008
Henry S. Kahn, physician National Center for Chronic Disease Prevention and Health Promotion (CDC), Giuseppina Imperatore, Yiling J. Cheng Send letter to journal: Re: An Alternative Assessment Method for Overweight hkahn{at}cdc.gov Henry S. Kahn, et al.	To the Editor.--- The recent Pediatrics article on “Assessment of Child and Adolescent Overweight and Obesity” (Krebs NF et al. Vol. 120 [Supplement] December 2007, pp. S193-S228) focused on defining obesity by using methods that should be accurate, appropriate, quick, and evidence-based. Although the authors described advantages and problems when using the body mass index, skinfolds, and waist circumference, we were surprised that their review made no mention of the waist/height ratio. We consider the waist/height ratio to be a practical index that might simplify the clinical and epidemiologic recognition of cardiometabolic risk among young patients.1-4 In addition, since waist circumference5 and visceral abdominal fat6 are inversely related to children’s physical activity, the waist/height ratio might also serve for the simplified and easily comprehensible monitoring of exercise interventions among growing children. A longitudinal study has recently provided reason to question whether children’s changes in body mass index (SD-score) or sum of skinfolds are adequate to describe their changes in metabolic risk as estimated by insulin resistance or the concentrations of circulating triglycerides, HDL -cholesterol, and adiponectin.7 Henry S. Kahn, MD, Giuseppina Imperatore, MD, PhD, Yiling J. Cheng, MD, PhD The opinions expressed in this correspondence are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention Reference List 1. Hara M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb 2002; 9:127-32. 2. Kahn HS, Imperatore G, Cheng YJ. A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J Pediatr 2005; 146:482-8. 3. McCarthy HD, Ashwell M. A study of central fatness using waist-to -height ratios in UK children and adolescents over two decades supports the simple message - `keep your waist circumference to less than half your height'. Int J Obes 2006; 30:988-92. 4. Freedman DS, Kahn HS, Mei Z et al. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 2007; 86:33-40. 5. Klein-Platat C, Oujaa M, Wagner A et al. Physical activity is inversely related to waist circumference in 12-y-old French adolescents. Int J Obes 2004; 29:9-14. 6. Saelens BE, Seeley RJ, van Schaick K, Donnelly LF, O'Brien KJ. Visceral abdominal fat is correlated with whole-body fat and physical activity among 8-y-old children at risk of obesity. Am J Clin Nutr 2007; 85:46-53. 7. Jeffery AN, Alba S, Murphy MJ et al. Behavior of insulin resistance and its metabolic correlates in prepubertal children: A longitudinal study (EarlyBird 32). Diabetes Care 2007; 30:2962-4. Conflict of Interest: None declared
Evaluating Impact of Treating Childhood Obesity 16 July 2008
Joanne P. Ikeda, Nutritionist/Dietitian University of California, Berkeley Send letter to journal: Re: Evaluating Impact of Treating Childhood Obesity jikeda{at}berkeley.edu Joanne P. Ikeda	Dear Colleagues, “Recommendations for Treatment of Child and Adolescent Overweight and Obesity” were published in the December, 2007, issue of Pediatrics. In reviewing the article, I was struck by the fact that the expected outcomes were entirely focused on changes in: weight; percentage overweight; BMI; BMI Z scores; and/or body composition. There was no attention paid as to how treatment efforts might impact psychological or social well-being despite the fact that there are valid instruments readily available for measuring such things as self-esteem, self-perception, body image, body appreciation, body image disturbance, moods and feelings, and eating disorders in children. Don't pediatricians consider themselves professionals who are concerned with the total health of children which includes physical, psychological and social well-being of children? If they do, doesn't it makes sense to advocate the use of tools that measure impact on all areas of well-being? Is it possible that while attempting to improve the physical well-being of children, pediatricians are ignoring the effect they are having on psychological and social health? Can pediatricians be so sure that they are doing only good and no harm that they don’t need to assess changes in these aspects of health? Isn’t it time to challenge the status quo and come out with a stance that calls upon child obesity researchers to expand their thinking with respect to the impact of interventions and treatment? -- Conflict of Interest: NONE