PEDIATRICS SUPPLEMENT ARTICLES http://pediatrics.aappublications.org PEDIATRICS RSS feed -- recent SUPPLEMENT ARTICLES articles 1098-4275 PEDIATRICS 0031-4005 PEDIATRICS http://pediatrics.aappublications.org/icons/banner/title.gif http://pediatrics.aappublications.org <![CDATA[Introduction to Issues and Implications of Screening, Surveillance, and Reporting of Children's BMI]]> http://pediatrics.aappublications.org/cgi/content/full/124/Supplement_1/S1?rss=1 Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586C American Academy of Pediatrics Supplement 124 S2 2009-09-01 S1 SUPPLEMENT ARTICLES <![CDATA[Challenges of Accurately Measuring and Using BMI and Other Indicators of Obesity in Children]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S3?rss=1 BMI is an important indicator of overweight and obesity in childhood and adolescence. When measurements are taken carefully and compared with appropriate growth charts and recommended cutoffs, BMI provides an excellent indicator of overweight and obesity that is sufficient for most clinical, screening, and surveillance purposes. Accurate measurements of height and weight require that adequate attention be given to data collection and management. Choosing appropriate equipment and measurement protocols and providing regular training and standardization of data collectors are critical aspects that apply to all settings in which BMI will be measured and used. Proxy measures for directly measured BMI, such as self-reports or parental reports of height and weight, are much less preferred and should only be used with caution and cognizance of the limitations, biases, and uncertainties attending these measures. There is little evidence that other measures of body fat such as skinfolds, waist circumference, or bioelectrical impedance are sufficiently practicable or provide appreciable added information to be used in the identification of children and adolescents who are overweight or obese. Consequently, for most clinical, school, or community settings these measures are not recommended for routine practice. These alternative measures of fatness remain important for research and perhaps in some specialized screening situations that include a specific focus on risk factors for cardiovascular or diabetic disease.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586D American Academy of Pediatrics Supplement 124 S22 2009-09-01 S3 SUPPLEMENT ARTICLES <![CDATA[The Validity of BMI as an Indicator of Body Fatness and Risk Among Children]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S23?rss=1 PURPOSE OF REVIEW: Although the prevalence of childhood obesity, as assessed by BMI (kg/m2), has tripled over the last 3 decades, this index is a measure of excess weight rather than excess body fatness. In this review we focus on the relation of BMI to body fatness and health risks, particularly on the ability of BMI for age ≥95th Centers for Disease Control and Prevention [CDC] percentile to identify children who have excess body fatness. We also examine whether these associations differ according to race/ethnicity and whether skinfold and circumference measurements provide additional information on body fatness or health risks.

RESULTS: The accuracy of BMI varies according to the degree of body fatness. Among relatively fat children, BMI is a good indicator of excess adiposity, but differences in the BMIs of relatively thin children can be largely due to fat-free mass. Although the accuracy of BMI in identifying children with excess body fatness depends on the chosen cut points, we have found that a high BMI-for-age has a moderately high (70%–80%) sensitivity and positive predictive value, along with a high specificity (95%). Children with a high BMI are much more likely to have adverse risk factor levels and to become obese adults than are thinner children. Skinfold thicknesses and the waist circumference may be useful in identifying children with moderately elevated levels of BMI (85th to 94th percentiles) who truly have excess body fatness or adverse risk factor levels.

CONCLUSION: A BMI for age at ≥95th percentile of the CDC reference population is a moderately sensitive and a specific indicator of excess adiposity among children.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586E American Academy of Pediatrics Supplement 124 S34 2009-09-01 S23 SUPPLEMENT ARTICLES <![CDATA[The Use of BMI in the Clinical Setting]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S35?rss=1 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.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586F American Academy of Pediatrics Supplement 124 S41 2009-09-01 S35 SUPPLEMENT ARTICLES <![CDATA[BMI Screening and Surveillance: An International Perspective]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S42?rss=1 International efforts to screen children have previously focused on the problem of malnutrition in the preschool years. The new World Health Organization–derived but US-based data for "optimum" growth in school-aged children may not be accepted in more than a few countries. Currently, an international perspective suggests that those school-aged children's BMIs that, on a percentile-ranking basis, track to adult BMIs of ≥25 kg/m2 are likely to be associated with an appreciable increased risk of the comorbidities associated with weight gain. There is limited evidence on the value of individually directed help for children with higher BMIs as a national policy, but national surveillance systems are badly needed to allow a better focus on the development of both public health and individual treatment policies.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586G American Academy of Pediatrics Supplement 124 S49 2009-09-01 S42 SUPPLEMENT ARTICLES <![CDATA[The Role of Culture in the Context of School-Based BMI Screening]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S50?rss=1 The high prevalence of overweight and obesity is a significant public health concern in the United States. Minority populations are disproportionately affected, and the impact of obesity on minority children is especially alarming. In this article we discuss school-based BMI reporting, which is intended to increase parental awareness of their children's weight status. This information could potentially lead parents of overweight and obese children to carefully examine and possibly change their children's diet and activity patterns. However, any program related to child weight status must consider culturally defined aspects of body size and shape. In other words, the cultural context in which information on child BMI is presented to and received by parents must be considered. In this article we review parental perceptions of child weight. Multiple studies have shown that parents of overweight or obese children often fail to correctly perceive their children as overweight. Possible reasons for, and implications of, this misperception of child weight status among minority parents are then explored within a cultural framework. The PEN-3 model is used to examine influences on health behaviors and could help inform the development of a culturally sensitive BMI-notification program for minority parents. Reporting materials congruent with the social and cultural values and practices of the target audience are likely to maximize program effectiveness. A culturally based BMI-notification program should be conceptualized as a small step in a comprehensive plan to reduce childhood obesity and improve the current and future health of minority children.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586H American Academy of Pediatrics Supplement 124 S62 2009-09-01 S50 SUPPLEMENT ARTICLES <![CDATA[Assessing BMI in West Virginia Schools: Parent Perspectives and the Influence of Context]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S63?rss=1 West Virginia is a state at the forefront of the obesity epidemic and one that is experiencing immense health and economic costs as a result. The childhood obesity research discussed in this article was conducted over the past 10 years through 4 projects that range from a school-based cardiovascular risk screening program to an evaluation of state legislation targeting childhood obesity via modifications in the school environment. In the course of these projects, we have collected BMI and other health indices on students, provided feedback to students and their parents, and assessed the obesity and health-related beliefs of West Virginians through individual and focus-group interviews and questionnaires. Our work has been accomplished by using an active-consent process, and BMI has typically been only 1 component of the comprehensive health data we collect and feedback we provide. Collaboration with state and local partners and regular dissemination of our findings have been key elements of the approach taken. The research and policy implications of our findings and approach are discussed.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586I American Academy of Pediatrics Supplement 124 S72 2009-09-01 S63 SUPPLEMENT ARTICLES <![CDATA[Arkansas' Experience: Statewide Surveillance and Parental Information on the Child Obesity Epidemic]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S73?rss=1 Parents, clinicians, public health officials, and policy makers need readily available information on the extent of the childhood obesity epidemic. As in any epidemic, the strategies and tools used to combat the imminent threat are frequently based on scientific rationale and experience but applied in areas in which we lack complete understanding. The urgent need for information requires execution of decisions that are not risk-free—such is the case of BMI screening obesity. Use of BMI percentiles to classify weight status among youth and quantify the epidemic can inform and engage parents and other key stakeholders. Arkansas has completed its sixth year of BMI screenings for public school students. Through a groundbreaking legislative mandate that requires BMI assessments in public schools, the state has achieved both enhanced awareness among parents and their children and increased engagement by school, clinical, public health, and community leaders in response to the epidemic. External evaluations conducted since institution of BMI assessments have revealed none of the initially feared negative consequences of BMI measurements such as teasing, use of diet pills, or excessive concerns about weight. In the face of this epidemic, the risks of using BMI assessments in clinical or school-based settings must be recognized but can be managed. Arkansas' Act 1220 and BMI-reporting efforts have not only afforded parents detailed information about their children's health but also provided longitudinal data needed to fully understand the scope of childhood and adolescent obesity in the state and to track progress made in combating this epidemic.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586J American Academy of Pediatrics Supplement 124 S82 2009-09-01 S73 SUPPLEMENT ARTICLES <![CDATA[Surveillance, Screening, and Reporting Children's BMI in a School-Based Setting: A Legal Perspective]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S83?rss=1 The rising epidemic of childhood and adolescent obesity is placing a heretofore unprecedented physical and fiscal burden on individuals and communities. Federal and state government officials who seek to determine the scope of the problem are using a spectrum of tools that include reporting, screening, and surveillance initiatives. The extent of authority to use these public health tools is yet to be determined, especially in the area of data use, privacy, and liability as government officials balance the need to improve public health with individual freedom and autonomy.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586K American Academy of Pediatrics Supplement 124 S88 2009-09-01 S83 SUPPLEMENT ARTICLES <![CDATA[BMI Measurement in Schools]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S89?rss=1 BACKGROUND AND OBJECTIVE: School-based BMI measurement has attracted attention across the nation as a potential approach to address obesity among youth. However, little is known about its impact or effectiveness in changing obesity rates or related physical activity and dietary behaviors that influence obesity. This article describes current BMI-measurement programs and practices, research, and expert recommendations and provides guidance on implementing such an approach.

METHODS: An extensive search for scientific articles, position statements, and current state legislation related to BMI-measurement programs was conducted. A literature and policy review was written and presented to a panel of experts. This panel, comprising experts in public health, education, school counseling, school medical care, and parenting, reviewed and provided expertise on this article.

RESULTS: School-based BMI-measurement programs are conducted for surveillance or screening purposes. Thirteen states are implementing school-based BMI-measurement programs as required by legislation. Few studies exist that assess the utility of these programs in preventing increases in obesity or the effects these programs may have on weight-related knowledge, attitudes, and behaviors of youth and their families. Typically, expert organizations support school-based BMI surveillance; however, controversy exists over screening. BMI screening does not currently meet all of the American Academy of Pediatrics’ criteria for determining whether screening for specific health conditions should be implemented in schools.

CONCLUSION: Schools initiating BMI-measurement programs should adhere to safeguards to minimize potential harms and maximize benefits, establish a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.

]]> Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586L American Academy of Pediatrics Supplement 124 S97 2009-09-01 S89 SUPPLEMENT ARTICLES <![CDATA[Issues and Implications of Screening, Surveillance, and Reporting of Children's BMI]]> http://pediatrics.aappublications.org/cgi/content/full/124/Supplement_1/S98?rss=1 Mon, 31 Aug 2009 06:41:19 PDT info:doi/10.1542/peds.2008-3586M American Academy of Pediatrics Supplement 124 S101 2009-09-01 S98 SUPPLEMENT ARTICLES