1. Using the Body Mass Index (BMI)-for-age Growth Charts: A Training for Health Care Provider Assistants Adapted by the CHDP Bay Area Nutrition Subcommittee (BANS) from Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition and Physical Activity Maternal and Child Nutrition Branch January 2006

2. Training Objectives Understand BMI and its importance for health care providers Understand BMI and its importance for health care providers Learn how to plot BMI on the BMI-for-age growth charts Learn how to plot BMI on the BMI-for-age growth charts

3. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

4. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

5. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

6. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1988 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

7. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

8. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1990 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

9. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1991 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

10. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1992 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

11. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1993 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

12. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1994 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

13. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

14. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1996 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

15. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1997 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

16. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1998 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

17. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

18. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

19. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

20. Source: Behavioral Risk Factor Surveillance System, CDC. (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002

21. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. How many…? 2000 2005 Nine Million Kids are Overweight

23. All Races 17.90% not enough data Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics for City and County of San Francisco 2004 BMI for age > 95% for Children 2-4 Years

24. All Races 19.20% White 17.90% Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics for City and County of San Francisco 2004 BMI for age > 95% for Children 5-19 Years

25. A number that compares a child’s weight to her height A number that compares a child’s weight to her height Body Mass Index (BMI) = Body Mass Index (BMI) = Weight (kg) / Height (m)² BMI is an effective test to check for possible overweight; but alone it is not a diagnostic tool BMI is an effective SCREENING test to check for possible overweight; but alone it is not a diagnostic tool What is BMI?

26. BMI is Only an Indirect Measure of Body Fat

27. BMI is Not the Same for Adults and Children Adult BMI is evaluated by use of cut-off numbers; for example BMI >30 is indicative of adult obesity Adult BMI is evaluated by use of cut-off numbers; for example BMI >30 is indicative of adult obesity The BMI for children is useful only when it is plotted on the “BMI-for-age Growth Chart” The BMI for children is useful only when it is plotted on the “BMI-for-age Growth Chart”

28. Example: 95th percentile tracking Age BMI 2 yrs 19.3 4 yrs 17.8 9 yrs 21.0 13 yrs 25.1 For Children, BMI Changes with Age Boys: 2 to 20 years BMI

29. Associated with clinical risk factors for chronic disease including hyperlipidemia, elevated insulin, and high blood pressure Associated with clinical risk factors for chronic disease including hyperlipidemia, elevated insulin, and high blood pressure Importance of Using BMI-for-age

30. CDC Standardized Growth Chart Formula to calculate BMI Published May 30, 2000 Percentiles (5 th,10 th,25 th, 50 th, 75 th,85 th,90 th,95 th )

31. What is a Percentile? 95 th 5 th 50 th Percentile 85 th

32. > 95 th percentileOverweight 85 th to < 95 th Risk of percentileoverweight < 5 th percentileUnderweight Using BMI-for-age Percentiles to Assess Risk

33. Steps to Plot BMI-for-age 1. Obtain accurate weight and height measurements 2. Select the appropriate growth chart 3. Record the data 4. Calculate BMI 5. Plot measurements

34. 5 year old boy Weight: 43.5 lb Height: 43 in BMI= 16.5 BMI-for-age = 75-84 th %tile Inaccurate height measurement: 42.5 in BMI=17 BMI-for-age = 85-94 th %tile 1. Obtain Accurate Weight and Height Measurements Accurate Measurements are Critical Boys: 2 to 20 years BMI

35. 2. Select the Appropriate Growth Chart For ages birth to 36 months old: For ages birth to 36 months old: “Length-for-age,” and “Weight-for-age” “Length-for-age,” and “Weight-for-age” “Weight-for-length,” and “Head Circumference-for-age” “Weight-for-length,” and “Head Circumference-for-age” For ages 2 to 20 years: For ages 2 to 20 years: “Weight-for-age,” and “Stature-for-age” “Weight-for-age,” and “Stature-for-age” Body Mass Index “BMI-for-age” Body Mass Index “BMI-for-age”

36. 3. Record Data

37. 4. Calculate BMI English: Wt (lbs.) ÷Ht (in.) ÷ Ht (in.) x 703 Metric: Wt (kg.) ÷Ht (cm.) ÷ Ht (cm.) x 10,000

38. 4. Calculate BMI Use a Pediatric BMI Wheel Use a Pediatric BMI Wheel

39. 5. Plot Measurements Age BMI 50 th 75 th 85 th 5 th 95 th

40. Practice using “BMI-for-age” Growth Chart Liz (4 y)Pete (3 y)Gabriella (4 y) Photos from UC Berkeley Longitudinal Study, 1973

41. Please Plot Pete Perfectly Photo from UC Berkeley Longitudinal Study, 1973 Measurements for Pete: Age= 3 y 3 wks Weight= 41 lbs (18.6 kg) Height= 39.7 in (100.8 cm) Find BMI and plot. BMI= Wt ( lbs) ÷ Ht (in) ÷ Ht (in) x 703

42. BMI=18.3 Boys: 2 to 20 years BMI Answers: Pete’s “BMI-for-age”

43. Let’s Look at Liz Liz

44. Liz’s - BMI Liz 17.7

45. 2-3-02

46. Graph Gabriella’s Growth

47. Gabriella’s BMI

49. For additional training materials related to the growth charts For tools related to the growth charts To download the growth charts Please visit: www.cdc.gov/growthcharts/

50.  Guidelines for Overweight in Adolescent Preventive Services (Am J Clin Nutr 1994;59:307-316)  Obesity Evaluation and Treatment: Expert Committee Recommendations (Pediatrics 1998 Sept;(102)3:e 29)  Assessment of Childhood and Adolescent Obesity: International Obesity Task Force (Am J Clin Nutr 1999, 70,suppl)  Centers for Disease Control and Prevention Website (www.cdc.gov/growthcharts)www.cdc.gov/growthcharts  American Academy of Pediatrics Policy Statement: Prevention of Pediatric Overweight and Obesity (Pediatrics 2003 Aug (112)2; 424-430) References