Growth Curves

It’s time for a change! Plotting your child’s height and weight on a growth curve is a familiar feature of well-child-checks at your pediatrician’s office. The most useful growth chart for predicting and preventing obesity, the body mass index (BMI) chart, is also the least used.

In August 2003 the American Academy of Pediatrics issued a call for action for pediatricians entitled, “Prevention of Pediatric Overweight and Obesity.” This official policy statement includes the recommendation to calculate and plot BMI once a year in all children and adolescents, to be able to notice early inappropriate weight gain.

The full policy contains 13 recommendations for pediatricians. Eight of them are for our interactions with families, and five are for our advocacy for children. I’d like all who are involved with children to be aware of these wise recommendations. Together we can turn the tide.

The AAP recommends:

1. Health supervision

• Identify and track patients at risk by virtue of family history, birth weight, or socioeconomic, ethnic, cultural, or environmental factors.
• Calculate and plot BMI once a year in all children and adolescents.
• Use change in BMI to identify rate of excessive weight gain relative to linear growth.
• Encourage, support, and protect breastfeeding.
• Encourage parents and caregivers to promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and whole grains; encouraging children’s autonomy in self-regulation of food intake and setting appropriate limits on choices; and modeling healthy food choices.
• Routinely promote physical activity, including unstructured play at home, in school, in childcare settings, and throughout the community.
• Recommend limitation of televisionand video time to a maximum of 2 hours per day.
• Recognize and monitor changes in obesity-associated risk factors for adult chronic disease, such as hypertension, dyslipidemia, hyperinsulinemia, impaired glucose tolerance, and symptoms of obstructive sleep apnea syndrome.

2. Advocacy

• Help parents, teachers, coaches, and others who influence youth to discuss health habits, not body habitus, as part of their efforts to control overweight and obesity.
• Enlist policy makers from local, state, and national organizations and schools to support a healthful lifestyle for all children, including proper diet and adequate opportunity for regular physical activity.
• Encourage organizations that are responsible for health care and health care financing to provide coverage for effective obesity prevention and treatment strategies.
• Encourage public and private sources to direct funding toward research into effective strategies to prevent overweight and obesity and to maximize limited family and community resources to achieve healthful outcomes for youth.
• Support and advocate for social marketing intended to promote healthful food choices and increased physical activity.