There is now controversy regarding the use of BMI when diagnosing children as being overweight. Cowie (2014) notes that athletic children are sometimes mistakenly diagnosed as being overweight, when there is no distinguishing between fat tissue, bone tissue, and lean muscle mass. The author also suggests that adding waist circumference to the measurement is a better predictive indicator of other future cardiovascular comorbidities (diabetes, coronary artery disease, etc.). Cowie (2014) also notes that the BMI chart does not take a child's stage of development into consideration.
Historically, a healthy weight for a child was based on
BMI:
- Overweight: BMI 85th to <95th
percentile
- Obese: BMI > 95th percentile
 |
| (Cowie, 2014) |
Given the controversy surrounding the use of BMI, do you
think BMI is still the best tool for assessing childhood obesity?
Reference:
Cowie, J. (2014). Measure of Obesity
in Children. Primary Health Care,
24(7), 18-23.
Hi David A., David D., Wayne, and Trevor,
ReplyDeleteI have always had an issue with only using the BMI to diagnoses an adult as overweight or obese. As you noted in the article by Cowie (2014), BMI could be inaccurate because it does not distinguish between fat tissue, bone tissue, and lean muscle mass. Mahmood (2015) explained that the CDC growth chart takes in account variability by sex and age of children by comparing sex- and age-specific reference values. However, there is still no consideration for race, ethnicity, or fat distribution. Aeberli, Gut-Knabenhas, Kusche-Ammann, Molinari, and Zimmerman (2013) indicated waist circumference (WC) is a useful predictor of metabolic disorders in children; therefore, combining both WC and BMI can be more accurate in predicting percent of body fat.
Thanks,
Kiesha
References:
Aeberli, I., Gut-Knabenhas, M., Kusche-Ammann, R., Molinari, L., & Zimmerman, M. (2013). A composite score combining waist circumference and body mass index more accurately predicts body fat percentage in 6- to 13-year-old children. European Journal of Nutrition, 52(1), 247-253.
Cowie, J. (2014). Measure of Obesity in Children. Primary Health Care, 24(7), 18-23.
Mahmood, L. (2015). The childhood obesity epidemic: A mini review. International Journal of Medicine and Public Health, 5(1), 6-9. http://dx.doi.org/10.4103/2230-8598.151234
BMI has always been a controversial method for diagnosing obesity. My mom for example underwent gastric bypass and lost 110 lbs, she was a size 4 post op and was almost gaunt looking, and her primary care doctor told her she was still obese according to the BMI chart. My mom said she did not care what the chart said she was as small as she was ever going to be, she was healthy and felt good. I have always struggled with the fact that I weigh more then I look like I do, I am always morbidly obese on these charts. I think I am average; all I care about is being healthy. I think that standardizing the method for diagnosing obesity for adults and children is very important.
ReplyDeleteA systematic review by Reilly (2010) showed that parents typically fail to recognize obesity in their children and adolescents. The information presented by Cowie (2014) shows that many children are misdiagnosed as obese because BMI does not consider development. The prevalence of childhood obesity is increasing so in order to help these children they first need an accurate diagnosis.
References
Cowie, J. (2014). Measurement of obesity in children. Primary Health Care, 24(7), 18-23.
Reilly, J. (2010). Assessment of obesity in children and adolescents: synthesis of recent systematic reviews and clinical guidelines. Journal of Human Nutrition & Dietetics, 23(3), 205-211. doi:10.1111/j.1365-277X.2010.01054.x
Thanks Alkiesha and Allyson,
ReplyDeleteIt wasn’t until I was working on my Master’s degree when I came across data on BMI that convinced me of its usefulness. What does BMI actually measure? If you have someone’s height and mass, you have a measurement of their stature and not a measurement of body composition. The problem is that BMI has turned into a body composition tool, wherein accuracy issues are controversially debated. My personal issues with the BMI scale were that while at my fittest, the BMI scale would indicate that I was obese because my increased muscle mass showed an increase in stature. I personally had a distrust in what the BMI scale reflects, and considered it an arguable and inaccurate measurement.
The best way to look at BMI is to, overlook personal accuracy and application, and look at what it objectively measures. From data collected among 16,868 participants from 1988 – 1994 and the National Death Index to 2006, BMI categories indicated increasing statistical significance according to mortality trends (Borrell & Lalitha, 2014). In other words, the higher the BMI category, the greater likelihood of mortality, especially from cardiovascular disease events. Only one of the many scales accounted for physical activity. Statistically, independent of fitness and body fat percentage, the greater the BMI the greater the likelihood of dying. Since most Americans in the higher BMI categories have excessive body fat, the scale has been labeled with stages of overweight and obesity classes. Since people with low body fat percentage can still have a large body stature, they dangerously perceive that the scale doesn’t apply to them. The best way to interpret BMI is not as a tool of obesity and mortality trends, but as a measurement of large body stature and mortality.
BMI isn’t calling anyone fat. It is a statistical tool to predict mortality, and no matter your body composition everyone should pay attention to its high correlated relationships.
-Trev
Borrell, L. N., & Lalitha, S. (2014). Body mass index categories and mortality risk in US adults: The effect of overweight and obesity on advancing death. American Journal of Public Health, 104(3), 512 - 519.