The 2000 Centers for Disease Control and Prevention growth charts are unable to accurately define and display BMI percentiles beyond the 97th percentile. At Children’s Hospital Colorado, we created new growth charts that allow clinicians to track and visualize BMI values in severely obese children. This growth chart defines a child’s BMI as a “percentage of the 95th percentile.” It has the potential to allow clinicians to define subgroups of severe obesity, monitor trends in obese children, and measure treatment success or failure.
Copyright © 2012 by the American Academy of Pediatrics
2012
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Implementation of a New Growth Chart for Obesity
Medical evaluation of severely obese children is complex and requires consideration of multisystem issues. As the national effort to prevent, evaluate and treat pediatric obesity intensifies, our tools for evaluation and diagnosis will need to be perfected. The most essential among these is a functional growth chart. In December, Gulati et al. report on a novel growth chart that allows clinicians to monitor BMI trends in severely obese children in a statistically meaningful way.1 Their chart draws on work initially proposed by Flegal et al. using "percentages of the 95th percentile".2 They correctly draw attention to the utility and limitations of BMI z-score, another commonly used tool to assess clinical progress in severely obese children who may be working toward a healthy weight with their medical providers. The published chart allows clinicians to better quantify and classify severe obesity and to see signs of clinical progress in children whose BMI percentile or z-score would otherwise be unusable or misleading. Further, they accomplished this within a popular electronic health record used nationally. If the authors of this work are able to share their more specific methodology and provide uploadable data files, any electronic health record system could be quickly upgraded to include this new chart. Given the epidemic of obesity, this would be highly valuable to any primary care pediatrician and even more so for those of us working in multidisciplinary pediatric obesity treatment clinics. Despite rapid technological advances in our field, there is arguably no more important tool for the pediatrician than a growth chart. Widespread implementation of the one created by Gulati et al. will be a welcome addition to our essential tools.
1. Gulati AK, Kaplan DW, Daniels SR. Clinical Tracking of Severely Obese Children: A New Growth Chart. Pediatrics. 2012; 130(6):1136-1140
2. Flegal KM, Wei R, Ogden CL, et al. Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. Am J Clin Nutr. 2009;90(5):1314-1320
Conflict of Interest:
None declared