I came across a JAMA article recently about weight loss strategies specifically for adolescents. The article has a case-study of a 14 year old girl with obesity, and then follows with more general recommendations (diet, physical activity, and behavioral strategies).
The first step to solving the obesity epidemic is recognizing that there is a problem. Calculating and plotting a child's BMI is a HEDIS 2012 guideline (as well as giving the appropriate nutrition/ activity counseling). In my experience, I have found that calculating and plotting the BMI is not commonplace in pediatric primary care. Often times, even IF BMI is calcualted it may not be plotted, or it is evaluated based on the adult BMI scale.
(CDC BMI Percentile example for children aged 2+)
There are sometimes red flags that are raised when using BMI as a diagnosis tool because it is not a perfect measure of body fat. The Body Mass Index (BMI) is regarded as a proxy for body fat-- not a perfect substitution. "Body mass index higher than the 85th percentile or showing a persistent upward trend warrants attention, and BMI at or above the 95th percentile requires full evaluation." (JAMA article).
Recognizing and diagnosing a child as overweight or obese early on can help the child and their family, along with their physician, correct the problem before other (bigger) problems occur (Diabetes, fatty liver, etc.) which, everyone can agree, is preferable.
There are many barriers to overcome when it comes to diagnosing overweight/ obesity in children. First of all, practices may or may not be using BMI percentiles as a screening tool. Without this, there is no way to diagnose a weight category. Another major barrier may be the social stigma of an overweight/ obesity diagnosis-- especially for children. Finding a way to gently share the BMI percentile with the child and parent is difficult, as people may become defensive, or may see the diagnosis as a personal attack or judgement. Lastly, there may be providers not paying much attention to BMI percentiles because they do not believe that sharing this information with patients (or their parents) will help anything-- ie: telling the patient to watch what they eat, and increase exercise may not result in weight loss, so why waste time in a busy well-visit with discussing this. This last point is a sticky one. As more information becomes available about strategies for weightloss in adolescents, like that provided in the JAMA article becomes available, this issue may be somewhat alleviated. However, patient compliance is always an issue-- and just because we're not confident that the patient will comply does not mean we should forgo giving them appropriate screenings and guidance. Obesity is linked to so many other health problems, that it is truly worth addressing, even though it may be difficult for everyone in the exam room.
* Ludwig, David. "Weight Loss Strategies for Adolscents" JAMA (2/1/12). Clinician's Corner.
