Assessing Child Growth Using

Body Mass Index (BMI)-for-Age

Growth Charts

Adapted by the State of California CHDP Nutrition Subcommittee from materials developed by
California Department of Health Care Services  Children’s Medical Services Branch
Centers for Disease Control and Prevention
Maternal and Child Health Bureau
May 2011
 Training Objectives
By the end of this presentation, you will be able to:
• describe the use of Body Mass Index (BMI) as a
screening tool for overweight and obesity
• calculate or determine BMI value from
measured weight and height
• plot BMI value on the growth chart
• determine BMI-for-age percentile
• interpret weight category
• record results on PM 160
 Obesity Trends in Children and Teens
Receiving CHDP Exams
Ages 5 to < 20

25
% ≥ 95th percentile

20

15 [Insert County]
California
10 Expected Level

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Customize chart with PedNSS data
from your county. See User Guide.

CDC Pediatric Nutrition Surveillance System (PedNSS) Data, 2000-2009.

Accessed online at www.dhcs.ca.gov/services/chdp/Pages/PedNSS2009.aspx (accessed 9/30/10).
 Childhood Overweight and Obesity
by Age Group
[Insert Your County Name] 2009
≥ 95th %ile
50 85th - < 95th %ile
% overweight or obese

40
29.0 26.2
22.5 21.8
30
18.7

20

18.3 20.2 20.8 19.7

10 15.9

0
2 - < 5 Yrs 5 - 8 Yrs 9 - 11 Yrs 12 - 14 Yrs 15 - < 20 Yrs
Customize chart with PedNSS data Age Group
from your county. See User Guide.
CDC Pediatric Nutrition Surveillance System (PedNSS) Data, 2009.
Accessed online at www.dhcs.ca.gov/services/chdp/Pages/PedNSS2009.aspx (accessed 9/30/10).
 Childhood Overweight and Obesity
by Ethnicity
California 2009 [Insert Your County Name]
Children Aged 5 to < 20 years

50
% overweight or

40 35.5
25.2 26.2
obese

30 17.9 21.2
18.9
13.5
20
20.5 19.5 20.1 21.0
10 17.7 14.1 14.6

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Customize chart with PedNSS data

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85th - < 95th %ile
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CDC Pediatric Nutrition Surveillance System (PedNSS) Data, 2009.

Accessed online at www.dhcs.ca.gov/services/chdp/Pages/PedNSS2009.aspx (accessed 9/30/10).
 What Is Body Mass Index?
• A number that compares an individual’s weight to height
• Body Mass Index (BMI) = Weight (kg) / Height (m)²
• As an indirect measure, a screening test for body fatness
 Why Use BMI-for-Age?
• Lifetime tracking tool
– Age 2 years through adulthood
• Examines weight, stature and age
• Screening for health and nutrition status
• Early indicator of other health risk factors
– Hyperlipidemia
– Elevated insulin
– High blood pressure
 Body Mass Index-for-Age
for Children and Teens
• Recommended by
– Centers for Disease Control
– American Academy of Pediatrics
– Expert Committee
– USPSTF
– White House Task Force
• Required by
– CHDP
– Health Plans
 Body Mass Index
Cutoff Values for Adults
• Standard weight categories
• Same for all ages
• Same for men and women
Weight Status BMI
Obese 30.0 and above
Overweight 25.0 - 29.9
Normal 18.5 - 24.9
Underweight Below 18.5
 For Children, BMI Changes with Age
Example: Child’s growth tracking along 95th percentile

Age 2 4 9 13
BMI Value 19.3 17.8 21.0 25.1
 BMI for Children and Teens
• Age- and sex-specific
• Plot BMI on growth chart to find percentile
• Weight status determined by percentile

Weight Status Category Percentile Range

Obese ≥ 95th percentile
Overweight 85th to < 95th percentile
Normal 5th to < 85th percentile
Underweight < 5th percentile
 What is a Percentile?
50th

85th

5th
95th

Major Percentile Divisions

 CDC
Growth Charts
Tip: Download and print from
www.cdc.gov/growthcharts/

Formula to calculate BMI

Percentile lines
5th - 10th - 25th - 50th
75th - 85th - 90th - 95th

Published May 30, 2000

(modified 2000-2001)
How to Read and Interpret
the Growth Chart

• A single point on the curve

indicates current status
• A series of BMI plots are needed
to determine the growth trend
• If growth deviates from the
expected growth pattern, further
assessment may be needed
 Adiposity Rebound

• The increase in BMI that

occurs after it reaches
its lowest point, usually
between ages 4 to 6
• Normal growth pattern
↑BMI

AGE →
 Adiposity Rebound
Child following 10th percentile curve
At what age does the BMI reach its lowest point?

↑BMI

AGE →
 Adiposity Rebound
Child following 85th percentile curve
At what age does the BMI reach its lowest point?

↑BMI

AGE →
 Early Adiposity Rebound

• Early adiposity rebound

(before age 5) is related to
higher BMI in adulthood
• An increase in BMI
percentile < 5 years
is a red flag
↑BMI

AGE →
 Early Adiposity Rebound
Without Intervention With Intervention

↑BMI ↑BMI

AGE → AGE →
 Excessive Adiposity Rebound

• Excessive adiposity
rebound is related to
higher BMI in adulthood
• Increasing BMI
percentiles crossing
major percentile lines
↑BMI

AGE → are red flags

Steps to Plot BMI-for-age
1. Select appropriate growth chart
2. Measure standing height accurately
3. Measure weight accurately
4. Determine BMI value
5. Determine BMI-for-age percentile
6. Record BMI percentile on PM 160
7. Determine weight category
 Chart Carlos Correctly
Step 1:
Select Appropriate Growth Chart
• Birth to 36 months: Boys or Girls
– Length-for-age
– Weight-for-age
– Head circumference
– Weight-for-length

• 2 to 20 years: Boys or Girls

– Stature-for-age
– Weight-for-age
– BMI-for-age
 Chart Carlos Correctly
Step 2: Measure Standing Height
Record on growth chart and PM 160
Date Age Weight Stature BMI*
3 32 # 38 ½ ” 15.2

4 36 # 41 ” 15.0

6 45 ¾ ”

3
45
 Chart Carlos Correctly
Step 3: Measure Weight
Record on growth chart and PM 160
Date Age Weight Stature BMI*
3 32 # 38 ½ ” 15.2

4 36 # 41 ” 15.0

6 43 ½ # 45 ¾ ”

4 53 04308
 Chart Carlos Correctly
Step 4A: Determine BMI Value
Method 1:
Using a calculator
• English measurements
Wt (pounds) ÷ Ht (inches) ÷ Ht (inches) x 703

• Metric measurements
Wt (kg) ÷ Ht (cm) ÷ Ht (cm) x 10,000

TIP: Formulas are listed on the BMI-for-age chart

Chart Carlos Correctly
Step 4A:
Determine BMI Value
Method 2:
Using a
BMI calculation wheel
• Find height on inner wheel
TIP: Mark with your thumb and index finger
• Line up the height with weight on outer wheel
• Read BMI value in the window on the inner wheel
TIP: Read decimal points from right to left!
 Chart Carlos Correctly
Step 4B: Determine BMI Value
Record on growth chart

Date Age Weight Stature BMI*

3 32 # 38 ½ ” 15.2

4 36 # 41 ” 15.0

6 43 ½ # 45 ¾ ” 14.6
 Chart Carlos Correctly
Step 5: Determine BMI-for-Age %ile
TIP: Use a transparent
growth chart plotting aid

• Find age on horizontal axis

• Find BMI value

on vertical axis

• Mark point of intersection

• Estimate BMI percentile

 Chart Carlos Correctly
Step 6:
Record BMI Percentile on PM 160
• Estimate a whole number between 1 and 99
that best represents the percentile point
plotted on the growth chart

3
45 0 4 308
2 5
 Chart Carlos Correctly
Step 7A:
Determine Weight Category
Weight Status Category Percentile Range
Obese ≥ 95th percentile
Overweight 85th to < 95th percentile
Normal 5th to < 85th percentile
Underweight < 5th percentile
 Chart Carlos Correctly
Step 7B: Record Abnormal Results
• On PM 160, enter
follow up code in
appropriate column under
“PROBLEM SUSPECTED”

• Enter diagnosis under

“COMMENTS/PROBLEMS”
– Underweight
– Overweight
– Obese
Accurate Measurements Are Critical
BMI for 5 year old boy
• Weight: 43.5 lb
• Height: 43.0 in
• BMI= 16.5
• BMI-for-age =
75-84th percentile
• Normal range

If height is inaccurate:
• Weight: 43.5 lb
• Height: 42.5 in
• BMI = 17.0
• BMI-for-age =
85-94th percentile
• Overweight range
 Summary
You are now able to:
• describe the use of BMI as a screening tool
• determine BMI value
• plot BMI value on the growth chart
• determine BMI-for-age percentile
• interpret weight category
• record results on PM 160
 Color-coded BMI Charts

• 5210 Let’s Go!

www.letsgo.org/

• Eat Smart, Move More

North Carolina
www.eatsmartmovemorenc.com/

• National Initiative
for Children’s Healthcare Quality
www.nichq.org/ > Childhood Obesity
 Growth Assessment Resources
• Essential clinical tools in training packet
• Resource handout lists sources for
– Online tutorials
– Online resources
– Growth charts
– Plotting aids
– BMI calculators and wheels
CDC BMI Percentile Calculator for Child and Teen
CHOP Body Mass Index and Z-Score Calculation in Children
Shape Up America! Childhood Obesity Assessment Calculator
– Software applications
 References
• American Academy of Pediatrics Policy Statement:
Prevention of Pediatric Overweight and Obesity. Pediatrics. 112: 424-430, 2003.
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424
• Assessment of Child and Adolescent Overweight and Obesity.
Pediatrics 120: S193-S228, 2007.
http://pediatrics.aappublications.org/cgi/content/full/120/Supplement_4/S193
• Expert Committee Recommendations Regarding the Prevention, Assessment,
and Treatment of Child and Adolescent Overweight and Obesity: Summary Report.
Pediatrics 120 : S164-S192, 2007.
http://pediatrics.aappublications.org/cgi/content/abstract/120/Supplement_4/S164
• Recommendations for Prevention of Childhood Obesity.
Pediatrics 120 : S229-S253, 2007.
http://pediatrics.aappublications.org/cgi/content/abstract/120/Supplement_4/S229
• The Validity of BMI as an Indicator of Body Fatness and Risk Among Children.
Pediatrics 124: S23-S34, 2009.
http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_1/S23