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Overweight Children and Adolescents: Screen, Assess and Manage

Assessment of Overweight Children and Adolescents
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4. Assessment of Overweight Children and Adolescents

Example 2: Screening and assessment for early onset of overweight

Screening: The BMI-for-age chart shows the growth pattern of a girl who was identified as overweight at 7 years of age. Her growth pattern shows that at age 2, her BMI-for-age was at the 15th percentile and then moved rapidly upward crossing the 25th, 50th, and 75th percentiles at 4 years of age. This upward trend continued to age 7, when BMI-for-age was at the 95th percentile.
 
Age Weight Stature
BMI
2 23 1/4 lb 33"
15
3 28 1/2 lb 36 1/4"
15.4
4 36 1/2 lb 39 1/4" 16.8
7 60 lb 46" 20
11 94 1/2 lb 52 3/4" 24
13 143 lb 60 1/4"
27.7
  BMI-for-age chart with child's points plotted
  To understand how changes in both stature and weight affect BMI-for-age, review the weight-for-age and stature-for-age charts. When this girl was 2 years old, her stature-for-age was slightly above the 25th percentile and the weight-for-age percentile was below the 10th. Her stature remained below the 50th percentile and dropped to a lower percentile as she got older. In contrast, her weight-for-age continued to increase at a faster rate than stature-for-age except between 7 and 11 years of age. Notice that a decrease in her weight-for-age was not reflected as a decrease in BMI-for-age because her stature-for-age percentile also decreased. As a result, she was still overweight at age 11 and 13.
 
Age Weight Stature
BMI
2 23 1/4 lb 33"
15
3 28 1/2 lb 36 1/4"
15.4
4 36 1/2 lb 39 1/4" 16.8
7 60 lb 46" 20
11 94 1/2 lb 52 3/4" 24
13 143 lb 60 1/4"
27.7
  Stature-for-age and weight-for-age chart with child's points plotted
  Assessment: This girl should have received further assessment when she first was identified as at risk of overweight at age 4. This would have been warranted since her BMI-for-age increased from the 25th percentile to the 85th percentile between ages 3 and 4 years. Further assessment might have included family history, parental concern about her weight, and dietary and physical activity assessments. From this information, appropriate weight management goals could have been instituted.
 

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