About the Body Mass Index (BMI)
The BMI is widely used but has significant limitations. Factors like pregnancy, muscular builds, or athleticism can misclassify individuals as obese, highlighting its imperfections. Despite this, BMI remains crucial in specific contexts, such as tracking children’s development and addressing other issues such as a failure to thrive, which can help identify forms of neglect or deficiencies.
BMI is also required for certain health protocols, like monitoring patients on antipsychotic medications, but this can feel tedious for providers. It also doesn’t account for cultural differences, leading to potential misclassification in children. While BMI isn’t always a reliable indicator for adults, it serves as a general safety net in healthcare, particularly for children, emphasizing the importance of considering multiple factors and the broader context in assessing health.
Different Forms of Weight with Kids
- Underweight: Evaluate if the family or parents are naturally small, as this might explain the child’s smaller size.
Assess activity levels, energetic children who are small may be naturally lean, but low activity in a small child could indicate an underlying issue. Consider the nutritional intake assess the child’s diet to ensure they are getting sufficient nutrients. Underfeeding can occur, sometimes unintentionally. Note possible socioeconomic factors, be mindful of families who may struggle to meet nutritional needs due to financial constraints, especially as living costs rise. Severely underweight (trigger warning) without underline conditions are addressed in another post. - Normal Weight: For children with a normal weight, it’s still essential to monitor growth and be vigilant about the side effects of medications. While some kids may experience rapid growth naturally, a weight gain of more than 5–10 pounds in a month may warrant discontinuing a medication. Significant weight changes, even with low doses and normal labs, can sometimes occur within weeks, as reported by parents. Beyond assessing mood, consistently inquire about any physical changes to ensure early detection and management of potential issues.
- Slightly Overweight/Obese: Educating families about healthy living is crucial, even when genetics play a role, such as in cases where the whole family may have a larger body type. Emphasize the importance of balanced nutrition, as some individuals struggle with maintaining healthy habits. Reassure parents that their child is still growing, and weight may naturally redistribute over time, alleviating feelings of personal failure. Discuss the severity of any mental health symptoms and explain that certain medications may not be suitable to start or continue, depending on the situation. Consider weight-neutral options like topiramate and bupropion when appropriate. Assess dietary habits thoroughly to identify areas needing improvement, ensuring a tailored and compassionate approach.
- Significantly Obese: Certain medications, such as olanzapine, other SGAs, mirtazapine, lithium, and quetiapine, may require dose adjustments or be contraindicated due to their potential impact on weight. While pediatricians should address obesity when psychotropic medications are not a factor, caution is crucial when managing medication changes for adolescents. For example, switching a slightly overweight teenager from olanzapine to a weight-neutral alternative can lead to a severe psychotic episode, so make sure the risks outweighs the benefits. Ultimately, adolescents and adults should be allowed to address weight concerns at their own pace, as forcing changes can have unintended consequences. In contrast, younger children are more responsive to changes and guidance on modifying weight-related behaviors.
Sidebar:I avoid prescribing Metformin for weight control or managing medication side effects, as insurance coverage can be challenging, and discontinuing the primary medication is often a better option. Most of my patients on Metformin are adults with diabetes, prescribed by their physician. Given its potential for severe gastrointestinal side effects like diarrhea and cramps, I don’t feel comfortable recommending it for children or teens, especially as these symptoms could interfere with their daily school activities.
In Conclusion
Severely obese adults require a dedicated team of specialists to manage weight loss due to potential severe health issues like chest pain after minimal exertion, which necessitates frequent professional monitoring. While independent exercise is beneficial, it’s crucial for patients to recognize and improve their own physical tolerance and take personal responsibility for their health. However, it’s important not to force these changes, as patients may not be mentally prepared, potentially worsening their psychological symptoms and overall mood.
Additional Information & Resources
- A really nice BMI chart for kids; the Boys Edition and the Girls Ed. by Healthy Kids for Professionals
- Adult BMI Calculator by CDC
- Has a BMI calculator with different levels of obesity and discusses the Ponderal Index (PI), which can be more accurate with tall and short individuals versus BMI that’s more for the general population –Calculator.Net
- Here’s another chart for kids’ height and for other general references.. and additional printouts-Healthy Kids of Australia.
- Read about treating AN/underweight outpatient.
CDC recommended charts for health care providers:
- Use the WHO growth charts to monitor growth for infants and children ages 0 to 2 years of age in the U.S.
- Use the CDC growth charts to monitor growth for children age 2 years and older in the U.S.
