BMI and Weight Issues

BMI
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About the Body Mass Index (BMI)

BMIs are still being utilized but it’s far from perfect. I work in community health so many EMRs or private practices probably don’t have to worry about it. Most of the time it’s calculated automatically so you don’t have to hurt your brain but I do have a small chart for kids’ height. Read about treating AN/underweight outpatient.

Some providers believe the accuracy of a BMI is a hit or miss. And that’s true! The BMI measures of what’s considered “obese” can be drastically different. I wear a size 10 but according to my BMI, I’m labeled obese like I fit everywhere just fine I promise! but this also occurs if a person is pregnant or muscular and people don’t associate big muscles or an athlete with “obesity”. So yes the BMI can be a huge problem.

However, people who are significantly obese sometimes don’t qualify for certain services like a CT or an MRI so true weight limits and the implications are important. Also, be mindful that most BMI calculators don’t factor in age, which can lead to a child being mislabeled. Some children’s BMI printouts are available at the bottom –Healthy Kids of Australia. 

BMIs are somewhat useless for adults but for my clinic’s EMR, it’s required on any patient prescribed an anti-psychotic. Plus if it’s too high you have to mention a plan i.e. promote healthy eating/activities, d/c medication…etc. I get the need to be proactive but it’s just tedious. As usual, we have to look at the whole picture and MULTIPLE factors. Don’t wait (no pun intended) until things are out of control. Therefore, the BMI is still the best measure to help us out, especially with kids. Mainly because a child not developing/failure to thrive is a serious issue including ruling out abuse/neglect. So think about BMIs as a general safety net.

Different Forms of Weight with Kids

  • Underweight:  I do have underdevelopment or tiny patients but I usually try to assess if the parent/family is small (is this r/t genetics?). I have a cousin who even when she was fully pregnant, was not over 100 pounds so some people are truly naturally small. Another assessment includes how active is the child? If the child isn’t that active and small that’s somewhat a red flag. Most kids are bursting with energy unless there’s another underline condition. Assess the nutrition intake because just like people overfeed the kid, the opposite is also true, and be mindful of families that possibly can’t meet their needs since everything is getting costly. Severely underweight without underline conditions are addressed in another post.
  • Normal Weight: continue to monitor normal growth and the side effects of meds. Some kids just grow like a weed but >5-10lbs in a month, I will consider switching antipsychotic medications. I had to do a lot of telehealth and sometimes the parents will notice significant weight changes in 2 weeks, even with low dosages and normal labs. So don’t just assess the mood but keep asking about any changes in the body.
  • Slightly Overweight/Obese: truly educate the family about the importance of healthy living. Even if it’s in genetics (i.e. the whole family is large) some people really have a hard time with nutrition. I also sort of pitch how we can’t start/continue certain medications but of course, it depends on the severity of the mental symptoms. Also, reassure the family the kid is still growing so the weight can be easily more dispersed (because some parents will take it as a personal failure). You can trial, topiramate, and bupropion, and consider weight-neutral medications. Ask about the food intake to see where the patient needs to seriously improve.
  • Significantly Obese: certain medications may be seriously be contraindicated or at least decrease the dose, especially with olanzapine or SGAs, mirtazapine, lithium, and quetiapine. The pediatrician should really be managing the effects of obesity if the psych medications are not a factor. I had a teenager on olanzapine who was slightly overweight and the mother wanted to change the doctor, mainly because she didn’t like me asking the son too many questions and felt like I should’ve just addressed her… So my colleague changed the antipsychotic to a more weight-neutral med and he had a complete psychotic outbreak. The mother and my colleague wanted to like “baby” this teenager when in actuality he was turning 18y/o. It got really scary for a minute but he got put back on olanzapine and continued to do well. The point I’m trying to make here is to let the teenagers/adults address their weight issues in their own way even if they’re obese… don’t force changes. Small kids/teens are easier to help modify their weight symptoms and behaviors.

Quick Side Note: I’ve never prescribed Metformin for weight control or side-effect management. I’ll rather d/c the medication. My patients that are on it are usually adult diabetics prescribed by their physician. Metformin can have severe GI effects like diarrhea and cramps that I don’t feel comfortable prescribing for kids/teens especially since they have to deal with school…

Lastly, patients especially adults that are severely obese need a team of specialists to manage weight loss. They may only be able to walk 10 minutes without having chest pain or some serious issue so they truly need frequent and professional monitoring. If the patient walks or work-out on their own GREAT. The ideal is for patients to know and improve their own tolerance and take more responsibility for their actions. Hence, you just can’t force these changes because a person may not be ready for that step, or you risk the mood and psych symptoms getting worse.

Additional Information & Resources 

CDC recommends that 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.

 

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