US health officials have revised a tool to track rising cases of severe obesity in children that had previously been off the charts.
New tables released Thursday by the Centers for Disease Control and Prevention now cover those up to a body mass index of 60, while the previous ones ended at 37, with additional categories to monitor obesity between ages 2 and 19.
Experts say that severe childhood obesity in the United States has nearly quadrupled in recent decades.
“A decade ago we noticed we were off our growth charts,” explained Dr. Tom Eng, who directs the weight loss surgery program at Lurie Children’s Hospital in Chicago.
The CDC charts are the most widely used tool for tracking the growth and development of children in the United States. Parents have been used to commenting on their kids’ progress since they were kids, said Dr. Alison Goodman of the CDC. The new charts will be “extremely helpful” in guiding better conversations between parents and health workers, he explained.
“These charts are used as a visual aid,” Goodman said.
CDC epidemiologist Cynthia Ogden said the old tables had been in use since 2000. They were based on data from US studies conducted between 1963 and 1994, when obese children were very few, let alone severely obese. Now about 4.5 million kids — about 6% — fall into that category.
Growth charts show patterns of development by age expressed in BMI, height and stride estimates, and also in curves called percentiles. Unlike adults, children are not identified as being obese or severely obese by BMI alone, noted Eng. Instead, percentiles are used, comparing the patient’s data with those of other children their age.
According to the CDC, a child is considered obese if they are in the 95th percentile on the growth chart, severely obese at the 120th, or with a BMI of 35 or higher. For example, a 17-year-old boy who is 5 feet 8 inches (1.72 m) tall and weighs 250 pounds (113 kg) would have a BMI of 38 and would be described as severely obese.
The old tables didn’t include kids like Brian Alcala of Aurora, Illinois, who first sought help as a high school freshman in 2019, when he was 5 feet 5 inches (1.65 m) tall and weighed nearly 300 pounds (300 kg). pound) was ,
“That’s when it got out of control,” recalled Alcala, who gained weight after developing a rare bone disease in childhood that limited her activity.
Children like Alcala with a BMI of 45, 50 or higher fell off the CDC charts, making it difficult to assess their condition or adequately chart their progress, often delaying treatment, Eng said. .
“It’s like driving a car at night without headlights or a dashboard,” Eng said. “You don’t know where you compare to your peers.”
Alcala, who is now 17, had weight-loss surgery in April and has lost 115 pounds, with 10 more to go.
“Everything is going well now,” he remarked.
However, one expert who questions the use of BMI to assess adults said doctors should be careful when using the new tables with children. They need to be careful not to focus on behaviors that lead to weight gain and stigmatize children and their families, said Dr. Tracy Richmond, an associate professor of pediatrics at Harvard Medical School.
“I have a problem with using this as a visual tool for families,” Richmond said. “The family and the child already know that they live in a larger body. We doctors are not going to add any new information with this.”
But Erica Alcala, Brian’s mother, said she’s glad the new table includes kids like her son.
“You don’t know it until you see it on paper and in front of you,” he said.
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