Use of Body Mass Index and Body Mass Index Growth Charts for Assessment of Childhood Weight Status in the United States: A Systematic Review

Abstract

Childhood obesity has greatly increased in the United States over the previous decades and has become a public health priority. Children at high risk for becoming and who are overweight/obese should be identified early, so that appropriate intervention strategies can be implemented. As monitoring growth is an essential component of well-child care and may help prevent excess weight gain during childhood, it is recommended in pediatric guidelines that practitioners regularly assess weight status in children. In 1998, and again in 2007, the Expert Committee on Obesity Evaluation and Treatment (Expert Committee) released recommendations for physicians, nurse practitioners, and nutritionists in the United States to use the growth charts that were to be released in 2000 by the Centers for Disease Control and Prevention (CDC) to assess weight status in children. These charts included a newly developed body mass index (BMI)-for-age growth chart. The use of BMI (weight in kilograms divided by the square of height in meters [kg/m]) as a measure of adiposity has been supported by the International Task Force on Obesity and the Expert Committee since 1994. Unlike adults, the absolute BMI value is not directly applicable to children for identifying weight status because of the adiposity rebound. The release of the BMI-for-age growth charts finally allowed practitioners in the United States to assess weight status in children using the BMI standard. Thus, in the United States a recommendation has been in place for more than a decade for practitioners to assess weight status in children using the BMI-for-age charts, and these charts have been available to practitioners for most of that same time period. Therefore, the primary objective of this systematic review was to summarize research conducted since 2000 regarding pediatric health care providers’ calculation of BMI and use of the BMIfor-age growth charts to assess weight status in children.