Earlier this week the Buffalo News carried Pediatricians slow to treat childhood obesity; an article critical of pediatricians - they were found in a survey to be "failing in large numbers to take Step 1 in the manual of fat prevention — calculating a child’s body mass index, or BMI." [emphasis mine]
Here readers are led to believe that Americas pediatricians are negligent in their basic duties of standard care for children - they're not calculating out BMI to "prevent" obesity in children.
Never mind the fact that the large majority are indeed weighing and measuring children at their routine well-child visits; ignore they have eyes to see and recognize a child who is too heavy; and heck, let's just forget they have experience, experience, experience, with years of taking care of kids to recognize the difference between an obese child and a normal child in their care.
Nope, let's just chastise them for exercising clinical judgement in their practice of medicine because they're not in lock-step with the additional recommendation to now calculate and chart BMI to "prevent obesity."
Some days I'm just tired of the misinformation and misleading of the public.
Calculating a BMI is data collection - nothing more; nothing less - and like any data collection, its usefullness is only as good as what one does with the data in hand.
Data such as a calculated BMI does not prevent disease (obesity); it is only a piece of a larger picture, and is a piece of data that is considered by many to be highly unreliable as a predictor of health.
Imagine for a moment you're a doctor, a pediatrician, and you've just weighed and measured this child:
He's five, stands 3'10" tall and you've determined he weighs 54-pounds, thanks to the nurse who weighed and measured him then added those figures to his chart before you entered the exam room.
You give him the once over and note he's lean and healthy; his mother tells you he's very active, quite a little monkey outside climbing, running and jumping whenever he has a chance - and you note too that he is itching to get out of your office as quickly as possible, laughing gleefully as you continue along with your physical of him.
Do you calculate his BMI at this point in time?
No? No you say?
Why, you've missed this healthy and active kid is at the 95th percentile according to the BMI - in children, that's "overweight," the politically correct way of classifying a child who registers obese on the BMI chart.
In this example, this child is one of the roughly 15% in our nation classified as "overweight" for age.
So much for your clinical judgement - you failed to recognize the fat kid in need of intervention to improve their diet and activity levels before they develop other diseases correlated with obesity!
So what are we to make of the survey?
How about some context.
The researchers reviewed the charts of 400 children and found pediatricians calculated BMI in roughly 1 in 20 children; while 91% did actually weigh and measure height in kids.
Somehow the researchers failed to ask or look at those who were calculated to compare to those not calculated - perhaps these pediatricians fail not in their care, but rather fail to see the usefulness of calculating each and every child, especially those obviously a healthy weight.
Let's do math!
According to the IOM, it's estimated that roughly 15% of children this age are at or above the 85th percentile for BMI. A closer look defines an estimated 10% are at or above the 95th percentile for BMI.
Children who hit the 85th percentile for BMI are said to be "at risk for overweight" and those who reach the 95th or higher are said to be "overweight."
Stated another way, 85% of kids are well within normal weight, and some are underweight (as problematic potentially as obesity) with BMI calculated below the 85th percetile; another 5% may be "at risk" for becoming overweight/obese because they fall between the 85th and 94.9th percentile for BMI.
Simply put - 90% of children today are not obese; 85% are not obese or at risk for overweight.
But we don't hear or see that much in the media, do we?
The media and authorities, it seems, are working really hard to scare the beejeebers out of parents these days.
Yes, the prevalence of children who are calculated as having a BMI at or above the 85th percentile has indeed increased. Where in the 70's roughly 5% of children were at or above the 85th percentile, today roughly 15% are.
But we're communicating the increased prevalence in terms designed to make the increase an issue for every parent to not only worry about, but do everything in their power to change, when the fact is that 85% of children are normal weight (or underweight).
We're not just targeting adults with the message we have a problem in the United States - today every child is being targeted - with messages about diet, exercise, risks to future health, and even the potential of premature death; hearing, repeatedly, they'll die at an earlier age than their parents because kids today are too fat.
We really need to ask ourselves, must we target all children in our attempts to reduce obesity in some children, or are our resources and time better spent when they're directed and focused on the children who really do need some help?
While it may seem useful to chastise pediatricians, whom are quite competent in their daily practice of medicine, for not calculating every child's BMI - maybe a better question is why are they being asked to when 85% of the kids walking into their office each day are not too heavy?
Do we really think pediatrians are so daft they'd visually miss recognizing an obese child?
Do we really want to require a doctor to spend time calculating out the BMI for all children s/he sees and chart they actually did calculate it out too, when 85% of the patients are likely to be below the 85th percentile?
Add to this, a percentage of the children falling at or above the 85th percentile are not really overweight or obese - by the simple BMI they are, but as the above picture illustrates visually, the BMI is not always an accurate measure of true fatness that should cause concern.
How useful is it really, in the long-term, to have every parent in America wondering if their pediatrician is failing their child because they're not calculating BMI at the office visit?