99th Percentile BMI Cutoff Points

Alternatively, an online BMI calculator is available on the CDC website, and BMI wheels have been developed to simplify this calculation for practitioners (order here). It is as important for pediatric practitioners to identify overweight and obese children as it is to recognize patients in whom BMI is increasing. Early intervention is critical for the prevention of childhood obesity. Thus, practitioners are urged to discuss and intervene by proposing nutritional, lifestyle, and behavior modifications for children in whom an upward trend in BMI is noted.

Obese children are at risk for developing numerous obesity-related conditions and medical problems during childhood (Table 3). Additionally, childhood obesity may be an independent risk factor for adult morbidity and mortality, regardless of the persistence of childhood obesity (2). The primary care provider should seek to identify associated comorbidities in each patient. Included in the list of obesity-related conditions are the psychological and social effects on overweight and obese children. These must be investigated thoroughly, as they may often be as damaging as the medical complications.

Type 2 Diabetes Mellitus Particular attention should also be focused on the occurrence of type 2 diabetes mellitus (DM) in children. Type 2 DM is being diagnosed more often in children. Less than a generation ago, type 2 DM was seen almost strictly as an adult disease, with less than 2% of new diabetic cases in children diagnosed as type 2 DM. Today, this number has increased to between 25% and 60% of new-onset childhood diabetics. With obesity being a major risk factor for type 2 DM, pediatric care providers must now view type 2 DM as a pediatric illness (3).

Cardiovascular Hypertension, ↑ [total cholesterol], ↑ [low-density lipoproteins], ↓ [high-density lipoproteins], syndrome X
Respiratory Abnormal respiratory muscle function and central respiratory regulation, diffi­culty with ventilation during surgery, lower arterial oxygenation, sleep apnea, Pickwickian syndrome, more frequent and severe upper respiratory infections, snoring, daytime somnolence, asthma
Orthopedic Coxa vara, slipped capital femoral epiphyses, Blount disease, Legg-Calv é-Perthes disease, degenerative arthritis, foot pain
Dermatologic Intertrigo, furunculosis, acanthosis nigricans
Immunologic Impaired cell-mediated immunity, polymorphonuclear leukocyte killing capacity, lymphocyte generation of migration inhibiting factor, and maturation rates of monocytes into macrophages
Gastro­intestinal Gallstones, hepatic steatosis, steatohepatitis
Neurologic seudotumor cerebri, hyperactivity and behavior problems (secondary to sleep apnea)
Somatotroph ↓ basal and stimulated growth hormone release with normal concentration of insulin-like growth factor-l, accelerated linear growth and bone age
Lactotroph ↑ basal serum prolactin but ↓ prolactin release in response to provocative stimuli
Gonadotroph Early entrance into puberty with normal circulating gonadotropin concentrations
Thyroid Normal serum T4 and reverse T3, normal or ↑ serum T3, ↓TSH-stimulated T4 release
Adrenal Normal serum cortisol but ↑ cortisol production and excretion, early adrenarche, ↑ adrenal androgens and dehydroepiandrosterone, normal serum catecholamines and 24-hour urinary catecholamine excretion
Gonad circulating gonadal androgens in males; ↑ androgens in females with ↓ sex-hormone binding globulin, dysmenorrhea, dysfunctional uterine bleeding, polycystic ovary syndrome
Pancreas fasting plasma insulin, ↑ insulin and glucagon release, ↑ resistance to insulin-mediated glucose transport, type 2 diabetes mellitus, pancreatitis (secondary to gallstones)

Adapted with permission from the AAP Pediatric Nutrition Handbook.4

Toolkit Base: