Should Pediatricians Use BMI to Measure Children’s Weight?

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Because obesity is a complex problem, we must be cautious when we accept easy answers for why children are gaining weight rapidly. Suppose we believe obesity is simply due to eating too much and not exercising enough. In that case, we blame the children and, more often, the parents. We must consider all the reasons that children could gain too much weight too quickly.

Most studies have found that weight, overweight, or obesity should not be discussed with or in front of children younger than 8. With all its variables and complexities, a younger child needs help understanding how weight is gained. More importantly, younger children are dependent entirely on their parents. This becomes an issue at the doctor's office. Body mass index (BMI) is often discussed with parents in front of their children. For a child who is gaining too much weight too fast, BMI scores can feel like a bad grade, like they are failing at being a healthy weight.

There are ways for us to talk with love, compassion, and kindness about gaining too much weight too fast. There is a way to feel worthy and compassionate toward ourselves and our children of any size, at any weight. Providing parents and children with all the health measurements will help them put body mass index into perspective if relayed to them at all. It helps you and your child build hope, resilience, and courage to keep making healthy choices, be active, and find the simple joys of meaningful and deep connections at home, school, and in their communities.

Should Pediatricians Use Body Mass Index to Measure Children's Weight?

Clinicians and public health professionals often use BMI to determine obesity. Let's talk about the history of BMI for a minute. It is a public health and research tool and not a tool for parents to assess their child's health. Here's why: First, Adolphe Quetelet created the body mass index in the 19th century. Quetelet created BMI to assess weight distribution across populations. He based his idea of "the ideal man" on the measurements of white, male Scottish and French soldiers.

Later in the 1970s, a few essential US-based doctors got frustrated with insurance companies arbitrarily setting weight and death standards to get insurance payments. The US-based doctors rebranded Quetelet's index for use in the United States. Other countries also adopted the BMI standard even though it used the measurements of white men. Despite its questionable history and implicit racism, BMI is how we measure health for all races, genders, and body types.

Knowing a child's BMI does not help parents assess how best to help their child. Height and weight alone aren't as accurate for children as they are for adults. Why? Kids' body fat percentages change as they grow, and their BMIs vary based on their age and gender.

According to a newly adopted policy in June 2023, the American Medical Association recognizes concerns about using BMI as a measurement due to its historical harm, usage for racist exclusion, and the fact that BMI is mainly based on data acquired from prior generations of non-Hispanic white populations.

Physicians often avoid the topic of too much weight gain because they may struggle to find the appropriate tone and language to address it. And because the obesity epidemic affects everyone, some nurses and doctors with weight issues may be reluctant to talk about weight, just like us. Many doctors and nurses struggled when tobacco was proven harmful to us. Doctors and nurses who smoked were often reluctant to discuss smoking with patients.

There is good news. The number of children with too much weight gain was leveling off before the COVID-19 pandemic. The number of children with too much weight gain has remained reasonably stable at about 17%, affecting approximately 12.7 million children and adolescents. The not-so-good news is that there are 12.7 million children who continue to struggle with gaining too much weight too fast. Many are seriously ill and need safe, effective, compassionate care.