For adults 21 and over, overweight is defined as a body mass index (BMI – weight/height2 [kg/m2]) of 25.0-29.9. Obesity (class 1) is defined as a BMI 30.0-34.9, obesity (class 2) is defined as BMI 35-39.9, and extreme obesity (class 3) is defined as a BMI ¡Ý40.
From birth to 2 years of age, weight-for-length is plotted on gender-specific Centers for Disease Control and Prevention (CDC) growth charts. Weight-for-length >95th percentile is defined as overweight.
For children 2-20 years old, BMI is plotted on gender-specific CDC BMI-for-age growth charts. BMI-for-age between the 85th-94th percentile is defined as at risk for overweight and BMI-for-age >95th percentile is defined as overweight.
The CDC growth charts for birth to 20 years of age were developed using data from a nationally representative sample, but they are not specific for children with developmental disorders. Children with developmental disorders may have altered growth patterns compared to children without developmental disorders. The CDC recommends, however, that the CDC growth charts be used to examine growth patterns over time for all children.
Condition-specific growth charts are available for these conditions:
The use of these charts should be carefully considered. They are limited by the fact that they are developed from small sample sizes and homogenous populations (little ethnic/geographic diversity). It is also unclear in many cases if consistent measuring techniques were used and if nutritional status/secondary medical conditions were taken into account when constructing these charts.
It may be difficult to measure height in children with the inability to stand, contractures, scoliosis, lack of head and trunk control, and the need to wear braces. There are some alternative measurements that can be used to assess linear growth (specific description/pictures for techniques):
All of these measurements can be plotted on the CDC stature-for-age or length-for-age charts to establish a growth pattern over time (even if measurements are <5th percentile).
If children are unable to stand, chair scales, bucket scales, wheelchair scales, or bed scales can be used. If only standing scales are available, weigh an adult holding the child, then weight the adult alone and subtract his/her weight from the original measurement. If a child requires braces to be able to stand, the braces can be weighed separately and subtracted from the child’s weight measurements.
If children with developmental disorders have decreased muscle mass or differences in bone size, they may have increased body fat (conferring increased health risks) without a BMI-for-age in the at risk/overweight percentile range. Mita et al. found that children with spina bifida were more likely than age matched controls to have increased percent body fat after age 6. Skinfold measurements can be useful in monitoring changes in a child’s body composition (more information on skinfold measurements).
2000 CDC Growth Charts: United States
CDC BMI Calculator
Centers for Disease Control and Prevention
Course Title: CDC Growth Chart Training
Health Resources and Services Administration: Maternal and Child Health Bureau
Course Title: The CDC Growth Charts for Children with Special Health Care Needs
Individuals with developmental disorders may have altered energy intake needs compared to patients without developmental disorders because of eating patterns, hypotonia, short stature, and limited mobility/physical activity. Rubin et al. found that individuals with Down syndrome who live in family settings are at higher risk for overweight and obesity compared with individuals living in group home or institutional settings. Therefore family counseling about nutrition and physical activity is important.
Condition-specific equations for estimating daily energy requirements (Children with Special Health Care Needs: Nutrition Care Handbook):
Down syndrome (children ages 5-11)
Spina bifida (minimally active children >8 years)
Prader-Willi Syndrome (all children and adolescents)
Example recommendations for decreasing calorie intake include increasing fruits, vegetables and whole grains and limiting fruit drinks/juices and sodas in the diet. For assessment of caloric intake and development of a calorie-appropriate eating plan, refer patients to a registered dietitian. Find a dietitian.
Bandini et al. analyzed NHANES 1999-2002 data and found that children with physical activity limitations had a 20% higher risk of being at risk for overweight and a 14% higher risk of being overweight compared to children without physical activity limitations. The CDC currently recommends that children and adolescents participate in at least 60 minutes of moderate intensity physical activity on most days of the week, preferably daily.
You can help parents and caregivers to reduce weight gain due to decreased physical activity by promoting appropriate, adaptive physical activities for individuals with developmental disorders:
In addition, recommend that parents and caregivers reduce television time.
American Academy of Pediatrics Policy Statement: Prevention of Pediatric Overweight and Obesity
Bright Future in Practice: Physical Activity, Children with Special Needs
University of Tennessee, Boling Center for Developmental Disabilities
Course Title: Interdisciplinary Leadership Training in Overweight Prevention and Intervention for Children with Special Health Care Needs
Assessment of potential complications of overweight
Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services
Obesity Evaluation and Treatment: Expert Committee Recommendations (children/adolescents)
American Medical Association
Adolescent Health: Nutrition and physical fitness
Assessment of potential complications
Referral to a registered dietitian may help patients to achieve their dietary goals Reduce calorie intake by 500-1000 calories per day (but not below 800 total calories). General calorie guidelines for weight loss: Women <165 pounds, sedentary women: 1000-1200 calories/day; Men, women ≥165 pounds, women who exercise: 1200-1600 calories/day.
National Heart, Lung, and Blood Institute: Obesity Education Initiative
Acosta, P.B. et al. (2003). Nutrient Intakes and Physical Growth of Children with Phenylketonuria Undergoing Nutrition Therapy. Journal of the American Dietetic Association, 103(9), 1167-1173.
Bandini, L.G., Curtin, C., Hamad, C., Tybor, D.J., Must, A. (2005). Prevalence of Overweight in Children with Developmental Disorders in the Continuous National Health and Nutrition Examination Survey (NHANES 1999-2002). The Journal Pediatrics, 146, 738-43.
Cronk, C., Crocker, A.C., Pueschel, S.M. et al. (1998). Growth Charts for Children with Down Syndrome: 1 Month to 18 Years of Age. Pediatrics, 81(1), 102-110.
Curtin, C., Bandini, L.G., Perrin, E.C., Tybor, .DJ., Must, A. (2005). Prevalence of Overweight in Children and Adolescents with Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorders: A Chart Review. BMC Pediatrics, 5, 48.
Haqq, A.M., Stadler, D.D., Jackson, R.H., Rosenfeld, R.G., Purnell, J.Q., LaFranchi, S.H. (2003). Effects of Growth Hormone on Pulmonary Function, Sleep Quality, Behavior, Cognition, Growth Velocity, Body Composition and Resting Energy Expenditure in Prader-Willi Syndrome. Journal of Clinical Endocrinology and Metabolism, 88(5), 2206-2212.
Havercamp, S.M., Scandlin, D., Roth, M. (2004). Health Disparities Among Adults with Developmental Disabilities, Adults with Other Disabilities, and Adults Not Reporting Disability in North Carolina. Public Health Reports, 119(4), 418-426.
Holm, V.A. (1995). Growth Charts for Prader-Willi Syndrome. In Greenswag L.R. & Alexander, R.C. (Eds.) Management of Prader-Willi Syndrome 2nd ed., New York: Springer-Verlag.
Horton, W.A., Rotter, J.I., Rimoin, D.L., et al. (1978). Standard Growth Curves for Achondroplasia. The Journal of Pediatrics, 93(3), 435-438.
Kline, A.D., Barr, M., Jackson, L.G. (1993). Growth Manifestations in the Brachmann-DeLange Syndrome. American Journal of Medical Genetics, 47(7), 1042-1049.
Krick, J., Murphy-Miller, P., Zeger, S., Wright, E. (1996). Pattern of Growth in Children with Cerebral Palsy. Journal of the American Dietetic Association. 96, 680-685.
Lyon, A.F., Preece, M.A., Grant, D.B. (1985). Growth Curves for Girls with Turner Syndrome. Archive of Disease in Children, 60(10), 932-935.
Mita, K., Akataki, K., Itoh, K., Ono, Y., Ishida, N., Oki, T. (1993). Assessment of Obesity of Children with Spina Bifida. Developmental Medicine and Children Neurology, 35(4), 305-11.
Morris, C.A,. Demsey, S.A, Leonard, C.O,. et al. (1998). Natural history of Williams syndrome: Physical Characteristics. The Journal of Pediatrics, 113(2), 318-326.
Myrelid, A. et al. (2002). Growth Charts for Downs Syndrome from Birth to 18 Years of Age. Archive of Disease in Children, 87, 97-103.
Position of the American Dietetic Association: (2004). Providing Nutritional Services for Infants, Children, and Adults with Developmental Disabilities and Special Health Care Needs. Journal of the American Dietetic Association, 104(1), 97-107.
Ranke, M.B., Pfluger, H., Rosendahl, W., et al. (1983). Turner Syndrome: Spontaneous Growth in 150 Cases and Review of the Literature. European Journal of Pediatrics, 141(2), 81-88.
Rimmer, J.H., Braddock, D., Marks, B. (1995). Health Characteristics and Behaviors of Adults with Mental Retardation Residing in Three Living Arrangements. Research in Developmental Disabilities, 16(6), 489-499.
Rubin, S.S., Rimmer, J.H., Chicoine, B., Braddock, D., McGuire, D.E, (1998). Overweight Prevalence in Persons with Down Syndrome. Mental Retardation, 36(3), 175-181.
Stevens, C.A., Hennekam, R.C., Blackburn, B.L. (1990). Growth in the Rubinstein-Taybi Syndrome. American Journal of Medical Genetics, 6, 51-55.
Styles, M,E,, Cole, T.J., Dennis, J., Preece, M.A. (2002). New Cross Sectional Stature, Weight, and Head Circumference References for Down’s Syndrome in the UK and Republic of Ireland. Archive of Disease in Children, 87, 104-108.
California Obesity Prevention Initiative
Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity
Executive Office of the President and the Department of Health and Human Services (DHHS)
United States Department of Agriculture
Nutrition information clearinghouse: http://www.nutrition.gov/
Dietary Guidelines for Americans 2005
The President’s Council on Physical Fitness and Sports
The President’s Challenge Physical Activity and Fitness Awards Program
DHHS Healthy Lifestyles Campaign
National Cancer Institute 5-to-9 a Day Campaign
CDC VERB Campaign (fitness for children ages 9-13)
CDC BAM! Campaign (nutrition and fitness for adolescents)
Federal Land Management Agencies
American Obesity Association
Holm V. In: Greenswag LR, Alexander RC, (Eds.) (1995). Management of Prader-Willi Syndrome. 2nd ed. New York: Springer-Verlag, 1995.
Pediatric Nutrition Practice Group and Dietetics in Developmental and Psychiatric Disorders. (2004). Children with Special Health Care Needs: Nutrition Care Handbook. Ed. Lucas BL. Chicago: American Dietetic Association,
Mary Ann Lewis, Dr.P.H., R.N., F.A.A.N.
Theodore A. Kastner, M.D., M.S.
Felice Weber Parisi, M.D., M.P.H.
Sam Yang, M.D.
Larry Yin, M.D., M.S.P.H., F.A.A.P.
Funded by a grant from the California Department of Developmental Services
For more information, contact:
Center for Health Improvement
1330 21st Street, Suite 100
Sacramento, CA 95814
This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.
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