Definition Height and Weight Measurement

The measurement of height or stature is a major indicator of bone length and general body size.
The recommended technique for height measurement includes the use of a vertical board with an
attached metric rule and horizontal headboard, collectively known as a stadiometer. The standard
measure of weight should be recorded using a calibrated electronic scale. The kilograms should
be recorded in the patient’s chart. For both height and weight measures, the patient should remove
shoes and heavy clothing/objects before the measurement.
BMI and CDC Percentiles
The BMI, the calculated number that adjusts weight for height, uses the following formula:
BMI = weight (kilograms)/height (meters2).
The Centers for Disease Control define at risk of overweight as a BMI between the 85th and 95th
percentile for age. Children are considered overweight or obese if the BMI is greater than the 95th
percentile for age. In adults, a BMI value greater than or equal to 25 but less than 30 is considered
overweight, and a BMI value greater than or equal to 30 defines obesity or severe overweight [27].
However, these BMI cutoffs are not appropriate for classifying children’s weight status. First,
childhood mortality is not likely to be related to body composition, so it is not possible to develop
risk-based criteria [28]. Second, BMI typically varies with age, decreasing in the preschool years,
and then increasing after about 6 years of age. Because of these changes in BMI with growth, agespecific
criteria are needed. Gender-specific criteria are also needed as a result of differences in
body composition and timing of growth patterns in adolescence for boys and girls [29]. Revised
growth charts with smoothed age and sex-specific BMI percentile curves were developed by the
National Center for Health Statistics for children aged 2 to 17 years [28]. According to current
standards, youths with a BMI greater than or equal to the 95th percentile for age and sex are
considered overweight, and those with a BMI falling between the 85th and 95th percentiles for age
and sex are considered at risk for overweight [30–32].
It is recommended that children with a BMI at the 85th or higher percentile be further evaluated
for complications associated with overweight and for recent excessive weight gain. Assessments
should include the evaluation of potential genetic, endocrine, or psychological syndromes [30,33–36].
Family medical, diet, and physical activity history should be considered to identify primary risk
factors for overweight, such as parental obesity, sedentary behaviors, early feeding practices,
metabolic or hormonal stress, socioeconomic factors, and ethnicity [5–7,9,34,37–41].
Circumference Measurements
An additional method of assessing body composition is the measurement of girth of various body
sections [42]. From the sum of the measurements, percentage body fat is determined from equations,
tables, or nomograms. A metal or fiberglass measuring tape with a metric scale is used to measure
the circumference of the waist and hip. The waist circumference is a useful indicator for determining
reduction in fat weight after treatment.
Blood Pressure and Heart Rate
Resting blood pressure (BP) measurement is taken as a measure of the force of the heart’s pumping
action. Hypertension in children and adolescents continues to be defined as systolic BP or diastolic
BP that is, on repeated measurement, above the 95th percentile. BP between the 90th and 95th
percentile in childhood had been designated “high normal.” To be consistent with the Seventh
Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure [43], this level of BP will now be termed “prehypertensive” and is an
indication for lifestyle modifications [43]. Pediatric hypertension is often observed in overweight
children, especially those with severe conditions.
Laboratory Blood Work (Baseline, 3 Months and 1 Year)
Biochemical markers, total cholesterol, triglycerides, high-density lipoproteins, and low-density
lipoproteins should be examined by drawing 10 to 20 cc of whole blood in a certified laboratory.
Children should be required to fast for 12 hours before the test.