Definitions for Children and Teens

For children and teens, BMI ranges above a normal weight have different labels (overweight and obese). Additionally, BMI ranges for children and teens are defined so that they take into account normal differences in body fat between boys and girls and differences in body fat at various ages. For more information about BMI for children and teens (also called BMI-for-age), visit BMI for Children and Teens. For more, Kids' BMIs are based on height and weight, like adult BMIs. But then that number is taken and placed on a growth chart to account for your child's age and gender because, unlike adults, kids are still growing. The ending result is not a plain BMI number but rather a BMI percentile. That percentile is also called "BMI for age." see Defining Childhood Overweight and Obesity. y y y y less than the 5th percentile Healthy Weight: 5th percentile up to the 85th percentile Overweight: 85th percentile up to the 95th percentile Obese: 95th percentile or greater

If youre concerned about your childs weight, or your child has been referred for treatment of childhood obesity, you are not alone. One-third of children in the United States are currently considered overweight or obese based on their body mass index, or BMI. (BMI is a calculation that uses height and weight to estimate how much body fat someone has.) Across Nemours campuses, teams of dedicated childhood obesity experts work one-on-one with your child and family to develop a personalized treatment plan. We take many factors into consideration, including your childs overall physical, social, and emotional health; the stage of your childs obesity; and your familys lifestyle and readiness for change. Our teams include: doctors who are subspecialists from a variety of medical areas physician assistants nurse practitioners exercise physiologists registered dietitians social workers psychologists researchers child advocates health information experts

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From prevention education to specialized treatment, our programs integrate the latest research and most advanced clinical care to address the whole child. Here are some of the services we offer:

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obesity prevention through primary care offices, including early identification and management of atrisk and less complex cases referral-based clinical weight management services, which include consultations with our doctors, registered dietitians, exercise specialists, and psychologists, as well as others who can help to identify the best methods for improving your childs healthy habits support groups and other specialized programs to address your childs physical, nutritional, emotional, social, and behavioral needs adolescent bariatric surgery (weight loss surgery to reduce the size of the stomach) for children who are severely obese and meet certain diagnostic criteria

For children with serious complications resulting from obesity (pre-diabetes, type 2 diabetes, sleep apnea, high blood pressure, asthma, stroke, and heart disease, among others), we offer numerous pediatric specialties all under one roof who can help co-manage your childs case. These experts are also able to provide guidance when it comes to the needs of special subsets of overweight or obese children, such as kids under the age of 5, or those with other medical conditions that may make it harder for them to lose weight (for example, cerebral palsy or spina bifida, which both may require wheelchair use.) Furthermore, all of Nemours services and programs are connected through NemoursOne, an electronic medical record that allows all of your childs doctors and caregivers to communicate in real time. This reduces redundancy in testing and other services, and keeps all team members up-to-date on your childs visits and progress. Nemours commitment to preventing and treating childhood obesity reaches far beyond our hospitals and clinics and out into the community. Nemours Health and Prevention Services (NHPS) is a division specially created to focus on health promotion and obesity prevention activities in the many different places where children and families spend their time, such as: child-care centers schools after-school programs primary care settings the built environment, which includes the physical environment of our communities, such as sidewalks, trails, bike paths, parks, and recreation areas the availability of which can increase families opportunities for physical activity and access to healthy foods.

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Although the centerpiece of NHPS endeavor is the promotion of the 5-2-1-Almost None healthy lifestyle, our campaign is even more broad-reaching. Our goal is to enhance community awareness of strategies to keep kids healthy through outreach efforts, publications, online resources, and advocacy on the local, state, and national level. Through increased awareness, we hope to engage parents, communities and decision makers as advocates for the creation of environments that make healthy choices easy for children and families. 5-2-1-Almost None.

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Eating at least five servings of fruits and vegetables a day Limiting screen time to no more than two hours a day Getting at least one hour of physical activity a day Drinking almost no sugary beverages. E at FIVE or more servings of fruits and vegetables a day Fruits and vegetables are key to a healthy diet. Most fruits and vegetables are full of nutrients.They are also low in calories and fat, and they are full of water and fiber, which makes them filling. For all of these reasons, they are a great choice for your family anytime

Tips to fill your diet with fruits and vegetables - Include two fruits or vegetables in every meal. - Add vegetables like broccoli, peppers, or tomatoes to your eggs or omelets. Try tomato slices on your breakfast bagel. - Add berries, bananas, or other brightly colored fruits to cereal, pancakes, or waffles. - Pile veggies on your pizza the possibilities are endless sliced tomato, mushrooms, onions, peppers, broccoli, and spinach. Sometimes you can even get pineapple on your pizza, yum! - Instead of plain lettuce (BORING!), add color and flavor to your salad with chopped apples, raisins, or mandarin oranges. - Order your sandwiches with lettuce, tomato, peppers, onions, or sprouts or maybe with all of the above! - Chop up fruits and vegetables and store them in the fridge so they re ready to eat. - Ask your parents to buy the fruits and vegetables you like so when you feel munchy, you ve got plenty of options. Try a new fruit or vegetable every week! -Try peanut butter or fat free or low-fat dips, dressings or cheese along with fruits and veggies. - Blend your favorite fruit with fat-free or 1% milk or frozen yogurt to make a smoothie.

Tips for Success:

n Get your child involved. Let them help you wash, cook, or chop the fruits and vegetables. They love to eat what they help to make. n Give your child a new fruit or vegetable with their favorite old ones. It can take ten or more tries for kids to like a new food. So, if they dont like it the first time, try it again. They might surprise you! n Make sure there is a fruit or vegetable choice at every meal. n Have fruits and vegetables where your child can see them. Have them on the counter or in the fridge, and pre-cut for easier grab and go snacks. n Be creative. Add fruits and vegetables to pancakes, cereal, oatmeal, pasta, or sandwiches. n Ask your child to help you choose vegetables and fruits to buy when shopping. Try new ones every week Although there is no real cure for obesity, Nemours family-centered approach helps families work together to change their behaviors and move toward success. We believe real progress can be made when communities are informed and activated, and primary health care providers are prepared and proactive. Thats why weve developed tools and resources to help primary care providers in the early identification of children at risk of obesity. For example, BMI data is tracked electronically at all of our primary care sites so that at-risk children can be identified earlier and receive intervention before problems begin. For children who are referred at the primary care level, specialty clinical services are available to assist families at each of our locations Behavior-based weight loss results are also tracked for ongoing research purposes. By determining the best practices of obesity prevention and treatment, we can better direct our future clinical intervention and prevention initiatives, as well as offer evidence-based support to primary care doctors.

Watch no more than TWO hours of screen time a day Try not to spend more than two hours per day in front of a screen! What s screen time? It s time you spend watching TV, DVDs or videos, using the computer, or playing video games. You ll be happy to hear that screen time DOES NOT include time you spend on the computer doing homework. Whew! So, not including homework, how much time do you spend in front of the screen every day? If you re like most kids, it s probably far more than the recommended two hours. Today, kids across the U.S. are racking up over six hours a day in screen time. That s about 45 hours per week more than a full time job! Unless you are working out with an exercise video or playing Wii Fit, how often are you moving while you are in front of a screen? Go outside and do something fun

like catching a football, sinking a free throw, or turning a jump rope. The more TV you watch, the less time you have to be active and healthy. Why do we always eat in front of the TV? How often do you grab a snack and eat it while watching TV? Snacking isn t bad if you only eat when you re hungry, but are you always hungry when you eat? Researchers have found that the more you watch TV, the more you eat especially the types of foods advertised on television, which usually aren t too healthy!

How do I get my child to turn off the TV or computer? Give your kids a screen time allowance. Help them make a list of the shows they really want to watch or games they really want to play. Make a log to track their screen time. Set a timer. Once two hours are up, find other fun things to do together. When your children reduce their screen time, give them a reward. Tips for Success Try reading and crafts. Have books, magazines, and puzzles around. n Go to the park or playground. Maybe take a walk around the neighborhood. Go together as a family. It s a great chance to be active together. n Instead of turning on the TV, turn on some music and have fun singing or dancing together. n Turn off the TV during dinner and take time to hear about your child s day. Talk about your child s highs and lows for the day. n Learn more about turning off the TV and find resources like TV budgets, Unplugged TV Guide, and fun things to do inside and outdoors. Can watching TV affect your grades? Yes! Poor academic achievement and obesity have been linked to excessive screen time. Here s a challenge: bury your TV by reading and getting active! For each hour that you read or do physical activity (walking, basketball, skateboarding, etc.), take a small piece of paper, write down your book or activity, and tape it over your TV screen. Keep reading, being active, and adding paper until your TV is buried in books and activities! Tips for tuning out what to do instead of watching TV - Read a really good book, comic book, or magazine that s not for school. - Play board games, card games, or invent your own game (and your own rules!).

- Make up wild, scary, or funny stories. - Help out around the house. - Act out your own TV show, play, or story. - Call or visit your family and friends. - Do some arts and crafts paint, draw, sculpt, or make bead jewelry. -Listen to music and have a dance party! - Volunteer to help out in your community. - Hang out with your friends and play sports, walk in the park, or go to the pool or skating rink. - Hang out with parents who knows? They may have something interesting to say today. -Join a sports program in your neighborhood. - Ride a bike, scooter, skateboard anything without a motor. -Turn off the TV during dinner and ask each person in your family about their day Try to get at least one hour of physical activity every day! Keep active for ONE hour or more every day Physical activity means moving your body. Most kids and adults do not move their bodies enough each day. One hour of activity is what kids need daily. Adults should be active for 30 minutes every day. If your heart is pumping fast, you are being active. Try to get breathless once each day! Tips for Success: n Be active together. Being active with your family is fun! Talk with your kids while walking the dog or shooting hoops. n Add more activity to the things you do. Park your car farther away from store entrances. Take the stairs instead of the elevator. n Set up a safe area in your home where you can play bad weather is no excuse. n Plan active family fun for the weekend. Try hiking, jumping rope, hula hooping, swimming in the local pool, or tossing a Frisbee in the park. n Pick some activities that are hard and easy. Try walking slow and dancing fast. n Throw a move it party! Turn up the music and dance!

Being active helps our bodies stay strong and healthy. Kids who are active may do better in school, have more energy, and sleep better.

You don t have to do the same thing for a whole hour. You can do as many different activities as you want and add up the minutes to meet your goal of one hour! For example, add up: 20 minutes for walking to school + 20 minutes for shooting hoops with friends + 10 minutes for raking the leaves + 10 minutes for walking your dog = 60 minutes (1 hour) Fun facts about physical activity - It keeps your body healthy so you can run faster, think better, and feel great! -It s good for your heart! When you make your heart beat faster, it gets stronger. - It makes your bones and muscles strong because they work hard to keep your body moving. -It can give you energy and help you to feel better when you re sad or worried. - You can help your family and be physically active at the same time! You can jump to reach the high spots when you help to wash the car, pretend you re lifting weights when you put away the groceries, shoot baskets when you throw your dirty laundry in the hamper, and sing and dance with a broom microphone when you sweep the deck! You can be a great role model for your family by showing them easy ways to get active. Physical activities you can do with your friends or family Tip: Put a check next to your favorite physical activities, and put this list on the fridge

where you and your family can see it. Keep track of your physical activity Use the chart below to keep track of your activity and the time you spent doing it. Try for one hour a day! You can make copies of this chart to use for the future since you will probably fill it up fast. What if it s raining outside?Puddle jump and see who can make the biggest splash Dance to your favorite music Borrow your mom s exercise video and work out Play Wii Fit or other exercise related video games

Physical activities you can do by yourself Go on a scavenger hunt Make an obstacle course Play capture the flag Play tag Play kickball Set up a field day Play catch Play 4-square Play volleyball Play touch football Play street hockey Throw a Frisbee Rake leaves Shovel snow

Do jumping jacks Ride your bike Hula Hoop Play hopscotch Take your pet for a walk (not your turtle, though, he might get tired!) Jump rope Walk, skip, jog, or run Shoot hoops DANCE! Roller skate (be sure to wear pads and a helmet!) Walk or run on the track at school Play hacky sack Skateboard

Swim Do push ups or sit ups Sunday Week 1 DANCE 1 HOUR Monday Tuesday

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Youth Physical Activity: TheRoleofSchools Being physically active is one of the most important steps to being healthy. Schools are an ideal setting for teaching youth how to adopt and maintain a healthy, active lifestyle. Schools can help youth learn how to be physically active for a lifetime. Why Should Schools Provide Physical Activity Programs? Youth who are physically active get physicaland mental health benefits.

Comprehensive school-based physical activity programs can help youth meet most of their physical activity needs. School-based physicalactivity programs benefit communities as well as students and schools. How Does Physical Activity Help? Builds strong bones and muscles. Decreases the likelihood of developing obesity and risk factors for diseases like type 2 diabetes and heart disease. May reduce anxiety and depression and promote positive mental health How Much Physical Activity Do Youth Need? Children and adolescents should do 60 minutes(1hour) or more of physical activity daily

AerobicActivities: Most of the 60 or more minutes per day should be either moderate- or vigorousintensity aerobic physical activity. Vigorous-intensity physical activity should be included at least 3 days per week. Examples of aerobic activities include bicycle riding, walking, running, dancing, and playing active games like tag, soccer, and basketball. Muscle-strengthening Activities: Include muscle-strengthening physical activity on at least 3 days of the week as part of the 60 or more minutes. Examples of muscle-strengthening activities for younger children include gymnastics, playing on a jungle gym, and climbing a tree. Examples of muscle-strengthening activities for adolescents include push-ups, pull-ups, and weightlifting exercises. Bone-strengthening Activities: Include bone-strengthening physical activity on at least 3 days of the week as part of the 60 or more minutes. Examples of bone-strengthening activities include hopping, skipping, jumping, running, and sports like gymnastics, basketball, and tennis. Some activities may address more than one category at a time. For example, gymnastics is both muscle strengthening and bone-strengthening while running is aerobic and bone-strengthening. Activities should be age-appropriate, enjoyable, and offer variety How Does Physical Activity Affect Academic Achievement? Physical activity can help youth improve their concentration, memory, and classroom behavior. Youth who spend more time in physical education class do not have lower test scores than youth who spend less time in physical education class. Elementary school girls who participated in more physical education had better math and reading tests scores than girls who had less time in physical education. What Can Schools Do To Promote Physical Activity for Youth? Have policies that provide time for organized physical activity and free play. Provide information to parents about the benefits of physical activity in messages sent home and at school events. Encourage staff to be active. School staff and school leadership are role models for students. Encourage families and local groups to be involved in school-based physical activities and events.

How Can Schools Help Youth Be More Physically Active? A large percentage of youth physical activity can be provided through a comprehensive schoolbased physical activity program with quality physical education as the corner stone. All of the parts of a physical activity program (listed below) help youth explore different physical activities and give them the chance to learn and practice the skills to establish physically active lifestyles. A comprehensive physical activity program includes the following: Quality Physical Education Gives students the knowledge and skills to participate in a life time of physical activity. Teaches movement skills Uses materials of the Uses activities (more than Meets Is an the and how to assess physicalactivity. for the age and skill level

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Activity Recommendation: Schools should participate in International Walk to School Week and support ongoing walk and bike to school programs (e.g., create safer routes to school, provide access to secure bike racks). How Can Schools Partner with Families and Community Groups? Let families know about physical activity programs community. at school and in the

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Energizers classroom-based physical activity program. Energizers are short classroom-based physical activities. By allowing students to stand and move during academic instruction, these activities provide students with an opportunity to increase daily physical activity levels during the school day. The activities last approximately 10 min, integrate grade-appropriate learning materials, involve no equipment, and require little teacher preparation. In the present study, teachers were asked to lead one 10-min activity per day for 12 wk. Teachers were trained to lead the activities, were provided with copies of all of the activities, and were allowed to choose whichever activity they wanted each day. Teachers were told which week their class would be assessed for physical activity and, if applicable, when their class would be observed for on-task behavior

Have ALMOST NO sugary drinks Sugary drinks include sodas and sports drinks. The best choices are water, fat-free or 1% milk, or half cup of 100% juice.Sugary drinks are not good for your body. They have added sugars and almost no nutrients. Healthy drinks have the nutrients your body needs. Tips for Success: n When thirsty THINK WATER. Keep water on hand to quench thirst. Add flavor to your water with fruit or vegetable slices. n Start at home. When you go to the store, buy healthy drinks instead of sugary drinks. Your children learn from you. Let them see you choose healthier drinks. n Change what you drink with meals. Serve water or fat-free milk at meals and snack time.

n Limit 100% juice to a half cup (4 oz.) per day. Water and fat-free or 1% milk are the best drinks for kids two and up Too much sugar can Cause cavities in your teeth Make you gain more weight than you should Can you guess what some sugary drinks might be? Any soda except for diet sodas Any juice that doesn t say 100% juice on the bottle Sports drinks Sweetened iced teas What can YOU do to drink almost no sugary beverages? - Set a goal try to have fewer sugary drinks each day than you do now. If you drink two a day now, try for only one! - Make a plan how will you meet your goal? By buying water at school instead of a soda? Or by ordering a small soda instead of a large? -Ask your parents not to buy sugary drinks and tell them why. If those drinks aren t in the house, making a healthy choice will be easier for everyone! - Read drink labels before you drink them. If a drink has added sugars, find a healthier choice, or drink only one serving (the bottle may contain more). - Choose water or fat-free or 1% milk for your drinks during the day and at your meals. - Try to drink sodas only on special occasions, not every day. -Put a splash of juice in a glass and fill the rest with water or seltzer. - Make a smoothie by blending some ice and fat-free milk or yogurt with frozen fruit. Smoothies are tasty treats and are good for you!

What is BMI? bo dy Mass Index (BMI) is an estimate of a person s body fat. Your child s doctor can best measure their BMI.Using height, weight, age, and gender, BMI ranks children in one of four categories: n Underweight Underweight = <18.5

Normal weight = 18.524.9 Overweight = 2529.9 Obesity = BMI of 30 or great

n Healthy weight n Overweight n Obese

BMI
( kg/m )= weight in kilograms / height in meters

An overweight child may have too much body fat. Too much body fat can lead to illness or other health problems. It is also more likely they will be overweight as adults. Obesity can lead to diabetes, high blood pressure, heart disease, and other health problems, even in children. Children who are underweight may also have health risks. If your child is . . .

Overweight or obese If your child s BMI is above the healthy weight range, you should talk with your child s doctor. You can also help by: n Making healthier choices using 5-2-1-Almost None. n Making changes for your whole family. Do not focus on one child.

n Letting your child choose their activities and healthy foods.Don t put your child on a diet unless directed to do so by your doctor. Healthy Weight If your child s BMI is in the healthy weight range, you can help your child to stay in this range by: n Making healthier choices using 5-2-1-Almost None. n Letting your child choose their activities and healthy foods. n Asking your child s doctor to check your child s BMI each year Underweight If your child s BMI is below the healthy weight range, you should talk with your child s doctor. You can help by: n Making healthier choices using 5-2-1-Almost None. n Letting your child choose their activities and healthy foods. Even if your child is thin, they still need to eat right and be active. n Encouraging your child not to try to gain weight unless told to by their doctor. If you are concerned about your child s weight, talk to their health care provider FITNESSGRAM is a tool many schools are using to measure the fitness of their students. FITNESSGRAM measures your child s: n strength - how strong n endurance - time active n flexibility - stretching and bending n aerobic capacity - how well their body uses oxygen Using these five tests: n Curl-Up - measures stomach strength and endurance n Trunk Lift - measures lower back strength and flexibility n Push-Up - measures upper body strength and endurance

2 20 years BOYS BMI for age percentile DATE AGE WEIGHT HEIGHT BMI

NAME : RECORD : COMMENTS BMI 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 AGE IN YEARS

BMI 27 26 25 24 23 22 21 20 19 18 16 15 14 13 12

Kg/m

Kg/m2 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20