In an attempt to combat Michigan's childhood obesity epidemic, Gov. Rick Snyder announced today that the state would begin tracking kids' body mass index through the Michigan Care Improvement Registry. Although the policy would be one of the most extensive government anti-childhood obesity efforts, pediatricians were divided over whether it would have the desired impact.
The tracking system would encourage pediatricians to calculate patients' BMI using height and weight measurements, and report these numbers to the state through the existing immunization tracking system, the Michigan Care Improvement Registry. The numbers would be reported anonymously, meaning that the child's identity would not be connected to his or her BMI in state records.
The hope is that having doctors track height and weight in this way would encourage more discussion among parents, kids and doctors about the dangers of being overweight, says Geralyn Lasher, director of communications at the Executive Office of the Governor.
The new policy does not require that doctors discuss obesity with kids and parents, nor does it provide physicians with the extra time or training needed to discuss weight problems -- a narrowness of focus that some doctors believes will limit the policy's effectiveness.
"Merely tracking and reporting BMI may encourage some doctors to do more to help their overweight patients, but it is far from enough," says Dr. Christina Scirica, director of the Pediatric Fitness Collaborative at Massachusetts General Hospital in Boston. "At the current time, many pediatricians feel ill-equipped to address obesity even after it has been identified," she says.
Others questioned the policy's use of BMI, an obesity metric some pediatricians call oversimplified and misleading , especially in children.
"BMI is a very poor tracking mechanism for a child, because it doesn't look at body fat. It looks at height and weight," says Dr. Dan Cooper, a chairman of the pediatrics department at the University of California at Irvine. "Take a high school football player who's 6 feet 1, and mostly muscle and someone who is 6 feet 1 and 30 percent fat, and they will have the same BMI," he says.
Cooper worries that discussing obesity in terms of BMI with parents and kids will be misleading, as tracking BMI does not reflect positive changes overweight kids can make in their activity level.
"If you have a kid in a fitness program who starts putting on muscle, his BMI may not change, but he is getting much healthier. I encourage discussion about weight and health, but you don't do it through mandating phony endpoints. This is just going to be a lot of money and bureaucracy. It won't' solve the problem," he says.
But Keith Ayoob, director of the Rose R. Kennedy Nutrition Clinic at Albert Einstein College of Medicine, defended the use of BMI, saying that while it's not a perfect measure, it's the "best we've got" for measuring obesity on a population.
The Michigan chapter of the American Academy of Pediatrics expressed it's support of the policy in a hearing earlier this week, according to executive director of the chapter, Denise Sloan.
Reporting Weight to the State
While Michigan's BMI tracking system will most likely become only an entry point for further discussion and intervention in cases of obesity, any pediatricians still believe it's worth the effort.
In Michigan, 12.4 percent of individuals under 18 are obese, and that rate rises to 31.7 percent among adult Michiganders. As many as two-thirds of adults in the state are overweight, if not obese, making Michigan the eighth fattest state in the nation.
Data Is Power?
"It is absolutely essential that pediatricians track BMI in their patients," Scirica says. "Obesity in childhood is highly predictive of obesity later in life, and the longer a child remains overweight and the more overweight they become, the harder it becomes to achieve a healthy weight."
Encouraging a regular conversation between pediatrician and parent about a child's weight is so important, Scirica says, because "some parents are simply not aware that their child is overweight or obese. Even among parents who do recognize that their child is overweight, there is a tendency to underestimate just how overweight their child is ... and underestimate the long-term health and other risks associated with their child's excess weight."
Childhood obesity is "arguably the No. 1 pediatric health problem," says Ayoob, "so if reporting on BMI -- something doctors should already be tracking on their own -- allows for documentation of a worsening or improvement, this could also help influence future policy."