Both the Institute of Medicine¹ and the American Academy of Pediatrics² have recommended the use of annual BMI assessment as a valuable tool in the early identification of excessive weight gain in children. Because obesity is difficult to treat, early intervention in overweight children is critical. A National Institutes of Health study found that overweight in early childhood increases the chances for overweight in later life and debunks the myth that children will outgrow their excess weight as they get older.³

BMI is a reliable indicator of body fatness in children. It is calculated from a child’s weight and height and the BMI number is then plotted on a CDC gender-specific BMI-for-age growth chart. This provides a percentile ranking that compares a child’s BMI to that of other children of the same age and gender. For example, a BMI-for-age percentile of 75% means the child’s BMI is greater than that of 75% of other children of the same age and gender.

This table lists the four categories of BMI-for-age percentile recognized by the CDC and shows how each category corresponds to the child’s weight status:

Percentile Value	Weight Status
Less than the 5th percentile	Underweight
5th to the 85th percentile	Healthy weight
85th to less than the 95th percentile	At risk of overweight
Equal to or greater than the 95th percentile	Overweight

Calculating and graphing a child’s BMI is a useful tool in identifying unusual increases in weight relative to growth in height. These five graphs demonstrate five different growth patterns and illustrate how BMI growth charts can be utilized to identify the need for preventive counseling and intervention. These charts were designed utilizing the CDC’s Epi-Info software (www.cdc.gov/epiinfo).

1. The name: The new drug is called “alli” (pronounced “Al-eye”) because it “conveys the concept of partnership with consumers in their weight-loss efforts.” The company’s February 7, 2007 press release states that “alli is not for everyone. It’s for the committed consumer who can follow a reduced-calorie, low-fat diet.”

2. The mechanism of action: alli™ works in the intestine where it partially blocks the breakdown and absorption of fats. By blocking about 25% of the fat eaten in a meal, it reduces the amount of dietary fat taken into your body. Studies show that alli™ works best when combined with a reduced-calorie diet and lifestyle change.

3. How to use: alli™ is taken in a single 60 milligram (mg) dose just prior to or during a fat-containing meal. The drug works best with a meal containing about 15 grams of fat. If the meal contains considerably more than 15 grams of fat, it can result in “bowel changes” that are not harmful, but can be disconcerting and inconvenient.

4. How alli™ differs from Xenical. The active ingredient in alli™, which is known as orlistat, is identical to the active ingredient in Xenical. alli™ will be available in 60 mg capsules over the counter (OTC). Xenical is prescribed in 120 mg capsules and “will remain available by prescription for those who should be treated under the care of a physician.”

5. How alli™ differs from other weight-loss supplements available on the market without prescription. The active ingredient in alli™ has been thoroughly tested in long-term clinical trials, which have been described in detail in respected peer-reviewed scientific journals. The clinical data have been reviewed and approved by the FDA, and alli™ has been marketed (as Xenical) in the US since 1999. There is no other weight-loss supplement available OTC today that has been similarly evaluated for both safety and efficacy.

When starting out, it is important to be realistic about your current fitness level. Do you currently do any planned physical activity? If so, how often—once a week, twice a week? How long are your exercise sessions? These are important questions to ask yourself because you do not want to go from being inactive to exercising 30 minutes five times a weeks. If you are not regularly active, start with shorter exercise sessions (5–10 minutes) a couple times a week and slowly work up to 30 minutes of exercise.

If you have been following this column for some time, then you likely developed a solid base level of fitness. At this level of fitness, I recommend that you do resistance training (also called strength training) along with aerobic exercise three days per week and aerobic exercise another two days per week.

Now let’s structure an exercise plan for three levels of fitness—beginner, intermediate and advanced. Below are some mini workouts you could do if you are strapped for time. These workouts are further described in the November 2006 issue of the SUA newsletter.

Beginner
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest & Repeat x 2

Inverted Row x 8
Push Ups (from knees) x 8
Rest & Repeat x 2

Intermediate
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest & Repeat x 3

Inverted Row x 8
Push Ups (from knees or when you are ready, from toes) x 8
Rest & Repeat x 3

Advanced
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest & Repeat x 4

Inverted Row x 8
Push Ups (from toes) x 8
Rest & Repeat x 4

To give these mini workouts a little more bang and variety, add an aerobic component between each set. For example, you could walk briskly, jog around the block or a track, walk or run up and down a few flights of stairs, or simply complete 15–30 jumping jacks. Depending on your fitness level, your new resistance/aerobic hybrid workout would look like this:

Beginner
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest
Walk briskly for 3–5 minutes
Rest & Repeat x 2

Inverted Row x 8
Push Ups (from knees) x 8
Rest
Walk briskly for 3–5 minutes
Rest & Repeat x 2

Intermediate
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest
25 Jumping Jacks or up and down a flight of stairs 5 times
Rest & Repeat 3 times

Inverted Row x 8
Push Ups (from knees or when you are ready, from toes) x 8
Rest
25 Jumping Jacks or up and down a flight of stairs 5 times
Rest & Repeat 3 times

Advanced
Bodyweight Squats x 15
Abdominal Crunches x 15
Rest
30 Jumping Jacks or up and down a flight of stairs 6–7 times
Rest & Repeat x 3

Inverted Row x 8–10
Push Ups (from toes) x 15
Rest
30 Jumping Jacks or up and down a flight of stairs 6–7 times
Rest & Repeat x 3

This workout could be repeated three times per week, such as Monday, Wednesday and Friday. On at least two other days per week, do some aerobic activity (e.g., play basketball, walk, jog, dance, swim, do gardening) for a minimum of 30 minutes.

Remember, it’s important to warm up, stretch and cool down with each workout session. Warm up with a low intensity exercise, like a slow and steady walk, then stretch the muscles you will be using during your workout session, for a total of 5–10 minutes. Cool down by walking or doing your activity at a lower intensity, then stretch, for a total of 5–10 minutes. Following these steps will help you to have a safe and effective workout.

Talk about teamwork! Jennifer and her son joined forces to eat healthier and meet their weight goals—he wanted to gain weight and she wanted to lose weight. His encouragement helped his mom close in on her weight-loss goals.

I am 5'8" tall and I was over 225 lbs. As the mom of three very athletic boys, I was beginning to feel like a slob. My oldest son needed to gain some weight and brought home an eating plan from the University of Nebraska. We both decided to use the plan to eat healthier. He was nearly a fanatic about getting enough protein and eating six times a day. I joined him, but as he gained, I lost. I lost about 30 pounds, then got stuck. I had been exercising and went for a few weeks without losing and got very frustrated. To encourage me, my son brought home three 10-pound dumb bells, put them in a book bag and had me walk around the house for 10 minutes. I couldn't believe how heavy it was! He reminded me that I had lost that much weight already and that I should be proud.

My son encouraged me to just work on losing 10 pounds at a time, not the huge goals. I have lost 65 pounds so far and have kept it off for two years. Now I am ready to go back to work and lose about 15 more. I have decided to do this five pounds at a time and to be ready for an even slimmer, more energetic and healthier 2007. Keeping a journal reminds me to keep at it and it helps me realize how overeating fast food can hurt!

INGREDIENTS:

• 2 tsp. olive oil
• 1 large onion, sliced
• 1 can (16 oz) whole tomatoes, drained (reserve juice) and coarsely chopped
• 1 bay leaf
• 1 clove garlic, minced
• 1 cup dry white wine
• ½ cup reserved tomato juice, from canned tomatoes
• ¼ cup lemon juice
• ¼ cup orange juice
• 1 Tbsp. fresh orange peel, grated
• 1 tsp. fennel seeds, crushed
• ½ tsp. dried oregano, crushed
• ½ tsp. dried thyme, crushed
• ½ tsp. dried basil, crushed
• Black pepper, to taste
• 1 lb. fish fillets (sole, flounder, salmon, or sea perch)

DIRECTIONS:

1. Heat oil in large non-stick skillet. Add onion and saute over moderate heat 5 minutes or until soft.
2. Add all remaining ingredients except fish.
3. Stir well and simmer 30 minutes, uncovered.
4. Arrange fish in a 10- by 6-inch baking dish; cover with sauce.
5. Bake, uncovered, at 375° F about 15 minutes or until fish flakes easily.

Nutritional analysis per serving: 178 calories, 12 grams carbohydrate, 4 grams fat, 1 gram saturated fat, 56 milligrams cholesterol, 22 grams protein, 260 milligrams sodium, 3 grams fiber.

Source: A Healthier You: Based on the Dietary Guidelines for Americans. US Department of Health and Human Services, 2005.
www.health.gov/dietaryguidelines/dga2005/healthieryou/html/recipes.html