Assessing Obesity in Children; Push-Ups
July 2008
Shape Up America! Newsletter

Assessing Obesity in Children
by Barbara J. Moore, PhD
In December 2007, the American Academy of Pediatrics (AAP) published a series of reports on the assessment,1 treatment2 and prevention3 of childhood obesity. These reports were the result of extensive research and deliberations by an expert committee of scientists and clinicians from 15 professional organizations including the AAP and the American Medical Association, in collaboration with the Health Resources and Service Administration and the Centers for Disease Control and Prevention (CDC).

Shape Up America! offers the first in a series of articles summarizing the expert committee recommendations.

The assessment report1 was based on over 300 studies published since 1995 and reviews the issues relevant to identifying overweight and obesity in children and adolescents. There has been considerable confusion about assessing weight status and whether the terms "obese" or "overweight" should be used to describe excess fat in children. The expert committee states that primary care providers should universally assess children for obesity risk to improve early identification of elevated body mass index (BMI), medical risks, and unhealthy eating and physical activity habits.4

The committee makes the following recommendations when assessing the weight of children:

  • Because it correlates well with body fat, BMI should be calculated and plotted on CDC growth charts at least annually. (To reduce errors, the calculation of BMI and plotting can be done automatically on the Shape Up America! or CDC Web sites.)

  • Each year, height and weight should be accurately measured in metric units and BMI calculated as weight in kilograms divided by the square of height in meters.

    • Because height is squared, any errors in height will be magnified. The expert committee prefers measuring height in centimeters since it offers greater precision. For those unable to use metric units, BMI may be calculated in pounds and inches using the equation: wt/ht2 x 703.

  • Height should be measured in bare or stocking feet with a wall-mounted height stadiometer (not a platform scale with a moveable rule on top), except in infants and children who are unable to stand erect. These children and infants under 2 years old should lie supine (face up) and fully extended for measurement of recumbent length, and 1.0 cm should be subtracted from this value before BMI is calculated.

  • Weight should be measured (preferably in kilograms) with a calibrated balance-beam scale, with the child in light clothing and bare or stocking feet.

Below are the new terminology and definitions of "overweight" and "obesity" recommended by the expert committee:

Age of child Definition of Overweight Definition of Obese Comments
Children and adolescents
2 to 18 years old
BMI ≥85th percentile but <95th percentile or BMI<30 kg/m2 (whichever is smaller). BMI ≥95th percentile for BMI by age and sex or >30 kg/m2 (whichever is smaller). "At risk for overweight" should be replaced with the term "overweight" as defined here. The former definition of "overweight" should be replaced with the term "obese" as defined here.
Children 2 years old or younger Weight-for-recumbent length percentiles should be used to evaluate weight relative to linear growth. (See CDC growth charts.) Children whose age- and sex-specific weight-for-length is ≥95th percentile are considered "overweight." The term "obese" should not be used in children this young. Recumbent length is measured in this age group and considered relative to the child's weight and age.

Table prepared by Shape Up America! based on information from reference 1.

Consideration of Possible Harm

The expert committee concluded there is no direct evidence of harm resulting from screening for childhood overweight and obesity.1 Although many studies have demonstrated an array of negative social and psychological consequences of obesity, the committee concluded that screening would not trigger or amplify any of these. The committee acknowledged that the US Preventive Services Task Force reviewed this issue in 2005 and described the level of evidence about possible harm as "insufficient."5

People seeking details and protocols for the accurate measurement of height (or stature), weight and recumbent length should consult reference 6.

Barbara J. Moore, PhD, is President and CEO of Shape Up America!

Push-Ups: A Great Exercise for Busy People
by Shelly McClellan, DPT
As a physical therapist, I am often confronted by people with questions on how to tone certain parts of the body. Isolated muscle strengthening is often required to restore balance and function in the case of injury. To accommodate busy people, and make the most of their time and efforts, I like to take a broader approach and prescribe exercises with multiple benefits.

The push up is a great exercise to do if you are healthy and want to strengthen your upper body or tone and improve its appearance. It requires no equipment, very little time and, if done consistently, will yield excellent results.

There are many ways to complete a push-up. Each way emphasizes a different part of the body. We will start easy and finish with the most challenging.

#1 Plank Position
Description: Prone (face down), arms extended straight, with hands contacting the floor directly beneath the shoulders, while toes or knees touch the floor. Hold it for as long as you can without losing your form. (Also see Do's and Don'ts below.)

Plank Position

#2 Partial Push-Up
Description: In plank position, with knees and hands on the ground, slowly move your whole body toward the floor and slowly return to the original position. Hold it 2 seconds at the bottom of the motion. (Also see Do's and Don'ts below.)

Partial Push-Up

#3 Full Push-Up
Description: In the full plank position, with toes and hands on the ground, slowly move your whole body toward the floor and then slowly return to the original position. Hold it 2 seconds at the bottom of the motion. (Also see Do's and Don'ts below.)

Full Push-Up

For all push-ups:

Do keep your ears parallel to your shoulders.
Keep your abdominal muscles tight and your back flat.

Don't let your back sag.
Don't let your head hang forward.

These variations work your abdominal muscles and the muscles of your shoulder girdle and arms effectively and efficiently. To increase the work load on your triceps (the muscle in your upper arm that we focused on in the April, May and June issues of the newsletter), you can vary the position of your hands. Moving your hands further apart makes the exercise harder. Be sure to maintain good form at all times.

Shelley McClellan, DPT, is a physical therapist with Great Northern Physical Therapy in Bozeman, MT. Wants Your Help has a new look and new features and the creators of the Web site would like to know what you think., a consumer health information Web site sponsored by the Office of Disease Prevention and Health Promotion of the US Department of Health and Human Services, now gives consumers even more news, tips and tools to stay healthy.

The new and easy-to-use features include:

  • Quick Guide to Healthy Living— Discover the top 5 things you can do to stay healthy, learn why it's important and how to get started.
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  • Personal Health Tools— Get menu and activity planners, health calculators and online check-ups, and take a quiz to learn about your health and lifestyle.

Give your feedback on the new Web site by clicking on the feedback icon.

Menus for Weight Loss and Healthy Eating
Shape Up America! offers these simple, convenient 1500 calorie and 2000 calorie menus to help you eat healthfully while controlling your calories. If you have any suggestions or comments, feel free to e-mail us at

My Story
The first step in losing weight is to be ready and willing to do what it takes to lose weight safely and healthfully. Makaila realizes that despite the challenges and hurtful "fat" talk that she endures, she is ready to do something about it. We wish her continued success in her weight loss efforts.

I'm 17 years old and I weigh about 220 pounds. Two weeks ago I was about 10 pounds heavier. I do not look like I weigh that much but I really do and at times I'm very uncomfortable with myself. All my friends are really skinny and they always talk about their weight and how "fat" they are, which really just makes me feel even worse about myself because I outweigh some of them by almost 100 lbs. But I hold my head high and keep going because even though almost everyone in my family is overweight and I really love food, I am going to lose weight!!!

Shape Up America! wants to hear about you! If you would like to share your personal success story and be an inspiration to others who desire to lose weight, simply use our story submission system on the SUA Web site.

Recipe of the Month
Beans give this tasty and filling recipe a high fiber boost.
Three Bean Chili
Makes 8 servings


  • 1 Tbsp. olive oil
  • 1 cup onion, peeled and finely chopped
  • 1 cup carrot, peeled and chopped
  • 1 cup red pepper, stems and seeds removed, chopped
  • 1 cup green pepper, stems and seeds removed, chopped
  • 3 cloves garlic, finely chopped
  • 1 Tbsp. chili powder
  • 1 tsp. ground cumin
  • 3 cups chopped fresh tomato, or 1 (28 oz.) can plum tomatoes with juice
  • 1 (16 oz.) can white beans (such as cannellini), rinsed and drained
  • 1 (16 oz.) can black beans, rinsed and drained
  • 1 (16 oz.) can red kidney beans, rinsed and drained
  • Salt and freshly ground pepper to taste
  • 1 cup shredded lettuce
  • 1 cup nonfat yogurt


  1. Heat oil in large heavy saucepan or Dutch oven over medium heat. Add onion, and sauté for 3-4 minutes. Add carrots, peppers and garlic and sauté until very soft and almost golden, about 10 minutes.
  2. Add chili powder and cumin, and stir while cooking for 2 minutes to release the aromas from the spices.
  3. Add tomato and beans. Season with salt and pepper. Bring to a boil and cook, uncovered, over low heat about 45 minutes, stirring occasionally.
  4. Ladle into bowls and garnish with shredded lettuce and yogurt.

Nutritional analysis per serving: 188 calories, 3 gram total fat, 0 grams saturated fat, 0 grams trans fat, 35 grams carbohydrate, 10 grams protein, 11 grams dietary fiber, 585 milligrams sodium

Source: Shape Up America!

phone: 406-686-4844

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