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To summarize research conducted since 2000 regarding pediatric healthcare providers' calculation of BMI and use of the BMI-for-age growth charts to assess weight status in children.

• All studies with primary data collection regarding calculation of BMI and use of the BMI-for-age growth charts
• Target population of children aged 2 to 18 years
• Written in English
• Data collection occurred no earlier than the year 2000 when the BMI-for-growth charts were released for practice
• Conducted in the United States.

Studies intervening on child weight status or trying to increase growth assessment in practitioners.

Recruitment

• PubMed was searched for concepts using a combination of Medical Subject Headings (MeSH) and keywords
• MeSH selections included terms such as Body Mass Index, Anthropometry, Overweight, Physicians' Practice Patterns, Nurse Practitioners, Pediatrics, Physician Assistants and Primary Health Care
• Keywords included primary care setting, well child visits, growth chart, growth monitoring, visit note, health supervision visit and body mass index
• Results were limited to the years 2000 to 2009 for ages 2 to 18 years and articles written in English only
• One independent reviewer screened the titles and abstracts of all studies identified by the PubMed search to determine potentially relevant studies
• Following the initial screening process, selected abstracts were reviewed by two additional reviewers independently
• Based on reviewer consensus articles were chosen for full text review.

Design

Systematic review.

Timing of Measurements

Summarized research conducted since 2000. All studies identified were published from 2002 to 2009 as refereed journal articles.

Dependent Variables

Assessment of weight status in children:

• Pediatric healthcare providers' calculation of BMI
• Use of the BMI-for-age growth charts.

• Initial N: 726 identified citations, 152 abstracts selected for review
• Attrition (final N): 12 were selected for inclusion:
  • Surveys/questionnaires: Seven
  • Used chart reviews: Two
  •  Used qualitative methods: Three.
• Age: Age range of two to 85 years, depending on the study methodology
• Other relevant demographics: Sample sizes ranged from eight to 4,640 participants
• Location: University of Tennessee, Knoxville.

Key Findings

• For the survey and questionnaire studies, four solely assessed if BMI was calculated by the health care providers and two solely assessed for the use of BMI for age growth charts by health care providers and one assessed for both. There was a large range in the percentage of health care providers reporting use of BMI calculations, the lowest percentage of health care providers reporting BMI was 4%, whereas the highest percentage reporting calculation of BMI was 64%.
• The two retrospective chart review studies investigated children in two different setting and both studies assessed BMI calculation whereas only one study assessed use of BMI-for-age growth chart
• In the qualitative studies, 29% reported routine calculation of BMI, whereas 33% of pediatricians used BMI-for-age-charts
• Calculation of BMI and the use of the BMI-for-age growth charts to assess weight status in children were not commonly used by pediatric health care providers
• Several barriers to following the guidelines of weight assessment in children were identified. The most common barriers included lack of awareness of the recommendations for assessing weight status, feelings of lack of effective treatment for childhood overweight/obesity, perception that time to calculate and plot BMI interferes with patient flow, challenging parental attitudes regarding childhood overweight/obesity (ie, denial, lack of motivation) and cultural barriers (ie, culture shapes attitudes and perceptions about weight and health and an overweight child may be viewed as a positive in certain cultures). 
• Methods other than calculating BMI and use of BMI-or-age growth charts for assessing weight status in children frequently reported in the reviewed articles included use of visual appearance and clinical impression, height and weight growth charts and change in weight percentile. The use of visual appearance and clinical impression appears to be one of the most common methods for assessing weight status in children by health care providers.

• Results from this review indicate that the recommendations are not being followed by pediatric health care providers with the most common barrier to use of the recommendations being the belief that weight status in children can be identified visually by health care providers
• Interventions for pediatric health care providers that effectively increase recommended weight assessment methodologies in children are required to increase rates of adherence to these recommendations
• The first step in addressing the childhood obesity epidemic is to assess and identify those at risk and at greatest need of intervention
• The lack of the occurrence of the first step in addressing a health care need, assessment and identification, hampers the ability of the pediatric health care community in reducing the prevalence of overweight and obesity in children in the United States.

Other:

No funding was received for this review

Authors note the following limitations:

• PubMed was the sole database used to identify studies; therefore, particular studies not available in this database may have been missed. The identification of articles was done systematically; however, search words were limited to those as mentioned previously.
• Limitations were set using PubMed to not allow articles in a language other than English
• The review only evaluated studies conducted in the United States; the generalizability of the outcomes to other countries is limited.