HJBR Jul/Aug 2023

with obesity are blamed. This blame game must stop, and a key way to change the cul- ture is to finally treat obesity as the medical diagnosis it is and equip healthcare provid- ers with safe and effective treatment options to offer their patients. Children don’t decide what they eat. Adults do. Is a child in a home with obese parents doomed to obesity? How can a child break out of the cycle and exercise healthy eating choices when the food is simply not available to them in their environment? It is the adult’s responsibility to provide the food choices to serve and prepare for kids, and the kid’s job is to determine what they eat and how much they eat. At the same time, the chronic disease of obesity is familial in nature: Having a parent with obesity is one of the strongest risk factors for childhood obesity. The treatment guide- lines listed in theAAPCPG [Clinical Practice Guidelines] are an important way to ensure kids are not “doomed”to have obesity. Many researchers and advocates are also work- ing in schools and with community part- ners to help kids build healthy habits and healthy environments, but parents and adult caregivers must join these efforts. Changes need to be made both at the household and school level but also at the macro level including policies, howwe design and adapt our physical environments, and ensuring there is easy, affordable access to healthy food and safe, fun physical activity options. There has been tremendous progress in the foods served as part of the National School Breakfast and Lunch Program, so this is a good start, but kids also consume a lot of calories outside of school. Do you believe BMI is the most effective and accurate gauge for all people/races/body types? Would other measures like waist size be more useful? Yes, BMI is the best clinical tool we have in our toolbox. The gold standard measure- ment of body composition, dual-energy X-ray absorptiometry or computed tomog- raphy, as you can imagine, is quite costly and challenging to implement in clinical or public health settings. My colleagues and I, along with many other scientists, have looked at other anthropometric measures of obesity. Ultimately, we keep arriving back at BMI as it is highly correlated with other health risks and remains an easy-tco-use, inexpensive standardized measure. For children, we consider BMI as a percentile based on the child’s age and sex, referenced against normative population values. The Trends in obesity among children and adolescents aged 2–19 years, by age: United States, 1963–1965 through 2017–2018 NOTE: Obesity is body mass index (BMI) at or above the 95th percentile from the sex-specific BMI-for-age 2000 CDC Growth Charts. SOURCES: National Center for Health Statistics, National Health Examination Surveys II (ages 6–11), III (ages 12–17); and National Health and Nutrition Examination Surveys (NHANES) I–III, and NHANES 1999–2000, 2001– 2002, 2003–2004, 2005–2006, 2007–2008, 2009–2010, 2011–2012, 2013–2014, 2015–2016, and 2017–2018.