DEFINITION OF PHYSICAL AND LABORATORY ASSESSMENTS

In the context of nutritional assessment of the at risk for overweight or overweight child or
adolescent, physical findings obtained by a medical exam, coupled with anthropometrics, blood
pressure measurements, and laboratory assessments obtained by a health professional, are important
in the formulation of weight management goals and evaluation of treatment outcomes. Initial
assessment of anthropometrics including accurate height and weight measurements, calculation of
BMI, and correct plotting of data points on age- and sex-appropriate growth charts enables the
practitioner to assess the weight status of the child or adolescent. This assessment along with the
absence or presence of any comorbidity allows the practitioner to determine weight management
goals (see Figures 8.1 and 8.2) [30].
Anthropometrics are the most widely used clinical tool in the evaluation of pediatric growth
and development. In assessing the overweight status of a child or adolescent, accurate and reliable
weight and height measurements are essential because they will be used to calculate the BMI
(weight [kg]/height [m2]). Weights can be recorded on a digital or triple-beam balance scale, and
heights can be measured by a wall-mounted stadiometer. Children and adolescents should be
gowned and in bare feet. Some pediatric patients refuse to wear gowns; therefore, they should be
instructed to bring the same lightweight clothing to every visit for anthropometric measurements.
The practitioner should also stock large adult gowns suitable for adolescents weighing over 200 lbs
in addition to pediatric gowns. Heights should be measured on a wall-mounted stadiometer with
the child or adolescent in bare feet; he or she should be standing comfortably erect against a
perpendicular measuring unit with a sliding headboard (wall-mounted stadiometer). The feet should
be as close together as possible, and the heels, buttocks, and shoulders should touch the measuring
unit. The headboard should be lowered against the top of the head with the head upright and the
chin parallel to the floor. The height, weight, and calculated BMI can be plotted on appropriate
Centers for Disease Control and Prevention age and gender growth charts. More information on
calculating BMI and plotting anthropometrics is available at http://www.cdc.gov/nchs. Serial laboratory
assessments, height and weight measurements, and BMI calculations provide a method of
formulating initial treatment goals and evaluating treatment outcomes as long as the measurements
are consistent and accurate.
Other physical findings are important components in nutritional assessment. Tanner Staging,
which assigns a stage of sexual development to the child or adolescent, can be used to assess the
growth potential of a child or adolescent. Menstrual history for females is also important for
assessment of growth potential, as the female adolescent’s growth spurt generally occurs in the year
before the onset of menses. By monitoring weight fluctuations during the menstrual cycle, the
practitioner can track weight status according to the effect of fluid retention before menses (wet
weight) and diuresis postmenses (dry weight) to assess overall anthropometric response to lifestyle
changes. The presence of acanthosis nigricans is significant in that it is a cutaneous marker of
insulin resistance. All of these physical and laboratory findings highlight the importance of a
multidisciplinary team approach to the evaluation of the overweight child or adolescent.
Educating the child or adolescent and family about the significance of abnormal physical
findings and laboratory assays, BMI, and the BMI percentiles can be a useful counseling tool in
pediatric weight management. Using the changes in laboratory parameters and physical findings as
outcome measures for evaluating the progress of the child or adolescent can help the family reduce
the emphasis on weight as the only outcome. Reduction of cardiac risk factors coupled with a stable
weight or BMI will positively affect health outcomes for the child or adolescent. Understanding the importance of multiple outcomes as a measure of progress toward weight management can enable
the child or adolescent and family to realize that healthy eating and exercise are lifelong commitments.