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LETTER TO EDITOR
Year : 2017  |  Volume : 61  |  Issue : 4  |  Page : 312-313  

Inappropriate classification of body mass index of adolescent girls under SABLA scheme


1 Junior Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
2 Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Date of Web Publication6-Dec-2017

Correspondence Address:
Malvika Sharma
Department of Community Medicine, Maulana Azad Medical College, 2, Bahadur Shah, Zafar Marg, New Delhi - 100 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_181_17

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How to cite this article:
Sharma M, Basu S, Banerjee B. Inappropriate classification of body mass index of adolescent girls under SABLA scheme. Indian J Public Health 2017;61:312-3

How to cite this URL:
Sharma M, Basu S, Banerjee B. Inappropriate classification of body mass index of adolescent girls under SABLA scheme. Indian J Public Health [serial online] 2017 [cited 2019 Nov 18];61:312-3. Available from: http://www.ijph.in/text.asp?2017/61/4/312/220052



Sir,

Adolescence is a phase of transition from childhood to adulthood marked by physical and accompanying psychological changes. The body changes rapidly during this time, and there is a gain of height and weight in the form of growth spurts. As a result, the body mass index (BMI) of the adolescent changes as he/she gains height and weight with age. The increase in BMI is nearly linear in boys during the second decade of life. The BMI-for-age percentiles for adolescent girls, on the other hand, are slightly convex upward as body fat continually increases in girls during most of the second decade, while boys tend to decrease fat after the age of 14 years. These physiological changes must be considered when interpreting BMI of adolescents.[1]

One of the services under the nonnutrition component of Rajiv Gandhi Scheme for Empowerment of Adolescent Girls-SABLA is quarterly health checkup which includes, among other things, measurement of height, weight, and BMI which are to be systematically recorded in Kishori Cards [Figure 1].[2] However, as per this card, a single cutoff is used for all the beneficiaries aged 11–18 years. The cutoff used for this age group is the same as that used for Indian/Asian adults. This classification would be suitable only for older adolescents when the BMI-for-age reaches an asymptote. For younger adolescent girls catered by this scheme, this would lead to gross misclassification whereby even normally growing adolescent girls would be labeled as malnourished and overweight girls would be labeled as normal.
Figure 1: Kishori Card issued under Rajiv Gandhi Scheme for Empowerment of Adolescent Girls-SABLA, Ministry of Women and Child Development.

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Growth of adolescents should be assessed using standard growth charts which reflect this changing trend, much like growth charts for under-five children. The World Health Organization has developed such growth charts for plotting BMI-for-age for boys and girls of age group 5–19 years [Figure 2]. As in under-five growth charts, overweight adolescents are those whose BMI-for-age lies in +1 to +2 standard deviation (SD) and those whose BMI-for-age is greater than +2 SD are classified as obese.[3] As the adolescent is growing with age, it is obvious that the BMI cutoff for overweight will be different for an 11-year-old adolescent girl (approximately 20 kg/m 2) and an 18-year-old adolescent girl (approximately 25 kg/m 2). A single cutoff point marking underweight, normal, and overweight (as in adults) is not appropriate. The growth chart committee of Indian Academy of Pediatrics has developed growth charts for monitoring BMI-for-age of 5–18-year-old Indian children.[4]
Figure 2: Body mass index-for-age chart for 5–19-year-old girls developed by the World Health Organization.

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Evaluation report of SABLA scheme has found that the tracking of BMI has been poor and inconsistent at programmatic level, so the impact of misclassification of BMI is hard to ascertain.[2] However, there is a need to adopt standard growth charts for Indian adolescents along the lines of “Road To Health” chart used for under-five children. This will allow the growth of adolescents to be systematically and accurately monitored and corrective actions to be taken for those who are undernourished as well as those who are overweight.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
HRSA Maternal and Child Health. Maternal and Child Health Bureau; MCHB Training Module- Adolescent Physical Development: Uses and Limitations of Growth Charts; c2017. Available Available from: https://www.depts.washington.edu/growth/module7/text/page3a.htm. [Last accessed on 2017 Jun 07].  Back to cited text no. 1
    
2.
Administrative Staff College of India. Evaluation of SABLA Scheme: A Report Submitted to Ministry of Women and Child Development. Hyderabad: Government of India; September, 2013.  Back to cited text no. 2
    
3.
World Health Organization. Growth Reference Data for 5-19 Years. WHO; c2017. Available Available from: http://www.who.int/growthref/en/. [Last accessed on 2017 Jun 07].  Back to cited text no. 3
    
4.
Khadilkar VV, Khadilkar AV. Revised Indian Academy of Pediatrics 2015 growth charts for height, weight and body mass index for 5-18-year-old Indian children. Indian J Endocrinol Metab 2015;19:470-6.  Back to cited text no. 4
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