Table 4.

Facilitators of Pediatric Primary Care Providers’ Use of BMI

Facilitators	Sample Comments
1. Provider tools
Calculated by computer or other staff	“The nurses just enter the height and the weight values and it’s an automatic calculation, and it works great.”
Prompt within medical record	“I don’t use the BMI for the parents, it’s more something for the medical [record], just to document from that standpoint.”
2. Diagnostic benefits
Confirm visual diagnosis	“Obviously, most of the kids who are overweight, I probably calculate their BMI a little more quickly than someone who looks like they are appropriate in terms of their size and height. The appearance is probably the thing [that] makes me calculate it.”
Assess discrepant height and weight measures	“If the height and the weight are spot on the 50th percentile, sometimes I wouldn’t plot the back side [BMI] at all. And when the weight’s at the...85th percentile and the height’s at the 50th percentile, ...then I would be more likely to plot it out.”
3. Counseling benefits
Provide an objective number	“It’s one thing to look at a child and say that they’re overweight or obese, but you give them a number, it’s just a little extra piece of information. It’s kind of like, ‘how bad was that earthquake?’ ’Well, it was a pretty bad earthquake.’ [...] It provides them with some scale, it might be just a little bit of extra information for them to help process the facts.”
Communicate risk	“[The BMI] may provide communication to the parents better. That’s the one place where it looks like it may make a difference. That you can show a parent just exactly, I mean you say ‘Your child is at risk for being overweight.’ They’re a little chunky baby fat kid, they may not even pay attention to you. You show them on a chart, yeah, that may make a difference.”
Trigger intervention	“If you see someone that’s overweight, [a BMI] does sort of trigger that you’re more likely to counsel them harder on that.”