For these reasons, it would be helpful to replicate Wang et al 's work based on standardized scores and, furthermore, to adjust for important potential confounding factors that may explain findings, including socioeconomic status, diet, physical activity, presence of chronic illness, and family history of cardiovascular disease The CDC specifically recommends that clinicians use BMI in combination with information on youth diet, physical activity, family history, and other health screens rather than as a diagnostic tool [ ]population health initiatives are already widespread to reduce youth overweight and obesity in the clinical, community-based organization, and school arenas 6-8 Any limitations in precision do not negate the important message ofthe work: child health matters for long-term health Steep declines in youth physical activity are routinely observed in adolescence9 and serve as a key rationale for widespread efforts to promote physical activity opportunities in the elementary school years to reduce obesity and promote fitness 8 Consistent with this literature, Wang et al observed that the preadolescent years are an important intervention period to support the establishment of healthy behaviors and reduce the risk of hypertension associated with high BMI [ ]across the United States, youths participate in annual fitness tests, such as the Presidential Physical Fitness Test and the FitnessGram by The Cooper Institute, which include anthropometric and fitness batteries to assess current and future health, support youths and their families in monitoring fitness progress, and provide opportunities foryouth population health surveillance 10 However, the authors' use of terms such as "early warning period" before the "explosion of overweight" perhaps should be reconsidered, particularly in light of the dynamic nature of youth BMI throughout development
Critically Evaluating Youth Body Mass Index Trajectories: Implications for Health Versus Stigma