insulin so sugar can get to your cells are damaged, and it impairs how the body breaks down sugars.

Some people may have a "healthy" BMI of less than 25, but may not be fit, because BMI does not account for muscle mass. Some people with a BMI over 25 can be fit and healthy. The truth about a person's risk of chronic disease is more accurately determined by their WHtR than their BMI. Studies show that central obesity or belly fat, is associated with higher mortality rates, even in individuals with normal BMI scores.

What is a healthy waist size for children? The answer depends on their height! Their waist should be no more than half their height. This is for both boys and girls, all ethnic groups and ages. And as luck would have it, it works the same for adults as well!

How to measure the waist: Measure waist and height accurately, because even small errors can cause the ratio to be inaccurate. When measuring waist and height, if possible, bring all family members into the activity. No need to "call anyone out" if their ratio is above .5. The measurement is appropriate for ages two and older. The beauty of starting to look at WHtR with younger children is that as they grow taller, if waist size remains, their ratio goes down.

Excessive abdominal fat or a WHtR over .5 is linked with higher risk for type 2 diabetes, elevated cholesterol or triglycerides, high blood pressure, coronary artery disease and other health conditions.

SCALING DOWN : HEALTHY WEIGHT STRATEGIES

Here are some great resources for parents interested in looking at healthy weight strategies for their children with special needs.

ABILITY PATH

Finding Balance Obesity and Children with Special Needs An online resource and social community for parents and professionals serving the needs of adults and children with disabilities. abilitypath.org/wp-content/uploads/2015/11/obesity-report.pdf

SPECIAL OLYMPICS

How to measure your own waist and height media.specialolympics.org/resources/health/disciplines/health-promotion/virtu- al/Waist-Height-Measurement-Guide-Imperial.pdf

BIOED: BAYLOR COLLEGE OF MEDICINE

Make body measurements fun for yourself and your children bioedonline.org/BioEd/cache/file/7E2446DB-EDF2-E213-50FE881FE130862F.pdf

IGAMEMOM

Fun Body Measurements with a piece of string igamemom.com/fun-body-measurement-activities-with-a-piece-of-string

A HEALTHY APPROACH : ADULT WAIST TO HEIGHT RATIO RESOURCES AND READINGS

NIH NATIONAL LIBRARY OF MEDICINE

Waist-to-height ratio is more predictive of years of life lost than body mass index pubmed.ncbi.nlm.nih.gov/25198730

Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis pubmed.ncbi.nlm.nih.gov/22106927

A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value pubmed.ncbi.nlm.nih.gov/20819243

CENTER ON TECHNOLOGY AND DISABILITY

A proposal for a primary screening tool: Keep your waist circumference to less than half your height

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0207-1

ASHWELL ASSOCIATES

The Ashwell Shape Chart ashwell.uk.com/shapechart.htm

NATIONAL DEAF CENTER

Evaluation of the impact of abdominal obesity on glucose and lipid metabolism disorders in adults with Down syndrome sciencedirect.com/science/article/abs/pii/S089142221400314X