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1 From the Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, and the Rowett Research Institute, Aberdeen, Scotland, United Kingdom.
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONUSE OF BMI TO...MEASURES OF BODY FATCORRELATION OF BMI WITH...POTENTIAL PROBLEMS WITH THE...REFERENCES |
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Key Words: BMI • body mass index • obesity • children • adolescents • underwater weighing • DXA • dual-energy X-ray absorptiometry • undernutrition • International Obesity Task Force
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONUSE OF BMI TO...MEASURES OF BODY FATCORRELATION OF BMI WITH...POTENTIAL PROBLEMS WITH THE...REFERENCES |
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The workshop began with a review of the validity of the body mass index (BMI; in kg/m2) as a measure of body fat and as an index of morbidity. Several factors were also considered that either contribute to the validity of the cutoff point used to define obesity or could modify or augment the definition of obesity. These factors included the effect of curve smoothing and transformations on the cutoff point, the likelihood that obesity will persist at various BMI cutpoints in childhood, and the contribution of visceral fat. The effect of obesity cutpoints, based on populations in the United States and United Kingdom, on prevalence was examined in several different populations to illustrate the importance of an international reference population to assess the prevalence of obesity. Because almost all the data considered at the workshop were derived from Europe or North America, validation studies in other populations are needed. Nonetheless, the articles included here and the consensus that emerged from the workshop provide a research agenda that will 1) significantly improve our understanding of the strengths and limitations of the measures used to define obesity, 2) define the characteristics of the populations required to develop an international reference population, and 3) help specify the research agenda necessary to validate the definition of obesity that we have proposed.
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USE OF BMI TO ASSESS OBESITY IN CHILDREN |
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TOPABSTRACTINTRODUCTIONUSE OF BMI TO...MEASURES OF BODY FATCORRELATION OF BMI WITH...POTENTIAL PROBLEMS WITH THE...REFERENCES |
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MEASURES OF BODY FAT |
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TOPABSTRACTINTRODUCTIONUSE OF BMI TO...MEASURES OF BODY FATCORRELATION OF BMI WITH...POTENTIAL PROBLEMS WITH THE...REFERENCES |
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Measurements of body composition in children and adolescents with which anthropometric measures can be correlated have generally been based on measurements of body density, determined either by underwater weighing or dual-energy X-ray absorptiometry (DXA). In the former, the weight of the subject is divided by the volume of water displaced by the subject, corrected for residual air in the lungs. Based on assumed densities of fat mass and fat-free mass, body composition can be estimated (5). More recently, use of DXA has provided an alternative measure of density. DXA offers several advantages over underwater weighing. First, because immersion is not required, a broader age range of subjects can be analyzed. Second, bone density can be measured directly and the composition of fat-free mass adjusted accordingly. Therefore, DXA appears to be less dependent on assumptions about the density of fat-free mass than is underwater weighing. Finally, no correction is required for residual air in the lungs.
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CORRELATION OF BMI WITH MEASURES OF TOTAL BODY FAT |
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TOPABSTRACTINTRODUCTIONUSE OF BMI TO...MEASURES OF BODY FATCORRELATION OF BMI WITH...POTENTIAL PROBLEMS WITH THE...REFERENCES |
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). The difference in strength of the correlations may indicate that underwater weighing provides a less reliable or valid measure of total body fat in children and adolescents than does DXA or that the assumptions that underlie the calculations of total body fat from underwater weighing are incorrect. On the basis of the DXA measurements, correlation coefficients between percentage body fat and BMI appear comparable among young boys and girls and lower among older boys than among older girls. The only study that examined subjects by stage of puberty (8) suggested that, at similar BMIs, mature boys had less body fat than girls.
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, correlation coefficients between percentage body fat and BMI for white and black children appear comparable. However, race and ethnicity add significantly to the regression coefficient when included in multiple regression models to predict percentage body fat (8). Black children had lower percentages body fat than did white children with the same BMI. In a separate study, black girls matched with white girls for BMI had significantly lower total, visceral, and subcutaneous adipose tissue (11). |
POTENTIAL PROBLEMS WITH THE USE OF THE BMI AS AN INDEX OF ADIPOSITY |
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TOPABSTRACTINTRODUCTIONUSE OF BMI TO...MEASURES OF BODY FATCORRELATION OF BMI WITH...POTENTIAL PROBLEMS WITH THE...REFERENCES |
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apply only to nonobese children and adolescents, these data do not exclude the possibility that a BMI above the 95th percentile may provide a more specific measure with which to identify children and adolescents with increased body fat. Calculation of the sensitivity and specificity of a BMI above the 85th and 95th percentiles for an increase in percentage body fat would provide critical insight into the validity of these BMI cutpoints to assess obesity. Lastly, prior undernutrition may affect the validity of the BMI. Several studies of populations with a significant prevalence of undernutrition have shown that among short children, factors other than increased body fat may be responsible for the increased weight-for-height (12). Additional studies of body composition in stunted populations with a high weight-for-height are essential to determine whether the higher weight-for-height is attributable to increased body fat. In summary, the BMI offers a reasonable measure of fatness in children and adolescents. To provide a consistent assessment of obesity across the life span, the cutpoint selected to identify obesity in children should agree with that used to identify obesity in adults.
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FOOTNOTES |
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REFERENCES |
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TOPABSTRACTINTRODUCTIONUSE OF BMI TO...MEASURES OF BODY FATCORRELATION OF BMI WITH...POTENTIAL PROBLEMS WITH THE...REFERENCES |
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This article has been cited by other articles:
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  D. J. Hoffman, A. L. Sawaya, P. A. Martins, M. A. McCrory, and S. B. Roberts Comparison of Techniques to Evaluate Adiposity in Stunted and Nonstunted Children Pediatrics, April 1, 2006; 117(4): e725 - e732. [Abstract] [Full Text] [PDF]
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E. W. Demerath, C. M. Schubert, L. M. Maynard, S. S. Sun, W. C. Chumlea, A. Pickoff, S. A. Czerwinski, B. Towne, and R. M. Siervogel Do Changes in Body Mass Index Percentile Reflect Changes in Body Composition in Children? Data From the Fels Longitudinal Study Pediatrics, March 1, 2006; 117(3): e487 - e495. [Abstract] [Full Text] [PDF]
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 J. Cawley, K. Joyner, and J. Sobal Size Matters: The Influence of Adolescents' Weight and Height on Dating and Sex Rationality and Society, February 1, 2006; 18(1): 67 - 94. [Abstract] [PDF]
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 M A Sabin, A L Ford, J M P Holly, L P Hunt, E C Crowne, and J P H Shield Characterisation of morbidity in a UK, hospital based, obesity clinic Arch. Dis. Child., February 1, 2006; 91(2): 126 - 130. [Abstract] [Full Text] [PDF]
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 S Sookoian, S I Garcia, P I Porto, G Dieuzeide, C D Gonzalez, and C J Pirola Peroxisome proliferator-activated receptor gamma and its coactivator-1 alpha may be associated with features of the metabolic syndrome in adolescents J. Mol. Endocrinol., October 1, 2005; 35(2): 373 - 380. [Abstract] [Full Text] [PDF]
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 C. S. Berkey, H. R. H. Rockett, W. C. Willett, and G. A. Colditz Milk, Dairy Fat, Dietary Calcium, and Weight Gain: A Longitudinal Study of Adolescents Arch Pediatr Adolesc Med, June 1, 2005; 159(6): 543 - 550. [Abstract] [Full Text] [PDF]
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T. H. Inge, N. F. Krebs, V. F. Garcia, J. A. Skelton, K. S. Guice, R. S. Strauss, C. T. Albanese, M. L. Brandt, L. D. Hammer, C. M. Harmon, et al. Bariatric Surgery for Severely Overweight Adolescents: Concerns and Recommendations Pediatrics, July 1, 2004; 114(1): 217 - 223. [Abstract] [Full Text] [PDF]
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 M. B Zimmermann, C. Gubeli, C. Puntener, and L. Molinari Detection of overweight and obesity in a national sample of 6-12-y-old Swiss children: accuracy and validity of reference values for body mass index from the US Centers for Disease Control and Prevention and the International Obesity Task Force Am. J. Clinical Nutrition, May 1, 2004; 79(5): 838 - 843. [Abstract] [Full Text] [PDF]
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 J. A. Nelson, M. A. Chiasson, and V. Ford Childhood Overweight in a New York City WIC Population Am J Public Health, March 1, 2004; 94(3): 458 - 462. [Abstract] [Full Text] [PDF]
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 J. B. Schwimmer, T. M. Burwinkle, and J. W. Varni Health-Related Quality of Life of Severely Obese Children and Adolescents JAMA, April 9, 2003; 289(14): 1813 - 1819. [Abstract] [Full Text] [PDF]
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C. S. Berkey, H. R. H. Rockett, M. W. Gillman, and G. A. Colditz One-Year Changes in Activity and in Inactivity Among 10- to 15-Year-Old Boys and Girls: Relationship to Change in Body Mass Index Pediatrics, April 1, 2003; 111(4): 836 - 843. [Abstract] [Full Text] [PDF]
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 A. Engeland, T. Bjorge, A. J. Sogaard, and A. Tverdal Body Mass Index in Adolescence in Relation to Total Mortality: 32-Year Follow-up of 227,000 Norwegian Boys and Girls Am. J. Epidemiol., March 15, 2003; 157(6): 517 - 523. [Abstract] [Full Text] [PDF]
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M. Visser, L. M. Bouter, G. M. McQuillan, M. H. Wener, and T. B. Harris Low-Grade Systemic Inflammation in Overweight Children Pediatrics, January 1, 2001; 107(1): 13e - 13. [Abstract] [Full Text]
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R. W Taylor, I. E Jones, S. M Williams, and A. Goulding Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19 y Am. J. Clinical Nutrition, August 1, 2000; 72(2): 490 - 495. [Abstract] [Full Text] [PDF]
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