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American Journal of Clinical Nutrition, Vol. 81, No. 1, 196-197, January 2005
© 2005 American Society for Clinical Nutrition

LETTER TO THE EDITOR

Reply to TJ Cole et al

Michael B Zimmermann

Laboratory for Human Nutrition
Swiss Federal Institute of Technology
Seestrasse 72
PO Box 474
CH-8803 Rüschlikon
Switzerland
E-mail: michael.zimmermann{at}ilw.agrl.ethz.ch

Dear Sir:

We agree with Cole et al that the tradeoff between sensitivity and specificity makes establishing cutoffs for the detection of obesity subjective, to some extent. However, we stand by our conclusion that the obesity cutoff of the Centers for Disease Control and Prevention (CDC) is superior to that of the International Obesity Task Force (IOTF) in Swiss children (1). Although the IOTF cutoff shows slightly higher specificity and has a lower rate of false-positive results, the false-positive rate in our sample was already low with the CDC cutoff, and we would weight the 20–30 point gain in sensitivity with the CDC cutoff as more important.

Cole et al recommend the use of a more extreme cutoff, the 99th percentile of percentage body fat from skinfold thicknesses, as the gold standard for classifying obesity rather than the 95th percentile of skinfold thickness, as used in our study (1). Although this would have improved the comparative results for the IOTF reference, we believe that a child above the 95th percentile for percentage body fat should be identified as obese, because even this degree of adiposity is associated with a high risk for the metabolic syndrome and biomarkers of adverse cardiovascular outcomes (2).

ACKNOWLEDGMENTS

The author had no conflict of interest to disclose.

REFERENCES

  1. Zimmermann MB, Gübeli C, Püntener C, Molinari L. 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 Clin Nutr 2004;79:838-843.[Abstract/Free Full Text]
  2. Weiss R, Dziura J, Burgert TS, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362-74.[Abstract/Free Full Text]




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