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Purpose Little is known about the suitability of three commonly-used body mass index (BMI) classification system for Indigenous children. This study aims to estimate overweight and obesity prevalence among school-aged Nunavik Inuit children according to International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) BMI classification systems, to measure agreement between those classification systems, and to investigate whether BMI status as defined by these classification systems is associated with levels of metabolic and inflammatory biomarkers. Methods Data were collected on 290 school-aged children (8–14 years; 50.7% girls) from the Nunavik Child Development Study (NCDS) with data collected in 2005–2010. Anthropometric parameters were measured and blood sampled. Participants were classified as normal weight, overweight and obese according to BMI classification systems. Weighted Kappa (kw) statistics assessed agreement between different BMI classification systems and multivariate analysis of variance ascertained their relationship with metabolic and inflammatory biomarkers. Results The combined prevalence rate of overweight/obesity was 26.9% (with 6.6% obesity) with IOTF, 24.1% (11.0%) with CDC, and 40.4% (12.8%) with WHO classification systems. Agreement was the highest between IOTF and CDC (kw=0.87) classifications, and substantial for IOTF and WHO (kw=0.69), and CDC and WHO (kw=0.73). Insulin and high-sensitivity C-reactive protein plasma levels were significantly higher from normal weight to obesity, regardless of classification system. Among obese subjects, higher insulin level was observed with IOTF. Conclusion Compared with other systems, IOTF classification appears to be more specific to identify overweight and obesity in Inuit children.

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