Severe obesity is a limitation for the use of body mass index standard deviation scores in children and adolescents

Júlíusson, Pétur Benedikt; Roelants, Mathieu; Benestad, Beate; Lekhal, Samira; Danielsen, Yngvild Sørebø; Hjelmesæth, Jøran; Hertel, Jens Kristoffer

doi:10.1111/apa.14113

Cited by 17 publications

(38 citation statements)

References 18 publications

(26 reference statements)

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“…The nature of BMI SDS to detect changes in weight status more sensitively for prepubertal children than in adolescence might explain some of the findings of Dalla Valle et al and our studies. Age, sex, obesity level and pubertal development all affect to BMI SDS values . In adolescence, large differences in BMI are seen smaller in BMI SDS especially in the case of severe obesity.…”

Section: Discussionsupporting

confidence: 49%

Distinct age‐related patterns of overweight development to guide school healthcare interventions

Häkkänen¹,

But

Ketola

et al. 2019

Acta Paediatrica

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Aim We aimed to identify groups of primary school children with similar overweight development, reveal age‐related patterns of overweight development in the resulting groups and analyse overweight‐related school healthcare interventions. Methods This retrospective longitudinal register study utilised electronic health records from six primary school years. From a random sample of 2000 sixth graders, we derived a study cohort of 508 children meeting criteria for overweight at least once during primary school. We investigated how many different groups (latent classes) of children with similar weight development would emerge by applying flexible latent class mixed models on body mass index standard deviation score. We also explored the resulting groups with respect to offered overweight‐related interventions. Results Per child, the data consisted in median 7 growth measurements over 5.4 years. We identified five overweight development groups for girls and four for boys. The groups converged temporarily around age 10 after which only some continued into obesity. School nurses and physicians offered overweight‐related interventions to children with obesity, less to children gaining weight or with overweight. Conclusion Obesity prevention might benefit from awareness of typical overweight development patterns when designing intervention studies or planning and timing multidisciplinary school health check programmes.

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Section: Discussionsupporting

confidence: 49%

Distinct age‐related patterns of overweight development to guide school healthcare interventions

Häkkänen¹,

But

Ketola

et al. 2019

Acta Paediatrica

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“…Three metrics of BMI were used in the analyses: BMI, BMI z ‐score and %IOTF‐25. The %IOTF‐25 is the BMI expressed as percentage relative to the age‐ and sex‐specific IOTF cut‐off for overweight (IOTF‐25), calculated as: 100 × (BMI/IOTF‐25) . The choice of the IOTF‐25 cut‐off as baseline has been addressed in a previous publication .…”

Section: Methodsmentioning

confidence: 99%

“…The %IOTF‐25 is the BMI expressed as percentage relative to the age‐ and sex‐specific IOTF cut‐off for overweight (IOTF‐25), calculated as: 100 × (BMI/IOTF‐25) . The choice of the IOTF‐25 cut‐off as baseline has been addressed in a previous publication . In brief, results for %IOTF‐30 and %CDC95 are highly comparable with those of %IOTF‐25, but the latter was chosen because it is based on a widely used international upper limit for a ‘healthy’ BMI and sets a clear target for clinical practice.…”

Section: Methodsmentioning

confidence: 99%

“…The z ‐score positions a child on the growth reference chart, and thus adjusts the measurement for age and sex. However, BMI z ‐scores have been shown to be an inadequate and possibly biased measure of adiposity in children with severe obesity because a wide range of high BMI values corresponds to a relatively narrow range of BMI z ‐scores in an age‐dependent way . Despite this well‐documented shortcoming, BMI z ‐scores are still widely used to evaluate the response of obesity treatment in children with severe obesity .…”

Section: Introductionmentioning

confidence: 99%

“…The BMI expressed as a percentage of a particular BMI cut‐off has been proposed as a more appropriate outcome parameter than BMI z ‐score in children with obesity. Examples are the percentage relative to the 95th percentile of the Centers for Disease Control and Prevention (%CDC95) BMI chart or relative to the IOTF overweight cut‐off (%IOTF‐25) . These studies usually focused on cross‐sectional data, for example when comparing children with different degrees of obesity, but only a few addressed the use of such measures for monitoring the weight status during longitudinal follow‐up of children or adolescents with obesity .…”

Section: Introductionmentioning

confidence: 99%

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Monitoring children and adolescents with severe obesity: body mass index (BMI), BMI z‐score or percentage above the International Obesity Task Force overweight cut‐off?

et al. 2019

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Aim: Body mass index (BMI) metrics are widely used as a proxy for adiposity in children with severe obesity. The BMI expressed as the percentage of a cut-off percentile for overweight or obesity has been proposed as a better alternative than BMI z-scores when monitoring children and adolescents with severe obesity.Methods: Annual changes in BMI, BMI z-score and the percentage above the International Obesity Task Force overweight cut-off (%IOTF-25) were compared with dual-energy X-ray absorptiometry (DXA) derived body fat (%BF-DXA) in 59 children and adolescents with severe obesity.Results: The change in %BF-DXA was correlated with the change in %IOTF-25 (r = 0.68) and BMI (r = 0.70), and somewhat less with the BMI z-score (r = 0.57). Cohen's Kappa statistic to detect an increase or decrease in %BF-DXA was fair for %IOTF-25 (j = 0.25; p = 0.04) and BMI (j = 0.33; p = 0.01), but not for the BMI z-score (j = 0.08; p = 0.5). The change in BMI was positively biased due to a natural increase with age. Conclusion: Changes in the BMI metrics included in the study are associated differentlyAbbreviations %BF, Percentage body fat; %IOTF-25, Percentage above the International Obesity Task Force definition of overweight; BMI, Body mass index; DXA, Dual-energy X-ray absorptiometry. Key notesThe percentage above the International Obesity Task Force overweight cut-off (%IOTF-25) has been suggested as an unbiased alternative with respect to age for the body mass index (BMI) or BMI z-score in children and adolescents with severe obesity. Changes in BMI, BMI z-scores and %IOTF-25 were compared with dual-energy x-ray absorptiometry of body composition. The %IOTF-25 might be a better alternative to BMI z-scores to monitor changes in adiposity.

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Management of excessive weight gain in childhood

Hawton¹,

Easter²,

Semple³

et al. 2023

Paediatrics and Child Health

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Severe obesity is a limitation for the use of body mass index standard deviation scores in children and adolescents

Abstract: Our findings suggest that it may be more appropriate to use the percentage above a particular BMI cut-off, such as the percentage above IOTF-25, than the IOTF, WHO and BGS BMI-SDS in paediatric patients with severe obesity.

Cited by 17 publications

References 18 publications

Distinct age‐related patterns of overweight development to guide school healthcare interventions

Distinct age‐related patterns of overweight development to guide school healthcare interventions

Monitoring children and adolescents with severe obesity: body mass index (BMI), BMI z‐score or percentage above the International Obesity Task Force overweight cut‐off?

Management of excessive weight gain in childhood

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