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. 2017 Sep;140(3):e20171072.
doi: 10.1542/peds.2017-1072. Epub 2017 Aug 22.

Tracking of BMI z Scores for Severe Obesity

David S Freedman  1 , Gerald S Berenson  2
Affiliations

Tracking of BMI z Scores for Severe Obesity

David S Freedman et al. Pediatrics. 2017 Sep.

Abstract

Background: Although the Centers for Disease Control (CDC) growth charts are widely used in studies of childhood obesity, BMI z scores are known to be inaccurate at values greater than the 97th percentile.

Methods: We used longitudinal data from 6994 children in the Bogalusa Heart Study who were examined multiple times to compare tracking of 3 BMI metrics: BMI-for-sex/age z score (BMIz), BMI expressed as a percentage of the 95th percentile (%BMIp95), and levels of BMI z score that adjust for the compression of very high z scores (adjusted z score [BMIaz]). The later 2 metrics, unlike BMIz, do not have an upper limit. The mean interval between examinations was 2.8 years. We were particularly interested in these metrics among children with obesity or severe obesity (%BMIp95 ≥120%).

Results: Although there was little difference in the tracking of the 3 metrics in the overall sample, among 247 children with severe obesity, the correlation of BMIz levels between examinations (r = 0.46) was substantially weaker than those for BMIaz and %BMIp95 (r = 0.65 and 0.61). Age-stratified analyses indicated that the weak tracking of BMIz was particularly evident before the age of 10 years (r = 0.36 vs 0.57 and 0.60). Several children with severe obesity showed BMIz decreases between examinations despite having BMI increases of over 5.

Conclusions: Among children with severe obesity, the tracking of BMIz is weak. This is because of the constraints in converting very high BMIs into z scores based on the CDC growth charts. Rather than using BMIz, it would be preferable to express very high BMIs relative to the CDC 95th percentile or to use BMIaz.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Maximum values of the BMI metrics among children in the Bogalusa Heart Study by sex and 2-year age groups.
FIGURE 2
FIGURE 2
Initial and subsequent levels of BMI, BMIz, BMIaz, and %BMIp95 among children who had severe obesity at the initial examination. The points labeled 1 through 4 represent the children who showed a BMIz decrease of more than 0.33 SDs between examinations but an increase in %BMIp95 of more than 10 U.
See this image and copyright information in PMC

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