Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts.
Open accessAbstract
Background The 2000 Centers for Disease Control and Prevention (CDC) growth charts included lambda-mu-sigma (LMS) parameters intended to calculate smoothed percentiles from only the 3rd to the 97th percentile. Objective The objective was to evaluate different approaches to describing more extreme values of body mass index (BMI)-for-age by using simple functions of the CDC growth charts. Design Empirical data for the 99th and the 1st percentiles of BMI-for-age were calculated from the data set used to construct the growth charts and were compared with estimates extrapolated from the CDC-supplied LMS parameters and to various functions of other smoothed percentiles. A set of reestimated LMS parameters that incorporated a smoothed 99th percentile were also evaluated. Results Extreme percentiles extrapolated from the CDC-supplied LMS parameters did not match well to the empirical data for the 99th percentile. A better fit to the empirical data was obtained by using 120% of the smoothed 95th percentile. The empirical first percentile was reasonably well approximated by extrapolations from the LMS values. The reestimated LMS parameters had several drawbacks and no clear advantages. Conclusions Several approximations can be used to describe extreme high values of BMI-for-age with the use of the CDC growth charts. Extrapolation from the CDC-supplied LMS parameters does not provide a good fit to the empirical 99th percentile values. Simple approximations to high values as percentages…
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Trends over time in obesity prevalence among US youth by age, race and Hispanic origin, income, and education of household head have been published.
“Trends over time in obesity prevalence among US youth by age, race and Hispanic origin, income, and education of household head have been published,1,5,13 but trends in obesity and severe obesity prevalence by urbanization level have not been well studied.”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [13]
Trends in obesity and severe obesity prevalence by urbanization level have not been well studied.
“Trends over time in obesity prevalence among US youth by age, race and Hispanic origin, income, and education of household head have been published,1,5,13 but trends in obesity and severe obesity prevalence by urbanization level have not been well studied.”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [13]
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“Regarding children and adolescents between the ages of 2 and 20 years of age, overweight is referred to as the BMI being between the 85th and the 95th percentiles for age and sex; obesity is referred to as the BMI being at or above the 95th percentile for age and sex; and severe obesity is referred to as the BMI being…”
BackgroundHigh Body Mass Index in Infancy May Predict Severe Obesity in Early Childhood
Smego, A. R., Woo, J. G., Klein, J. A., Suh, C. A., Bansal, D., Bliss, S., Daniels, S. R., Bolling, C. F., & Crimmins, N. A. (2016) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2016.11.020 · Cited by 90 · see citing works
Freedman, D. S., Butte, N. F., Taveras, E. M., Goodman, A. B., Ogden, C. L., & Blanck, H. M. (2017) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2017.03.039 · Cited by 89 · see citing works
“The disagreement between very high BMI-for-age percentiles calculated from the CDC growth charts and those that are directly observed in the data has led to the use of 120% of the 95th percentile of BMI (%BMIp95) for the classification of severe obesity among children.(6,7) Despite the limitations of very high BMI z-s…”
BackgroundMethodInfluentialSelf-citationSevere obesity in children: prevalence, persistence and relation to hypertension
Lo, J. C.-M., Chandra, M., Sinaiko, A. R., Daniels, S. R., Prineas, R. J., Maring, B., Parker, E. D., Sherwood, N. E., Daley, M. F., Kharbanda, E. O., et al. (2014) · International Journal of Pediatric Endocrinology · doi:10.1186/1687-9856-2014-3 · Cited by 88 · see citing works
“In this study, we found that classifying obesity severity based on BMI percentage of the 95 percentile, as previously proposed by others [9,11], has the advantage of more precisely categorizing extremely obese individuals for both clinical tracking and research purposes.”
MethodKidney outcomes three years after bariatric surgery in severely obese adolescents
Nehus, E. J., Khoury, J. C., Inge, T. H., Xiao, N., Jenkins, T. M., Moxey‐Mims, M., & Mitsnefes, M. M. (2016) · Kidney International · doi:10.1016/j.kint.2016.09.031 · Cited by 86 · see citing works
Prevalence of severe childhood obesity in England: 2006–2013
Ells, L. J., Hancock, C., Copley, V. R., Mead, E., Dinsdale, H., Kinra, S., Viner, R., & Rutter, H. (2015) · Archives of Disease in Childhood · doi:10.1136/archdischild-2014-307036 · Cited by 85 · see citing works
Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER
Kumar, S., King, E. C., Christison, A. L., Kelly, A. S., Ariza, A. J., Borzutzky, C., Cuda, S. E., Kirk, S., Abraham-Pratt, I., Ali, L., et al. (2019) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.12.049 · Cited by 84 · see citing works
Wei, R. X., Ogden, C. L., Parsons, V. L., Freedman, D. S., & Hales, C. M. (2020) · Annals of Human Biology · doi:10.1080/03014460.2020.1808065 · Cited by 83 · see citing works
Self-citationWeghuber, D., Forslund, A. H., Ahlström, H. K., Alderborn, A., Bergström, K., Brunner, S. M., Cadamuro, J., Ciba, I., Dahlbom, M., Heu, V., et al. (2020) · Pediatric Obesity · doi:10.1111/ijpo.12624 · Cited by 79 · see citing works
Katzmarzyk, P. T., Shen, W., Baxter-Jones, A. D. G., Bell, J. D., Butte, N. F., Demerath, E. W., Gilsanz, V., Goran, M. I., Hirschler, V., Hu, H. H., et al. (2012) · Pediatric Obesity · doi:10.1111/j.2047-6310.2012.00073.x · Cited by 77 · see citing works
de Onís, M. (2017) · Springer eBooks · doi:10.1007/978-3-319-43739-2_6 · Cited by 77 · see citing works
Richardson, A. S., Dietz, W. H., & Gordon‐Larsen, P. (2013) · Pediatric Obesity · doi:10.1111/j.2047-6310.2013.00196.x · Cited by 76 · see citing works
“Among the 14 738 eligible respondents at wave II, we excluded those with missing sample weights (n = 1170), Native American (n = 114) for inadequate sample size, missing race (n = 15), missing baseline height and weight measures (n = 135), underweight at baseline (BMI < 5th percentile CDC/NCHS growth curves <20 years…”
BackgroundMethodInfluentialBone Loss in Adolescents After Bariatric Surgery
Kaulfers, A.-M. D., Bean, J. A., Inge, T. H., Dolan, L. M., & Kalkwarf, H. J. (2011) · PEDIATRICS · doi:10.1542/peds.2010-0785 · Cited by 76 · see citing works
High Blood Pressure in Overweight and Obese Youth: ok Implications for Screening
Koebnick, C., Black, M., Wu, J., Martinez, M. P., Smith, N., Kuizon, B., Cuan, D., Young, D., Lawrence, J., & Jacobsen, S. (2013) · The Journal of Clinical Hypertension · doi:10.1111/jch.12199 · Cited by 72 · see citing works
Topiramate for Weight Reduction in Adolescents With Severe Obesity
Fox, C. K., Marlatt, K. L., Rudser, K. D., & Kelly, A. S. (2014) · Clinical Pediatrics · doi:10.1177/0009922814542481 · Cited by 75 · see citing works
“2 times the 95th percentile or BMI ≥35 kg/m(2) is the fastest growing obesity category in children and adolescents, with a reported prevalence of 4% to 6%.(1-5) While obesity in childhood is associated with increased risk of cardiovascular disease (CVD),(6,7) type 2 diabetes mellitus (T2DM),(8,9) and premature death,(…”
BackgroundAn intervention to preschool children for reducing screen time: a randomized controlled trial
Yilmaz, G., Çaylan, N., & Karacan, C. D. (2014) · Child Care Health and Development · doi:10.1111/cch.12133 · Cited by 74 · see citing works
“Therefore, family practitioners and paediatricians should be playing the main role in strategies for reducing screen time of children (American Academy of Pediatrics 2001, 2012; Epstein et al. 2009).”
BackgroundMethodInfluentialOptimisation of children z-score calculation based on new statistical techniques
Martínez-Millana, A., Hulst, J. M., Boon, M., Witters, P., Fernández-Llatas, C., Asseiceira, I., Calvo‐Lerma, J., Basagoiti, I., Traver, V., Boeck, K. D., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0208362 · Cited by 74 · see citing works
Koebnick, C., Getahun, D. T., Smith, N., Porter, A. H., Der-Sarkissian, J. K., & Jacobsen, S. J. (2010) · International Journal of Pediatric Obesity · doi:10.3109/17477166.2010.491118 · Cited by 71 · see citing works
de Onís, M. (2008) · Humana Press eBooks · doi:10.1007/978-1-59745-464-3_5 · Cited by 71 · see citing works
Robbins, J. M., Mallya, G. G., Polansky, M., & Schwarz, D. F. (2012) · Preventing Chronic Disease · doi:10.5888/pcd9.120118 · Cited by 70 · see citing works
Czepiel, K. S., Perez, N. P., Reyes, K. J. C., Sabharwal, S., & Stanford, F. C. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.00290 · Cited by 70 · see citing works
Prevalence of obesity and extreme obesity in children aged 3–5 years
Lo, J. C.-M., Maring, B., Chandra, M., Daniels, S. R., Sinaiko, A. R., Daley, M. F., Sherwood, N. E., Kharbanda, E. O., Parker, E. D., Adams, K. F., et al. (2013) · Pediatric Obesity · doi:10.1111/j.2047-6310.2013.00154.x · Cited by 68 · see citing works
“Classifying high BMI values as a percentage of the 95th percentile has been proposed as a more flexible approach to characterizing obesity severity based on evidence that this approach may provide a better fit to empiric data than BMI percentile estimates above the 97th percentile (10).”
MethodInfluentialHales, C. M., Freedman, D. S., Akinbami, L. J., Wei, R., & Ogden, C. L. (2022) · doi:10.15620/cdc:121711 · Cited by 71 · see citing works
Self-citationChildhood Obesity for Pediatric Gastroenterologists
Huang, J. S., Barlow, S. E., Quirós‐Tejeira, R. E., Scheimann, A. O., Skelton, J. A., Suskind, D. L., Tsai, P., Uko, V. E., Warolin, J., Xanthakos, S. A., et al. (2012) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e31826d3c62 · Cited by 67 · see citing works
“Proposals have included the adult definition of morbid obesity (BMI of 40 kg/m(2)) in adolescents, BMI of 99th percentile, or a recent proposal of BMI 120% of the obesity cutpoint (95th percentile BMI) (2,3).”
BackgroundLi, L., Pérez, A., Wu, L.-T. T., Ranjit, N., Brown, H. S., & Kelder, S. H. (2016) · Childhood Obesity · doi:10.1089/chi.2015.0136 · Cited by 67 · see citing works
Kelly, A. S., Fox, C. K., Rudser, K. D., Gross, A. C., & Ryder, J. R. (2016) · International Journal of Obesity · doi:10.1038/ijo.2016.69 · Cited by 64 · see citing works
Marks, B. E., Khilnani, A., Meyers, A. G., Flokas, M. E., Gai, J., Monaghan, M. C., Streisand, R. M., & Estrada, E. (2021) · Hormone Research in Paediatrics · doi:10.1159/000519797 · Cited by 63 · see citing works
Fox, C. K., Kaizer, A. M., Rudser, K. D., Nathan, B. M., Gross, A. C., Sunni, M., Abuzzahab, M. J., Schwartz, B. L., Kumar, S., Petryk, A., et al. (2016) · Obesity · doi:10.1002/oby.21633 · Cited by 63 · see citing works
“2 times the 95th percentile or BMI 35 kg/m(2) (1,2), affects approximately 6% of children and adolescents in the United States and the prevalence is rising (1,3,4).”
Hoelscher, D. M., Butte, N. F., Barlow, S. E., Vandewater, E. A., Sharma, S. V., Huang, T. T. ‐., Finkelstein, E. A., Pont, S. J., Sacher, P. M., Byrd-Williams, C. E., et al. (2015) · Childhood Obesity · doi:10.1089/chi.2014.0084 · Cited by 62 · see citing works
“Weight, height, and body composition are measured using the same procedures, and obesity status is categorized using cut-off points for overweight (BMI > 25) and obesity (BMI > 30).(41,42)”
Developing an Algorithm to Detect Early Childhood Obesity in Two Tertiary Pediatric Medical Centers
Brady, C. C., Namjou, B., Kennebeck, S., Bickel, J. P., Patibandla, N., Ni, Y., Driest, S. L. V., Chen, L., Roach, A., Cobb, B. A., et al. (2016) · Applied Clinical Informatics · doi:10.4338/aci-2016-01-ra-0015 · Cited by 56 · see citing works
“Severe childhood obesity in children older than 24 months, equivalent to Class 2 obesity in adults is considered 120% of 95th percentile of body mass index (BMI) for age [2, 3].”
BackgroundAn Integrated Clinic-Community Partnership for Child Obesity Treatment: A Randomized Pilot Trial
Hoffman, J., Frerichs, L., Story, M. T., Jones, J., Gaskin, K., Apple, A., Skinner, A. C., & Armstrong, S. (2017) · PEDIATRICS · doi:10.1542/peds.2017-1444 · Cited by 60 · see citing works
“The institutional review boards from Duke University (Pro00066366) and the University of North Carolina at Chapel Hill (15-1867) approved the study protocol. study Participants Participants included a consecutive sample of patients aged 5 to 11 with a BMI ≥95th percentile, referred by their primary care provider to th…”
BackgroundHealth Disparities in Adolescent Bariatric Surgery: Nationwide Outcomes and Utilization
Lopez, O. N., Jupiter, D. C., Bohanon, F. J., Radhakrishnan, R. S., & Bowen, K. A. (2017) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2017.05.028 · Cited by 58 · see citing works
Adiposity and Physical Activity Are Not Related to Academic Achievement in School-Aged Children
LeBlanc, M. M., Martin, C. K., Han, H., Newton, R. L., SOTHERN, M. S., Webber, L. S., Davis, A. B., & Williamson, D. A. (2012) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e31825b849e · Cited by 56 · see citing works
Badr, H., Paxton, R. J., Ater, J. L., Urbauer, D. L., & Demark‐Wahnefried, W. (2011) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2011.09.004 · Cited by 56 · see citing works
“Adolescent and child survivors were categorized as underweight (<5th percentile), normal (≥5th to <85th percentile), and overweight or obese (≥85th percentile) based on guidelines established by the CDC (22).”
MethodInfluentialGow, M. L., Baur, L. A., Ho, M. M., Chisholm, K. W., Noakes, M., Cowell, C. T., & Garnett, S. P. (2016) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-016-0367-9 · Cited by 55 · see citing works
Michalsky, M. P., Inge, T. H., TEICH, S. A., Eneli, I., Miller, R., Brandt, M. L., Helmrath, M. A., Harmon, C. M., Zeller, M. H., Jenkins, T. M., et al. (2013) · Seminars in Pediatric Surgery · doi:10.1053/j.sempedsurg.2013.10.020 · Cited by 54 · see citing works
“BMI ≥ 120% of the 95th percentile).[1] In addition, a mounting body of evidence demonstrates a parallel increase in the prevalence of obesity-related comorbid diseases (e.”
BackgroundKirk, S., Armstrong, S., King, E. C., Trapp, C. M., Grow, H. M., Tucker, J. M., Joseph, M. M., Liu, L. L., Weedn, A. E., Sweeney, B. R., et al. (2016) · Childhood Obesity · doi:10.1089/chi.2016.0060 · Cited by 54 · see citing works
Jebeile, H., Gow, M. L., Lister, N. B., Haghighi, M. M., Ayer, J. G., Cowell, C. T. C. T., Baur, L. A., & Garnett, S. P. (2019) · Journal of Nutrition · doi:10.1093/jn/nxz049 · Cited by 54 · see citing works
Koebnick, C., Black, M., Wu, J., Martinez, M. P., Smith, N., Kuizon, B., Jacobsen, S., & Reynolds, K. (2013) · The Journal of Clinical Hypertension · doi:10.1111/jch.12173 · Cited by 49 · see citing works
Atay, Z., & Bereket, A. (2016) · Obesity Medicine · doi:10.1016/j.obmed.2016.05.005 · Cited by 53 · see citing works
“Severe obesity is defined as BMI 120 percent of the 95th percentile values corresponding to approximately the 99th percentile, or BMI Z-score 2.33 (ie, 2.33 standard deviations [SD] above the mean) (Skinner and Skelton, 2014; Flegal et al., 2009).”
BackgroundInfluentialAssociations between childhood obesity and upper and lower extremity injuries
Adams, A., Kessler, J. I., Deramerian, K., Smith, N., Black, M., Porter, A. H., Jacobsen, S., & Koebnick, C. (2012) · Injury Prevention · doi:10.1136/injuryprev-2012-040341 · Cited by 61 · see citing works
Freedman, D. S., Ogden, C. L., & Kit, B. K. (2015) · BMC Pediatrics · doi:10.1186/s12887-015-0493-6 · Cited by 50 · see citing works
“PBF Slaughter line varies by race and sexual maturation in the Slaughter equations,[26] and the illustrated line is for white, pubescent boys.”
BackgroundMethodInfluentialSelf-citationKessler, J. I., Jacobs, J. C., Cannamela, P. C., Shea, K. G., & Weiss, J. M. (2018) · Journal of Pediatric Orthopaedics · doi:10.1097/bpo.0000000000001158 · Cited by 51 · see citing works
Chromosomal microarray analysis in the genetic evaluation of 279 patients with syndromic obesity
D’Angelo, C. S., Varela, M. C., de Castro, C. I. E., Otto, P. A., Pérez, A. B. A., Lourenço, C. M., Kim, C. A., Bertola, D. R., Kok, F., Garcia-Alonso, L., et al. (2018) · Molecular Cytogenetics · doi:10.1186/s13039-018-0363-7 · Cited by 51 · see citing works
“Among a subset of 208 children and adolescents (BMI ≥ 95th percentile), we further classified obesity based on the BMI expressed as a percentage above the 95th BMI percentile according to age and sex, as previously described [24, 25]: a BMI 100–119% of the 95th percentile was used to define moderate obesity and a BMI…”
MethodMetabolic and Bariatric Surgery in Adolescents
Chalklin, C. G., Harper, E. R., & Beamish, A. J. (2021) · Current Obesity Reports · doi:10.1007/s13679-021-00423-3 · Cited by 52 · see citing works
SHAH, A. S., Dolan, L. M., Khoury, P. R., Gao, Z., Kimball, T. R., & Urbina, E. M. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-4562 · Cited by 50 · see citing works
“Here, only obese (BMI 100–119th of the 95th percentile or class I obesity) and severe obese ( 120% of the 95th percentile or class II and III obesity) (14) participants were compared.”
BackgroundEfficacy of a Community‐ Versus Primary Care–Centered Program for Childhood Obesity: TX CORD RCT
Butte, N. F., Hoelscher, D. M., Barlow, S. E., Pont, S. J., Durand, C. P., Vandewater, E. A., Liu, Y., Adolph, A. L., Pérez, A., Wilson, T. A., et al. (2017) · Obesity · doi:10.1002/oby.21929 · Cited by 51 · see citing works
“the 95th percentile (%BMIp95) (18), as recommended (22,23) to track children with BMI> 97th percentile.”
BackgroundSocial determinants of disparities in weight among US children and adolescents.
Rossen, L. M., & Talih, M. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.07.010 · Cited by 48 · see citing works
“Most prior studies have examined differences in the proportion of children falling above various body mass index (BMI) cutoffs (e.g., 97th or 99th percentile [9,22,23], 1.2 times the 95th percentile [21,26]).”
BackgroundInfluentialDay, S. E., Konty, K., Leventer‐Roberts, M., Nonas, C., & Harris, T. G. (2014) · Preventing Chronic Disease · doi:10.5888/pcd11.130439 · Cited by 49 · see citing works
“A more accurate approach to establishing a cut-off at 120% of the 95th percentile was proposed in 2009 and has since been widely accepted (6,20).”
Method
- Authors
- Flegal, K. M., Wei, R., Ogden, C. L., Freedman, D. S., Johnson, C. L., & Curtin, L. R.
- Affiliations
- Centers for Disease Control and Prevention (US)
- National Center for Health Statistics (US)
- Corresponding author
- Flegal, Katherine M
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2009-11
- Volume
- 90
- Issue
- 5
- Pages
- 1314-1320
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2130113732
- Cited by
- 435
- References
- 29
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 27 · 2023: 14 · 2022: 25 · 2021: 32 · 2020: 44 · 2019: 33 · 2018: 38 · 2017: 42 · 2016: 30 · 2015: 26 · 2014: 29 · 2013: 28 · 2012: 28
- FWCI
- 16.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Keywords
- body mass index for age, CDC growth charts, 99th percentile, overweight children, childhood obesity
- MeSH terms
- Adolescent, Centers for Disease Control and Prevention, U.S., Child, Child, Preschool, Female, Growth, Humans, Male, Nutrition Surveys, Thinness, United States, Body Mass Index, Overweight, Young Adult
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