Measuring severe obesity in pediatrics using body mass index-derived metrics from the Centers for Disease Control and Prevention and World Health Organization: a secondary analysis of CANadian Pediatric Weight management Registry (CANPWR) data

Abstract

Purpose: To examine cross-sectional and longitudinal relationships between body mass index (BMI)-derived metrics for measuring severe obesity (SO) using the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) references and cardiometabolic risk factors in children and adolescents.Methods: In this cohort study completed from 2013 to 2021, we examined data from 3-to 18-year-olds enrolled in the CANadian Pediatric Weight management Registry. Anthropometric data were used to create nine BMIderived metrics based on the CDC and WHO references. Cardiometabolic risk factors were examined, including dysglycemia, dyslipidemia, and elevated blood pressure. Analyses included intraclass correlation coe cients (ICC) and receiver operator characteristic area-under-the-curve (ROC AUC).Results: Our sample included 1,288 participants (n=666 [51.7%] girls; n=874 [67.9%] white), with SO of 59.9-67.0%. ICCs revealed high tracking (0.90-0.94) for most BMI-derived metrics. ROC AUC analyses showed CDC and WHO metrics discriminated the presence of cardiometabolic risk factors, which improved with increasing numbers of risk factors. Overall, most BMI-derived metrics rated poorly in identifying presence of cardiometabolic risk factors.Conclusion: CDC BMI percent of the 95 th percentile and WHO BMIz performed similarly as measures of SO, suggesting both can be used for clinical care and research in pediatrics. The latter de nition may be particularly useful for clinicians and researchers from countries that recommend using the WHO growth reference. What Is KnownSevere obesity in pediatrics is a global health issue.Few reports have evaluated BMI-derived metrics based on the WHO growth reference. What is NewOur analyses showed that CDC BMI p95 and WHO BMIz performed similarly as evidence-based measures of severe obesity in pediatrics. WHO BMIz should be particularly useful for clinicians and researchers from countries that recommend using the WHO growth reference.

Multiobjective Optimization of Fuzzy System for Cardiovascular Risk Classification

“…Another aspect to consider concerns studies such as [6][7][8], where it is stated that the BMI is not the best measure of health. Despite some controversy over BMI as an exclusive factor in health assessment, in this paper it is employed as a reference to adjust the fuzzy system.…”

“…Additionally, the review article [5] discusses the past, present, and future of metabolic syndrome, which is a cluster of risk factors that increase the risk of cardiovascular disease. It is also noteworthy to highlight studies such as [6][7][8], where it is stated that BMI is not the best measure of health; therefore, this index may be controversial for some healthcare providers.…”