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David S. Freedman, PhD; Jack Wang, MS; John C. Thornton, PhD; Zuguo Mei, MD; Aviva B. Sopher, MD, MS; Richard N. Pierson Jr, MD; William H. Dietz, MD, PhD; Mary Horlick, MD

Arch Pediatr Adolesc Med. 2009;163(9):805-811.

Objective  To examine the ability of various body mass index (BMI)–for-age categories, including the Centers for Disease Control and Prevention's 85th to 94th percentiles, to correctly classify the body fatness of children and adolescents.

Design  Cross-sectional.

Setting  The New York Obesity Research Center at St Luke’s–Roosevelt Hospital from 1995 to 2000.

Participants  Healthy 5- to 18-year-old children and adolescents (N = 1196) were recruited in the New York City area through newspaper notices, announcements at schools and activity centers, and word of mouth.

Main Outcome Measures  Percent body fat as determined by dual-energy x-ray absorptiometry. Body fatness cutoffs were chosen so that the number of children in each category (normal, moderate, and elevated fatness) would equal the number of children in the corresponding BMI-for-age category (<85th percentile, 85th-94th percentile, and 95th percentile, respectively).

Results  About 77% of the children who had a BMI for age at or above the 95th percentile had an elevated body fatness, but levels of body fatness among children who had a BMI for age between the 85th and 94th percentiles (n = 200) were more variable; about one-half of these children had a moderate level of body fatness, but 30% had a normal body fatness and 20% had an elevated body fatness. The prevalence of normal levels of body fatness among these 200 children was highest among black children (50%) and among those within the 85th to 89th percentiles of BMI for age (40%).

Conclusion  Body mass index is an appropriate screening test to identify children who should have further evaluation and follow-up, but it is not diagnostic of level of adiposity.

Author Affiliations: Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Freedman, Mei, and Dietz); Body Composition Unit, Department of Medicine, New York Obesity Research Center, St Luke’s–Roosevelt Hospital, (Mr Wang and Drs Thornton, Sopher, and Pierson) and Department of Pediatrics, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center (Dr Sopher), New York, New York and National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland (Dr Horlick).

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