BMJ 2000;320:1240 ( 6 May )

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Establishing a standard definition for child overweight and obesity worldwide: international survey

Tim J Cole, professor of medical statistics, ^a Mary C Bellizzi, health policy officer, ^b Katherine M Flegal, senior research scientist, ^c William H Dietz, director. ^d

^a Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH, ^b International Obesity Task Force Secretariat, London NW1 2NS, ^c National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville MD 20782, USA, ^d Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta GA 30341-3724, USA

Correspondence to: T J Cole tim.cole{at}ich.ucl.ac.uk

Objective: To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points.
Design: International survey of six large nationally representative cross sectional growth studies.
Setting: Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States.
Subjects: 97 876 males and 94 851 females from birth to 25 years of age.
Main outcome measure: Body mass index (weight/height²).
Results: For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m² for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2-18 years.
Conclusions: The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.

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• Barlow, S. E., and the Expert Committee, (2007). Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics 120: S164-S192 [Abstract] [Full text]  
• Krebs, N. F., Himes, J. H., Jacobson, D., Nicklas, T. A., Guilday, P., Styne, D. (2007). Assessment of Child and Adolescent Overweight and Obesity. Pediatrics 120: S193-S228 [Abstract] [Full text]  
• Kivimaki, M., Lawlor, D. A, Smith, G. D., Elovainio, M., Jokela, M., Keltikangas-Jarvinen, L., Viikari, J. S., Raitakari, O. T (2007). Substantial intergenerational increases in body mass index are not explained by the fetal overnutrition hypothesis: the Cardiovascular Risk in Young Finns Study. Am. J. Clin. Nutr. 86: 1509-1514 [Abstract] [Full text]  
• Yanez, A. A., Peix, M. A., Atserias, N., Arnau, A., Brug, J., Yanez, A. A., Peix, M. A., Atserias, N., Arnau, A., Brug, J. (2007). Association of Eating Attitudes Between Teenage Girls and Their Parents. Int J Soc Psychiatry 53: 507-513 [Abstract]  

Rapid Responses:

Read all Rapid Responses

Definition of overweight and obesity in children: software for clinical and epidemiological studies

Nicolas Stettler
bmj.com, 14 May 2000 [Full text]

Definition of childhood overweight/obesity

Jean Mulligan
bmj.com, 17 May 2000 [Full text]

Reanalysis suggests that the new definition for child obesity has questionable validity in puberty

Sanjay Kinra
bmj.com, 29 May 2000 [Full text]

Diabetes mellitus and global climate change

Subhash C Arya
bmj.com, 26 May 2000 [Full text]

Re: Reanalysis suggests that the new definition for child obesity has questionable validity in puber

Sanjay Kinra
bmj.com, 4 Jun 2000 [Full text]

BMI centile charts

J Vignerova
bmj.com, 7 Oct 2000 [Full text]

Establishing a standard definition for child overweight and obesity worldwide

Sophie S F Leung
bmj.com, 20 Aug 2001 [Full text]

Underweight in children – how show we define fine it?

Charles Agyemang, PhD
bmj.com, 1 Feb 2007 [Full text]