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

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1240
  1. Tim J Cole, professor of medical statistics (tim.cole{at},
  2. Mary C Bellizzi, health policy officerb,
  3. Katherine M Flegal, senior research scientistc,
  4. William H Dietz, directord
  1. a Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH
  2. b nternational Obesity Task Force Secretariat, London NW1 2NS
  3. c National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville MD 20782, USA
  4. d Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta GA 30341-3724, USA
  1. Correspondence to: T J Cole
  • Accepted 21 January 2000


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.


  • Funding This work was supported by the Childhood Obesity Working Group of the International Obesity Task Force. TJC is supported by a Medical Research Council programme grant

  • Competing interests None declared

  • Accepted 21 January 2000
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