Extended BMI Charts Help Address the Pediatric Obesity Crisis

— They provide an important tool for screening and managing patients

by
Marisa Censani, MD



January 28, 2023

As a pediatric endocrinologist, I am acutely aware of our country’s surging and highly alarming childhood obesity rates. What has been a growing epidemic for decades has catapulted into a full-blown pediatric health crisis — and I am concerned for my patients and other children struggling with overweight or obesity.

Nearly 20% of American children are affected by obesity, and modeling data predict the numbers will increase steadily in the future. In response to the rise in childhood obesity, the CDC updated its body mass index (BMI) charts for children and adolescents with severe obesity.

Understanding the CDC Updates

For children and adolescents, BMI percentiles are determined by height, weight, and age for males and females. They are important in childhood obesity management with height and weight percentiles used to discuss the progress of children’s growth with their families.

BMI-for-age categories from the CDC for patients ages 2-19 include:

• BMI between the 5th and 85th percentiles meets criteria for healthy weight
• BMI at the 85th to 95th percentile meets criteria for overweight
• BMI equal to or above the 95th percentile meets criteria for obesity
• BMI higher than 120% of the 95th percentile (or >35 kg/m2) meets criteria for severe obesity

The CDC’s new charts extend BMI-for-age growth charts to 60 kg/m2 with four new percentile curves above the 95th percentile. Prior to the update, BMI charts for children ages 2 to 19 had been published in 2000 and were based on data from 1963 to 1980 when obesity rates in children were much lower.

While the previous charts stopped at a BMI of 37 kg/m2 and did not extend beyond the 97th percentile, the new charts now extend to a BMI of 60 kg/m2 and have additional categories for tracking obesity. They were created from 1988-2016 data from nationally representative samples of children and adolescents.

Addressing the Rise in Childhood Obesity

The CDC changes come as a result of the skyrocketing obesity rates in children over the past 40 years. Data from the National Center for Health Statistics found that during the 4 year period that ended in 1980, 5.5% of children ages 2 to 19 met criteria for obesity and 1.3% met criteria for severe obesity. Fast forward to 2018, the childhood obesity rate more than tripled with 19.3% of children meeting criteria for obesity and 6.1% or 4.5 million children and adolescents meeting criteria for severe obesity in 2018.

In fact, a recent cross-sectional study, which collected data from nearly 15,000 U.S. children and adolescents who took part in the National Health and Nutritional Examination Survey (NHANES), revealed that among children and adolescents, the prevalence of obesity increased from 17.7% between 2011-2012 to 21.5% from the 2017-2020 survey. Obesity was found to increase from 18.1% to 21.4% for boys and from 17.2% to 21.6% for girls, and this increase was seen in children and adolescents from every racial and ethnic background.

The clinical data prove that we are currently at a crossroads in the fight against childhood obesity — especially in the wake of the COVID-19 pandemic. In my practice, children who had been losing weight before the pandemic were returning with an average weight gain of between 10 and 20 lb. This is further proof that time is of the essence — and it is up to providers to help pediatric patients change the trajectory of their weight to potentially avoid life-threatening health issues.

Looking to the Future

Children with obesity are at higher risk for several medical conditions such as metabolic syndrome, insulin resistance, high blood pressure, and hyperlipidemia. We also know that children with obesity are more likely to become adults with obesity and are at a higher risk for serious health problems including type 2 diabetes, stroke, and ischemic heart disease later in life.

The updates to extend the BMI-for-age growth charts by the CDC give providers another important tool for screening and managing patients facing childhood obesity. Additionally, the changes allow for more accurate information to be used in clinical practice, and the ability for providers to track a patient’s progress in comparison to data from nationally representative samples of children and adolescents with obesity from the past 2 decades, which had not been available previously.

As physicians and healthcare providers, we have an important role to play in advancing initiatives that support healthier outcomes for children and their families. The updates from the CDC better reflect the current childhood obesity crisis today and give providers insights to intervene — early and often — to help patients live healthier lives.

Marisa Censani, MD, is a pediatric endocrinologist and the director of the Pediatric Obesity Program in the Division of Pediatric Endocrinology at Weill Cornell Medicine and NewYork-Presbyterian Hospital. She currently serves on the Board of Trustees of the Obesity Medicine Association (OMA) and is co-author of OMA’s Pediatric Obesity Algorithm.