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BMI and children

Is BMI missing 25 percent of obese children?

Using BMI to diagnose children as obese may be missing 25 percent of kids who have excess body fat despite a normal BMI

Physicians using BMI to diagnose children as obese may be missing 25 percent of kids who have excess body fat despite a normal BMI, according to a Mayo Clinic study published online in Pediatric Obesity. The researchers found that BMI has high specificity in identifying paediatric obesity, meaning BMI accurately identifies children who are obese. Conversely, it also has a moderate sensitivity and can miss children who actually should be considered obese according to the percent of fat in their bodies.

"If we are using BMI to find out which children are obese, it works if the BMI is high, but what about the children who have a normal BMI but do have excess fat? Those parents may get a false sense of reassurance that they do not need to focus on a better weight for their children," said dr Francisco Lopez-Jimenez, senior study author and director of preventive cardiology at Mayo Clinic, Rochester, MN.

In the meta-analysis, the researchers used 37 eligible studies that evaluated 53,521 patients, ages 4-18. It is the first systematic review and meta-analysis to assess the diagnostic performance of BMI to identify excess body fat, compared with techniques considered reference standard to measure obesity. These other techniques include skin-fold thickness measurement and dual-energy X-ray absorptiometry, which can be used to measure body composition and fat content.

"Our research raises the concern that we very well may be missing a large group of children who potentially could be at risk for these diseases as they get older," said Dr Asma Javed, the study's first author and a pediatric endocrinology fellow at Mayo Clinic Children's Center. "We hope our results shine a light on this issue for physicians, parents, public health officials and policymakers."

The found that commonly used BMI cut-offs for obesity showed pooled sensitivity to detect high adiposity of 0.73 (confidence interval [CI] 0.67–0.79), specificity of 0.93 (CI 0.88–0.96) and diagnostic odds ratio of 36.93 (CI 20.75–65.71).

"The lesson is that we need additional research in children to determine the potential impact of having high fat in the setting of normal BMI to recognise this issue and perhaps justify the use of body composition techniques to detect obesity at an early stage," concluded Lopez-Jimenez.

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