Issues and Implications of Screening, Surveillance, and Reporting of Children’s BMI

There was general agreement that BMI was a sound epidemiologic tool for the assessment of overweight and obesity in populations, as well as a useful clinical tool. Several limitations with respect to the use of BMI were raised or confirmed. These limitations included use of triceps skinfold measurements to further differentiate children at risk whose BMI was between the 85th and 95th percentiles, additional efforts to clarify BMI measurements beyond the 97th percentile, selfor parent-reported height and weight, and challenges with communication of the meaning of BMI to parents. As Freedman and Sherry1 indicated, the use of the triceps skinfold does not provide much useful additional information except for children between the 85th and 95th percentiles. In this group, an increased triceps skinfold helps distinguish children who are overweight but not overfat from children who are overweight because of increased body frame or muscle mass. Although 1 published article suggested use of the 99th percentile for the classification of severe obesity, extrapolation of BMI categories beyond the 97th percentile are based on few measurements and, therefore, should be done with caution. Efforts should be made to achieve a consensus on how to classify severely obese children.