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Measuring severe obesity in pediatrics using body mass index-derived metrics from the Centers for Disease Control and Prevention and World Health Organization: a secondary analysis of CANadian Pediatric Weight management Registry (CANPWR) data

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Abstract

To examine the (i) relationships between various body mass index (BMI)-derived metrics for measuring severe obesity (SO) over time based the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) references and (ii) ability of these metrics to discriminate children and adolescents based on the presence of cardiometabolic risk factors. In this cohort study completed from 2013 to 2021, we examined data from 3- to 18-year-olds enrolled in the CANadian Pediatric Weight management Registry. Anthropometric data were used to create nine BMI-derived metrics based on the CDC and WHO references. Cardiometabolic risk factors were examined, including dysglycemia, dyslipidemia, and elevated blood pressure. Analyses included Pearson correlations, intraclass correlation coefficients (ICC), and receiver operator characteristic area-under-the-curve (ROC AUC). Our sample included 1,288 participants (n = 666 [52%] girls; n = 874 [68%] white). The prevalence of SO varied from 60–67%, depending on the definition. Most BMI-derived metrics were positively and significantly related to one another (r = 0.45–1.00); ICCs revealed high tracking (0.90–0.94). ROC AUC analyses showed CDC and WHO metrics had a modest ability to discriminate the presence of cardiometabolic risk factors, which improved slightly with increasing numbers of risk factors. Overall, most BMI-derived metrics rated poorly in identifying presence of cardiometabolic risk factors.

   Conclusion: CDC BMI percent of the 95th percentile and WHO BMIz performed similarly as measures of SO, although neither showed particularly impressive discrimination. They appear to be interchangeable in clinical care and research in pediatrics, but there is a need for a universal standard. WHO BMIz may be useful for clinicians and researchers from countries that recommend using the WHO growth reference.

What is Known:

• Severe obesity in pediatrics is a global health issue.

• Few reports have evaluated body mass index (BMI)-derived metrics based on the World Health Organization growth reference.

What is New:

• Our analyses showed that the Centers for Disease Control and Prevention BMI percent of the 95th percentile and World Health Organization (WHO) BMI z-score (BMIz) performed similarly as measures of severe obesity in pediatrics.

• WHO BMIz should be a useful metric to measure severe obesity for clinicians and researchers from countries that recommend using the WHO growth reference.

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Data availability

Study data may be made available upon reasonable request from Geoff Ball (corresponding author) and Katherine Morrison (CANPWR Principal Investigator).

Abbreviations

BIC:

Bayesian Information Criteria

BMI:

Body mass index

BMIz:

Body mass index z-score

CANPWR:

CANadian Pediatric Weight management Registry

CDC:

Centers for Disease Control and Prevention

DBP:

Diastolic blood pressure

HDL:

High density lipoprotein

ICC:

Intraclass correlation coefficients

LDL:

Low density lipoprotein

ROC AUC:

Receiver operator characteristic area-under-the-curve

SBP:

Systolic blood pressure

SO:

Severe obesity

WHO:

World Health Organization

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Acknowledgements

The authors wish to thank all the families who contributed their data to the CANPWR study as well as all the research, clinical, and administrative team members across our sites for their assistance in collecting and managing study data.

On behalf of the CANadian Pediatric Weight management Registry (CANPWR) investigators

Katherine M. Morrison is the Principal Investigator for the CANPWR Study. She is the senior author on this manuscript, submitting on behalf of the CANPWR Investigators, which includes (in alphabetical order): Annick Buchholz, PhD; J-P Chanoine, MD, PhD; Jill Hamilton, MD; Josephine Ho, MD, MSc; Anne-Marie Laberge, MD, MPH, PhD; Laurent Legault, MD; Lehana Thabane, PhD; Mark S Tremblay, PhD; Ian Zenlea, MD, MPH.

Funding

This research was funded by the Stollery Children’s Hospital Foundation and the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute at the University of Alberta.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 – 87th Ave, AB, T6G 1C9, Edmonton, Canada

    Geoff D. C. Ball

  2. Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada

    Atul K. Sharma

  3. School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada

    Sarah A. Moore

  4. Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Daniel L. Metzger

  5. Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada

    Doug Klein

  6. Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Katherine M. Morrison

  7. Carleton University, Ottawa, ON, Canada

    Annick Buchholz

  8. University of British Columbia, Vancouver, BC, Canada

    J-P Chanoine

  9. The Hospital for Sick Children, Toronto, ON, Canada

    Jill Hamilton

  10. University of Calgary, Calgary, AB, Canada

    Josephine Ho

  11. University of Montreal, Montreal, QC, Canada

    Anne-Marie Laberge

  12. McGill University, Montreal, QC, Canada

    Laurent Legault

  13. McMaster University, Hamilton, QC, Canada

    Lehana Thabane

  14. University of Ottawa, Ottawa, ON, Canada

    Mark S Tremblay

  15. Trillium Health Partners, Mississauga, ON, Canada

    Ian Zenlea

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  1. Geoff D. C. Ball
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  4. Daniel L. Metzger
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  5. Doug Klein
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  6. Katherine M. Morrison
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Consortia

on behalf of the CANadian Pediatric Weight management Registry (CANPWR) Investigators

  • Annick Buchholz
  • , J-P Chanoine
  • , Jill Hamilton
  • , Josephine Ho
  • , Anne-Marie Laberge
  • , Laurent Legault
  • , Lehana Thabane
  • , Mark S Tremblay
  •  & Ian Zenlea

Contributions

Dr. Geoff Ball conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript. Dr. Atul Sharma helped to conceptualize and design the study, planned, and conducted data analysis, and critically reviewed and revised the manuscript. Dr. Sarah A Moore helped to conceptualize and design the study, and critically reviewed and revised the manuscript. Dr. Daniel L Metzger assisted with data analysis, and critically reviewed and revised the manuscript for important intellectual content. Dr. Doug Klein helped to conceptualize and design the study, and critically reviewed and revised the manuscript. Dr. Katherine Morrison helped to conceptualize and design the study, led the collection and management of study data from the multi-centre CANadian Pediatric Weight management Registry (CANPWR) study, and critically reviewed and revised the manuscript. Drs. Annick Buchholz, J-P Chanoine, Jill Hamilton, MD, Josephine Ho, Anne-Marie Laberge, Laurent Legault, Lehana Thabane, Mark S Tremblay, and Ian Zenlea are CANPWR Investigators who critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Geoff D. C. Ball.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Each of the nine participating weight management clinics obtained ethical approval from their local institutional research ethics boards. Approval for this secondary analysis of CANPWR data was provided by the University of Alberta Health Research Ethics Board (Pro00113132).

Consent statement

Patient consent was required for our study.

Competing interests

Geoff Ball has received research funding from the Canadian Institutes of Health Research, Alberta Health Services, the Women and Children’s Health Research Institute (University of Alberta), and the Public Health Agency of Canada. He has served as a consultant for Novo Nordisk Canada. The other authors have no example conflicts of interest to disclose.

Additional information

Communicated by Gregorio Milani.

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Ball, G.D.C., Sharma, A.K., Moore, S.A. et al. Measuring severe obesity in pediatrics using body mass index-derived metrics from the Centers for Disease Control and Prevention and World Health Organization: a secondary analysis of CANadian Pediatric Weight management Registry (CANPWR) data. Eur J Pediatr 182, 3679–3690 (2023). https://doi.org/10.1007/s00431-023-05039-4

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