The major factor limiting our understanding of the true extent of the childhood obesity problem is the lack of a standard population-level methodology for measuring overweight and obesity in children and adolescents. Presently a number of different methods or indices are in use with a variety of cut-off points for designating a child as obese. The US National Center for Health Statistics (NCHS) growth reference charts have been recommended by the WHO for international use since the late 1970s but a number of serious technical and biological problems have been identified with their development and application.
An expert working group of the International Obesity Task Force investigated this issue and concluded that BMI-for-age, based on a redefined international reference population from 5 to 18 years, was a reasonable index of adiposity and could be used for population studies. They identified a novel approach to determine cut-off values that classify children as overweight or obese using percentiles that correlate to the standard cut-off points for BMI in adults (34). WHO is also in the process of developing a new growth reference for infants and children from birth to 5 years.
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