{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:45:54Z","timestamp":1792809954703,"version":"4.5.0"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,2,28]],"date-time":"2017-02-28T00:00:00Z","timestamp":1488240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K24 DK10589"],"award-info":[{"award-number":["K24 DK10589"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000130","name":"National Center for Chronic Disease Prevention and Health Promotion","doi-asserted-by":"publisher","award":["RFA\u2010DP\u201011\u2010007"],"award-info":[{"award-number":["RFA\u2010DP\u201011\u2010007"]}],"id":[{"id":"10.13039\/100000130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000130","name":"National Center for Chronic Disease Prevention and Health Promotion","doi-asserted-by":"publisher","award":["U18DP003370"],"award-info":[{"award-number":["U18DP003370"]}],"id":[{"id":"10.13039\/100000130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Although the Centers for Disease Control and Prevention (CDC) growth charts are widely used, BMI\u2010for\u2010age <jats:italic>z<\/jats:italic>\u2010Scores (BMIz) are known to be uninformative above the 97th percentile. This study compared the relations of BMIz and other BMI metrics (%BMI<jats:sub>p95<\/jats:sub>, percent of 95th percentile, and \u0394BMI<jats:sub>p95<\/jats:sub>, BMI minus 95th percentile) to circumferences, skinfolds, and fat mass. We were particularly interested in the differences among children with severe obesity (%BMI<jats:sub>p95<\/jats:sub>\u2009\u2265\u2009120).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data was used from 30,003 2\u2010 to 19\u2010year\u2010olds who were examined from 1999\u20102000 through 2013\u20102014 in the National Health and Nutrition Examination Survey (NHANES).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The theoretical maximum BMIz based on the growth charts varied by more than threefold across ages. The BMI metrics were strongly intercorrelated, but BMIz was less strongly related to the adiposity measures than were \u0394BMI<jats:sub>p95<\/jats:sub> and %BMI<jats:sub>p95<\/jats:sub>. Among children with severe obesity, circumferences and triceps skinfold showed almost no association with BMIz (<jats:italic>r<\/jats:italic>\u2009\u2264\u20090.10), whereas associations with %BMI<jats:sub>p95<\/jats:sub> and \u0394BMI<jats:sub>p95<\/jats:sub> ranged from <jats:italic>r<\/jats:italic>\u2009=\u20090.32 to 0.79. Corresponding associations with fat mass \u00f7 height<jats:sup>2<\/jats:sup> ranged from <jats:italic>r<\/jats:italic>\u2009=\u20090.40 (BMIz) to <jats:italic>r<\/jats:italic> =0.82 (%BMI<jats:sub>p95<\/jats:sub>) among 8\u2010 to 19\u2010year\u2010olds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among children with severe obesity, BMIz is only weakly associated with other measures of body fatness. Very high BMIs should be expressed relative to the CDC 95th percentile, particularly in studies that evaluate obesity interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/oby.21782","type":"journal-article","created":{"date-parts":[[2017,2,28]],"date-time":"2017-02-28T13:51:18Z","timestamp":1488289878000},"page":"739-746","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":229,"title":["BMI <i>z<\/i>\u2010Scores are a poor indicator of adiposity among 2\u2010 to 19\u2010year\u2010olds with very high BMIs, NHANES 1999\u20102000 to 2013\u20102014"],"prefix":"10.1002","volume":"25","author":[{"given":"David S.","family":"Freedman","sequence":"first","affiliation":[{"name":"Division of Nutrition Physical Activity, and Obesity, Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy F.","family":"Butte","sequence":"additional","affiliation":[{"name":"Children's Nutrition Research Center, Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsie M.","family":"Taveras","sequence":"additional","affiliation":[{"name":"Department of Pediatrics MassGeneral Hospital for Children Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Lundeen","sequence":"additional","affiliation":[{"name":"Division of Nutrition Physical Activity, and Obesity, Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi M.","family":"Blanck","sequence":"additional","affiliation":[{"name":"Division of Nutrition Physical Activity, and Obesity, Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyson B.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Division of Nutrition Physical Activity, and Obesity, Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia L.","family":"Ogden","sequence":"additional","affiliation":[{"name":"National Center for Health Statistics, Centers for Disease Control and Prevention Hyattsville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,2,28]]},"reference":[{"key":"e_1_2_5_2_1","article-title":"2000 CDC Growth Charts for the United States: methods and development","author":"Kuczmarski RJ","year":"2002","journal-title":"Vital and Health Statistics"},{"key":"e_1_2_5_3_1","article-title":"Changes in terminology for childhood overweight and obesity","author":"Ogden CL","year":"2010","journal-title":"National Health Statistics Reports"},{"key":"e_1_2_5_4_1","article-title":"Construction of LMS parameters for the Centers for Disease Control and Prevention 2000 growth charts","author":"Flegal KM","year":"2013","journal-title":"National Health Statistics Reports"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780111005"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.28335"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182a5cfb3"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12277"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2013.02.120118"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-14-225"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2014.06.009"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1602090"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.20608"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2006.07.014"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/17477160902957133"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-305163"},{"key":"e_1_2_5_17_1","unstructured":"Centers for Disease Control and Prevention. 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