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  • Pediatric Technical Report
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BMI was right all along: taller children really are fatter (implications of making childhood BMI independent of height) EarlyBird 48

International Journal of Obesity volume 35, pages 541–547 (2011)Cite this article

Subjects

Abstract

Objective:

Several studies suggest that taller children may be wrongly labelled as ‘overweight’ because body mass index (BMI) is not independent of height (Ht) in childhood, and recommend adjustment to render the index Ht independent. We used objective measures of %body fat and hormonal/metabolic markers of fatness to investigate whether BMI and the corresponding fat mass index (FMI) mislead in childhood, or whether taller children really are fatter.

Design:

Longitudinal observational study measuring children annually from age 7 to 12 years.

Subjects:

Two hundred and eighty healthy children (56% boys) from the EarlyBird study.

Measurements:

BMI (body mass (BM)/Ht2), FMI (fat mass (FM)/Ht2), %body fat ((FM/BM) × 100, where FM was measured by dual-energy X-ray absorptiometry), fasting leptin (a hormonal measure of body fatness) and insulin resistance (a metabolic marker derived from the validated homeostasis model assessment program for insulin resistance - HOMA2-IR) were all analysed in relation to Ht. Alternative Ht-independent indices of BM and FM were compared with BMI and FMI as indicators of true fatness and related health risk.

Results:

BMI and FMI correlated with Ht at each annual time point (r∼0.47 and 0.46, respectively), yet these correlations were similar in strength to those between Ht and %fat (r∼0.47), leptin (r∼0.41) and insulin resistance (r∼0.40). Also, children who grew the most between 7 and 12 years showed greater increases in BMI, FMI, leptin and insulin resistance (tertile 1 vs 3, all p<0.05). BMI and FMI explained ∼20% more of the variation in %fat, ∼15% more in leptin and ∼10% more in insulin resistance than the respective Ht-independent reformulations (BM/Ht3.5 and FM/Ht7, both p<0.001).

Conclusion:

Taller children really are fatter than their shorter peers, have higher leptin levels and are more insulin resistant. Attempts to render indices of BM or FM independent of Ht in children seem inappropriate if the object of the index is to convey health risk.

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Acknowledgements

We thank Karen Brookes and Val Morgan for their assistance with data collection and Sharan Griffin and Geraldine Pearce for operating the dual-energy X-ray absorptiometry machine. The EarlyBird Diabetes Study is funded by Diabetes UK, Bright Futures Trust, Smith's Charity, Child Growth Foundation, Diabetes Foundation, Beatrice Laing Trust, Abbott, Astra-Zeneca, GSK, Ipsen, Roche. None of the sources funding this study had any involvement in the study design, collection or analysis of data, interpretation of findings or writing of the manuscript.

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  1. Department of Endocrinology and Metabolism, Peninsula College of Medicine and Dentistry, Plymouth Campus, Plymouth, UK

    B S Metcalf, J Hosking, A E Frémeaux, A N Jeffery, L D Voss & T J Wilkin

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  1. B S Metcalf
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  2. J Hosking
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  3. A E Frémeaux
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  4. A N Jeffery
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  5. L D Voss
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Correspondence to B S Metcalf.

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Metcalf, B., Hosking, J., Frémeaux, A. et al. BMI was right all along: taller children really are fatter (implications of making childhood BMI independent of height) EarlyBird 48. Int J Obes 35, 541–547 (2011). https://doi.org/10.1038/ijo.2010.258

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  • DOI: https://doi.org/10.1038/ijo.2010.258

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