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Epidemiology and Population Health

The effect of height on estimates of the change in BMI-based prevalence of childhood obesity



Body mass index (BMI, body mass/height2) is biased toward height in children. Here we investigate how change in population height affected change in BMI-based estimates of the prevalence of overweight and obesity in Australian children.


Height, weight, and percent body fat (%BF) were measured at ages 8, 10, and 12 years (1855 sets of measures). Age-specific relationships between BMI and height were derived, adjusting for %BF, to estimate the degree of height bias inherent in BMI. Then, from cross-sectional measurements recorded in 1985 (N = 2388) and 1995 (N = 2148) in 8, 10, and 12 year olds, changes in overweight/obesity prevalences were calculated before and after accounting for the BMI-height bias.


Estimates of the effect of height on BMI following adjustment for %BF were similar across age groups and all were significant at p < 0.001. Referring to 12 year olds, at the same %BF for a 1% increase in height there was 0.77% (95% CI 0.55, 0.99) increase in BMI in boys, and 0.74% (0.28, 1.02) increase in girls. Between 1985 and 1995, mean height of 12-year-old boys and girls increased 3.9 and 3.2 cm, respectively. In 1985 unadjusted prevalences of combined overweight/obesity in boys and girls were 13.5% and 13.0%, respectively, and in 1995 were 24% and 24.5%. The latter values were reduced to 21.6% and 22.6% after adjusting for increased height.


Previously reported increases in childhood overweight/obesity in Australia between 1985 and 1995 were likely to be moderately overestimated as a result of increased population height; suggesting that population height be taken into account in any pediatric investigation of changes in overweight/obesity prevalence over time.

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We thank the children, parents, teachers, and other staff associated with the Australian Capital Territory Department of Education and Training for their willing cooperation. Gratitude is expressed to Ms Karen Gravenmaker, who carried out and analyzed the DXA assessments of body composition under the supervision of Dr. Ahmad Javaid at The Canberra Hospital.


The work was supported by the Commonwealth Education Trust (London, UK). The funders had no role in the study design, data collection, analysis, or interpretation or writing of this report.

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Correspondence to Richard D. Telford.

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This study was approved by the ACT Health and Community Care Human Research Ethics Committee and the Ethics Committee at the Australian Institute of Sport.

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Supplementary information


Genstat statistical output of the estimates of (the natural logarithms) of explanatory variables percent body fat and height for response variable BMI

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Telford, R.D., Olds, T.S., Telford, R.M. et al. The effect of height on estimates of the change in BMI-based prevalence of childhood obesity. Int J Obes 45, 2506–2510 (2021).

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