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Background: Recent studies have shown considerable variation in body fatness among children and adolescents defined as obese by a percentile rank for skinfold thickness., Methods: We examined the relationship between percent body fat and risk for elevated blood pressure, serum total cholesterol, and serum lipoprotein ratios in a biracial sample of 3320 children and adolescents aged 5 to 18 years. Equations developed specifically for children using the sum of subscapular (S) and triceps (T) skinfolds were used to estimate percent fat. The S/T ratio provided an index of trunkal fat patterning., Results: Significant overrepresentation (greater than 20%) of the uppermost quintile (UQ) for cardiovascular disease (CVD) risk factors was evident at or above 25% fat in males (32.2% to 37.3% in UQ) and at or above 30% fat in females (26.6% to 45.4% in UQ), even after adjusting for age, race, fasting status, and trunkal fat patterning., Conclusions: These data support the concept of body fatness standards in White and Black children and adolescents as significant predictors of CVD risk factors. Potential applications of these obesity standards include epidemiologic surveys, pediatric health screenings, and youth fitness tests.

The persistence of obesity and overweight over eight years was assessed in a biracial (Black-White) cohort of 1,490 two-to 14-year-olds. Initial levels of triceps skinfold thickness (TRSF) and Rohrer index (weight/height3) were moderately predictive of subsequent levels: r = 0.54 and 0.67, respectively. However, TRSF and Rohrer index tended to track most strongly in Black females (r = 0.64 and 0.72) and less well in both White females (r = 0.45 and 0.57) and preschool children (r = 0.45 and 0.54). Based on elevated levels of TRSF or Rohrer index, children were classified as obese or overweight, respectively. Of the 222 children who were initially above the 85th percentile for TRSF, 43 per cent remained obese after eight years. Persistence of overweight was slightly greater at follow-up, with 50 per cent of initially overweight children staying above the 85th percentile for Rohrer index. Severe, initial obesity/overweight (greater than 95th percentile) and consecutively elevated levels increased the probability of remaining obese/overweight. Results indicate that moderate, juvenile-onset obesity is malleable, but that the child who is extremely obese over consecutive examinations is likely to become an obese adult.

Secular changes in height and weight measurements were examined in five- to 14-year-olds from 1973 to 1984. The age-sex specific 85th percentile was used to classify persons as overweight (based on ponderal index; kg/m3). Secular increases in weight (2.5 kg), and ponderosity (0.5-0.7 kg/m3) were found. Gains in ponderosity over the 11-year period were greater at the 75th percentile than at the 25th percentile, and the prevalence of overweight increased from 15 per cent to 24 per cent.