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The article summarizes evidence base for the diagnostic accuracy of body mass index (BMI) in youth and discusses views on what is realized by a definition of overweight and obesity based on high BMI. The BMI is defined and the use of BMI in children and adolescents is described. Choice of a BMI-for-age reference standard and body mass index z-scores are analyzed. Research considerations, implications for longitudinal research into adulthood, and considerations for public health surveillance are discussed.

Background: Obesity is a risk factor for severe and difficult-to-treat asthma. However, the impact of different physiques on long-term outcomes is poorly understood. We aimed to investigate the correlation between obesity and asthma-associated long-term mortality in Japanese adults., Methods: From the data on 3146 individuals with air pollution-related respiratory diseases in the Omuta City Air Pollution-Related Health Damage Cohort Program, 697 adult patients with asthma were analyzed. Hazard ratios for long-term all-cause and respiratory disease -related mortality were compared in patients with different physiques using the Cox proportional hazard models. The classification of physiques was based on the WHO obesity criteria., Results: Of the 697 patients, 439 died during the median observation period of 26.3 years. The number (% of total) of underweight, normal-weight, pre-obese, and obese class I-III individuals were 75 (10.8%), 459 (65.9%), 140 (20.1%), and 23 (3.3%), respectively. The Cox proportional hazard model (adjusted hazard ratio [95% confidence interval], P value) showed that pre-obese group had a significantly reduced risk for all-cause (0.65 [0.51 to 0.83], P < 0.05) and respiratory disease (0.55 [0.37 to 0.81], P < 0.05)-related mortality related to normal-weight group., Conclusions: Our cohort program demonstrated that being slightly overweight may reduce the risk of long-term mortality in patients with asthma. However, the influence of obesity on long-term outcomes remains unclear in asthma, because of the small number of obese patients included in our study. Our findings suggest that interventions, including nutrition and exercises, should be provided to Japanese patients with asthma., (Copyright © 2021 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.)

Childhood obesity is one of the most serious public health problems. The prevalence of obesity among children is increasing and may negatively affect their immediate health, but it can also lead to obesity in adulthood. The aim of the study was to compare BMI cut-off points by examining three main international references: the World Health Organization (WHO), the International Task Force Obesity (IOTF) and the US Center for Disease Control and Prevention (CDC). Ultimately, the study group consisted of 18,144 children and adolescents aged 6.5-17.5 years. Body mass was measured on medical scales with an accuracy of ± 100 g and height measurement was taken using a height meter with an accuracy of ± 0.1 cm three times. Underweight, overweight and obesity were calculated according to WHO, IOTF and CDC BMI international references. There were differences in the incidence of underweight between the classifications: 16.8% according to IATF, 5.3% according to WHO and 9.9% according to CDC. There were also differences in the incidence of overweight and obesity between the classifications: 13% according to IOTF, 19.7% according to WHO and 14.1% according to CDC. In the CDC and WHO studies, a significantly higher prevalence of childhood obesity (4.0% and 4.7%, respectively) was observed compared with IOTF (2.1%). The prevalence of overweight and obesity in this study was higher among boys compared to girls. However, estimates of prevalence of overweight and obesity differ in methods and reference cut-off points. Higher prevalence was obtained in IOTF classification, followed by the WHO and CDC classification., Competing Interests: The authors have declared that no competing interests exist.

Autonomic imbalance in overweight/obese persons could lead to an increased risk of cardiovascular complications including hypertension and arrhythmias. Baroreceptor reflex sensitivity is a sensitive indicator to detect an altered sympathovagal balance in overweight/obese individuals. This study investigated the effects of overweight/obesity on baroreceptor sensitivity in young Saudi males at rest and in response to physiological challenges., Subjects and Methods: In this cross-sectional study, spontaneous baroreceptor sensitivity at rest and in response to deep breathing, isometric hand grip exercise and moderate intensity isotonic exercise were recorded in 20 normal weight and 20 overweight/obese subjects. Finger arterial blood pressure signal, recorded through Finometer, was used to calculate baroreceptor sensitivity through cross-correlation method. The baroreceptor sensitivity data were log transformed before application of parametric tests., Results: The spontaneous baroreceptor sensitivity was similar in both groups at baseline, but exhibited a significant increase during deep breathing only in normal weight (p < .001). Immediately after the isotonic exercise the baroreceptor sensitivity was significantly lower than baseline in both normal weight and overweight/obese and remained significantly lower in overweight/obese individuals compared to normal weight (p < .05) throughout the recovery period. There was a significant rise in baroreceptor sensitivity after isometric exercise in overweight/obese group only (p = .001). Pearson's correlation showed a significant negative correlation of baroreceptor sensitivity with body mass index during deep breathing (r = -.472, p = .004) and in post-isotonic exercise recovery period (r = -.414, p = .013)., Conclusion: A significantly reduced baroreceptor sensitivity response to deep breathing, reduced baroreceptor sensitivity recovery after isotonic exercise, and an exaggerated shoot up after isometric exercise in overweight/obese suggests an altered sympathovagal balance. Baroreceptor sensitivity measurements in response to physiological challenges, deep breathing, and isotonic exercise, may be more sensitive investigations for detection of early attenuation of cardiac autonomic function. This would enable timely intervention thereby delaying complications and improving the quality of life., (© 2020 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)

Objective: People with diabetes show great variability in weight gain and duration of obesity at the time of diagnosis. BMI trajectories and other cardiometabolic risk factors prior to type 2 diabetes were investigated., Methods: A total of 6,223 participants from the Rotterdam Study cohort were included. BMI patterns before diagnosis of diabetes were identified through latent class trajectories., Results: During a mean follow-up of 13.7 years, 565 participants developed type 2 diabetes. Three distinct trajectories of BMI were identified, including the "progressive overweight" group (n = 481, 85.1%), "progressive weight loss" group (n = 59, 10.4%), and "persistently high BMI" group (n = 25, 4.4%). The majority, the progressive overweight group, was characterized by a steady increase of BMI in the overweight range 10 years before diabetes diagnosis. The progressive weight loss group had fluctuations of glucose and marked beta cell function loss. The persistently high BMI group was characterized by a slight increase in insulin levels and sharp increase of insulin resistance accompanied by a rapid decrease of beta cell function., Conclusions: Heterogeneity of BMI changes prior to type 2 diabetes was found in a middle-aged and elderly white population. Prevention strategies should be tailored rather than focusing only on high-risk individuals., (© 2020 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society (TOS).)

Background: The World Health Organization (WHO-2007) and the International Obesity Task Force (IOTF-Cole) systems assess child weight status. However, derived estimations often differ. We aimed to a) compare the prevalence of overweight and obesity, b) analyze individual and contextual factors associated with child weight using multilevel analysis and c) explore the spatial distribution of overweight and obesity using both classification systems., Methods: We used data from the 2015/2016 National School Height and Weight Census in El Salvador. Information on 111,991 children aged 6.0-9.9 years attending the first grade was analyzed. Body mass index Z-score (BMIZ), overweight and obesity were defined with both classification systems. Weighted kappa was used to measure agreement. Child, school and municipal potential determinants of BMIZ were examined by multilevel analysis. Municipal spatial clustering of overweight and obesity was tested using Moran's Index and Getis-ord Gi* statistics., Results: The combined prevalence of overweight and obesity was higher according to the WHO system than the IOTF (30.4% vs 23.1%). The weighted kappa was 0.83. Boys, children attending urban schools, children attending private schools, and children residing in municipalities with high human development index had higher BMIZ than their counterparts. The Moran's indexes were positives and significant. Clusters of high prevalence (above the national prevalence) of overweight and obesity were found in 29 municipalities using the WHO and IOTF systems. For obesity, 28 and 23 municipalities in clusters of high prevalence were detected using the WHO and IOTF criteria, respectively., Conclusions: Overweight and obesity is high among school-age children in El Salvador. The prevalence of overweight and obesity was higher when using the WHO system, as compared to the IOTF system. Irrespective of the classification system, the multilevel and spatial analysis derived similar interpretations. These results support the need for national preventive interventions with targeting strategies to reduce overweight and obesity in school-age children.

Background : At present, whether to use the World Health Organization's (WHO) growth standards or native growth standards to assess the nutritional status in a given population is unclear. This study aimed to compare the differences between the WHO's growth standards and China's growth standards in assessing the nutritional status of children aged 0~36 months. Methods : We used z-scores to evaluate the nutritional status of children. The weight-for-age z-scores (WAZs), length/height-for-age z-scores (LAZ/HAZs), and weight-for-length/height z-scores (WLZ/WHZs) were calculated using the WHO's growth standards and China's growth standards. MeNemar's test was used to compare the nutritional status of children. Results : The results in this study showed that there were differences between the WHO's standards and China's standards in assessing children's nutritional status except for stunting and obesity. The prevalence of underweight assessed using China's standards was higher than when using the WHO's standards (except when 3 and 36 months old). The prevalence of wasting was significantly higher when assessed using China's standards than when using the WHO's standards from 12 to 36 months. The prevalence of overweight was higher when assessed using the WHO's standards from 3 to 8 months. Conclusions : Both the WHO's and China's growth standards are useful measures in assessing children's nutritional status but with key significant differences. Therefore, caution should be taken in selecting appropriate measures in a given population.

Objective: Despite the increasing literature on the association of diabetes with inflammation, cardiovascular risk, and vitamin D (25(OH)D) concentrations, strong evidence on the direction of causality among these factors is still lacking. This gap could be addressed by means of artificial neural networks (ANN) analysis. Methods: Retrospective observational study was carried out by means of an innovative data mining analysis-known as auto-contractive map (AutoCM)-and semantic mapping followed by Activation and Competition System on data of workers referring to an occupational-health outpatient clinic. Parameters analyzed included weight, height, waist circumference, body mass index (BMI), percentage of fat mass, glucose, insulin, glycated hemoglobin (HbA1c), creatinine, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, uric acid, fibrinogen, homocysteine, C-reactive protein (CRP), diastolic and systolic blood pressure, and 25(OH)D. Results: The study included 309 workers. Of these, 23.6% were overweight, 40.5% were classified into the first class of obesity, 23.3% were in the second class, and 12.6% were in the third class (BMI > 40 kg/m ). All mean biochemical values were in normal range, except for total cholesterol, low- and high-density lipoprotein cholesterol, CRP, and 25(OH)D. HbA1c was between 39 and 46 mmol/mol in 51.78%. 25(OH)D levels were sufficient in only 12.6%. Highest inverse correlation for hyperglycemia onset was with BMI and waist circumference, suggesting a protective role of 25(OH)D against their increase. AutoCM processing and the semantic map evidenced direct association of 25(OH)D with high link strength (0.99) to low CRP levels and low high-density lipoprotein cholesterol levels. Low 25(OH)D led to changes in glucose, which affected metabolic syndrome biomarkers, first of which was homeostatic model assessment index and blood glucose, but not 25(OH)D. Conclusions: The use of ANN suggests a key role of 25(OH)D respect to all considered metabolic parameters in the development of diabetes and evidences a causation between low 25(OH)D and high glucose concentrations.

Introduction: Overweight and obesity have the features of a worldwide epidemic, making it a public health problem. The traditional classification with the body mass index is a good start, but after the evidence of the biochemical activities of adipose tissue, its measurement is a necessity. There are multiple formulas for this purpose, but with little possibility of applying it in Primary Care. The following formulas are proposed for its use in this setting; Men=(body mass index [BMI/Abdominal Circumference [AC]*10)+BMI. Women=([BMI/AC]*10)+BMI+10., Material and Methods: A descriptive, prospective study was conducted, including 505 women and 489 men aged between 30 and 90 years. Weight, height, and abdominal circumference were measured, and the body mass index, percentage of fat using the CUN BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) and proposed formulas were calculated., Results: Comparative calculations were made between CUN BAE and formulas. No significant differences were observed in the descriptive values (Women χ 2 =1.1; P=.89. Men χ 2 =0.8; P=.93. The confidence interval and standard error p=1. The numerical correlation shows r=0.94; p=0.0001; R 2 =0.89. The relative error of the mean in men was 5.48% and -0.43% in women. The comparison of medians demonstrated Wilcoxon=0.8333. The study of sensitivity and specificity for cut-off points shows a ROC curve AUC=0.986; P=<.0001., Conclusions: The lack of significant differences between the results of both formulas, makes it possible to be proposed for the calculation of the fat percentage in body weight in Primary Care Clinics., (Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Many studies have reported negative association between fitness level and BMI categories but the lack of body weight correction and the systematic use of physical endurance test made these differences controversial. Thus, the aim of this study was the assessment of physical fitness level associated to BMI using alternative tests., Methods: BMI was calculated as body mass/stature2 while fitness level was assessed using field test. In particular, Sit and Reach (SAR), Standing Broad Jump (SBJ), Shuttle Run Test 5 mx 10 (SHR), Sit ups (SUP), Bent arm hang (BAH) were assessed in 2545 students. Subsequently, normal weight/overweight/obesity/underweight/thinness students were classified according to the cut-off points defined in literature and then the relative fitness results., Results: The performances in SBJ showed very low differences between BMI categories such as for SUP test. The effects size in SHR were low or close to moderate while in BAH thin students revealed high performance than normal/overweight peers. In SAR test no clear trends in the BMI categories were observed., Conclusions: All test (exluding BAH) were similar for normal, overweight and thin students. This finding can be useful to teachers to encourage over/under-weighted students to adopt active life style because they are close to normal weight counterparts.

Objective: This study is to examine the influence of familiarity on energy intake, eating behavior, and concentration of the plasma gut hormones in lean and overweight young male subjects., Methods: Twenty-eight lean and twenty-eight overweight participants were recruited. Their food consumption was documented and analyzed when they had a test meal while they were paired with friends or strangers at the same weight stature. Their eating behavior was recorded with cameras hidden in the carton, and postprandial plasma gut hormone concentration were measured., Results: Compared with overweight strangers (OS), overweight friends (OF) had increased food consumption, prolonged and decreased number of chews per 10 g food. Compared with OS, postprandial plasma concentration of cholecystokinin-8 was significantly lower in OF group at 30, 60, and 90 min, whereas the concentration of glucagon-like peptide 1 was significantly lower at 60 and 90 min. Plasma ghrelin concentration was significantly higher in the OF group than that in the OS group at 90 and 120 min. No significant differences in gut hormone concentration were observed between lean strangers (LS) and lean friends (LF) groups at all time points., Conclusion: Familiarity plays an important role in increasing energy intake and in changing of postprandial gut hormone concentration in overweight individuals., (Copyright © 2018 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

Purpose: Rural residents are significantly more likely to be overweight and obese than are urban residents. However, few data have compared weight control program responses in these population groups. Therefore, the primary aim of this study was to evaluate the weight loss outcomes of participants in a multisite, online behavioral intervention by residential location (rural vs urban) and, second, assess any possible differences in adherence to treatment goals., Methods: A total of 492 adult participants (mean BMI = 35.7 kg/m 2 ; 90% female; 24% minority) were categorized based on their home ZIP code and the 2010 US Census Urban and Rural Classification criteria (58.3% rural; 41.7% urban). Weight (kg) was measured in-person at baseline and 6 months after participating in a behavioral weight control intervention. Adherence to physical activity and calorie and fat intake goals was assessed based on weekly self-monitoring journals. Weekly online chat attendance and completion of weekly online self-monitoring journals were recorded. Presence of obesogenic foods in the home was self-reported at baseline and 6 months., Findings: There were no statistically significant differences in weight loss between rural and urban participants (-6.1 kg vs -5.3 kg, P = .16), nor were there differences in chat attendance, self-monitoring journals, self-reported physical activity, calorie intake, or obesogenic foods reported in the household., Conclusions: Overall, there was no difference in weight loss and adherence to treatment goals for rural and urban participants. Further research on rural and urban residents is necessary to explore the factors responsible for the disparity in obesity prevalence., (© 2017 National Rural Health Association.)

Objective: To examine adolescents' and mothers' misclassification of the adolescents' body weight and associated early life predictors., Methods: Data are from a sample of women and their children who were part of a longitudinal Australian birth cohort study. We analysed data of 3925 adolescents, 3721 mothers, and 2593 mother-offspring pairs. At the 14-year follow up, we derived adolescents' body weight category (underweight, normal or overweight) based on their measured height and weight and adolescents reported their similar subjective weight categories. Similarly, mothers reported perceived weight of their adolescents' offspring. We compared objectively measured weight with subjective weight perceptions to identify misclassifications. Possible predictors of weight misclassification were taken from pregnancy, childhood and the adolescent period., Results: Almost a third of adolescents and a quarter of mothers misclassified the adolescents' body weight. Underestimation was observed more often in overweight adolescents. Overestimation was observed more often in underweight adolescents. More than a third of underweight adolescents and almost half of mothers of underweight children overestimated the adolescent's body weight. Normal weight females overestimated their body weight more than their males' counterparts. Predictor of misclassification included being female; dieting to lose weight; having over or underweight mothers; and having high level of poor mental health., Conclusions: Findings of this study suggest that adolescent weight misclassification is common across all BMI categories. Being female, dieting to lose weight, poor mental health and maternal BMI status predict misclassification. Further studies are needed to evaluate the population health significance of weight misclassifications., (Copyright © 2017. Published by Elsevier Ltd.)

Background: The 'obesity paradox' refers to the fact that obese patients have better outcomes than normal weight patients. This has been observed in multiple cardiovascular conditions, but evidence for obesity paradox in pulmonary hypertension (PH) remains sparse., Methods: We categorized 267 patients from the National Institute of Health-PH registry into five groups based on body mass index (BMI): underweight, normal weight, overweight, obese and morbidly obese. Mortality was compared in BMI groups using the χ 2 statistic. Five-year probability of death using the PH connection (PHC) risk equation was calculated, and the model was compared with BMI groups using Cox proportional hazards regression and Kaplan-Meier (KM) survival curves., Results: Patients had a median age of 39 years (interquartile range 30-50 years), a median BMI of 23.4 kg m - 2 (21.0-26.8 kg m -2 ) and an overall mortality at 5 years of 50.2%. We found a U-shaped relationship between survival and 1-year mortality with the best 1-year survival in overweight patients. KM curves showed the best survival in the overweight, followed by obese and morbidly obese patients, and the worst survival in normal weight and underweight patients (log-rank P=0.0008). In a Cox proportional hazards analysis, increasing BMI was a highly significant predictor of improved survival even after adjustment for the PHC risk equation with a hazard ratio for death of 0.921 per kg m -2 (95% confidence interval: 0.886-0.954) (P<0.0001)., Conclusion: We observed that the best survival was in the overweight patients, making this more of an 'overweight paradox' than an 'obesity paradox'. This has implications for risk stratification and prognosis in group 1 PH patients.

Background: One prominent reason patients undergo bariatric surgery is to reduce their excess weight and body mass index. Weight status classifications (WSCs), based on calculated body mass index, organize patients into distinct groups (underweight, healthy weight, overweight, class I obesity, class II obesity, and class III obesity) for treatment recommendations, including surgery for patients with obesity. Bariatric patients' perceptions of their WSC is important to consider, because patients who accurately perceive their WSC presurgery have greater motivation for health behavior changes; alternatively, incongruence between perceived and calculated WSC could deter motivation and ultimately their health changes postsurgery., Objectives: This study seeks to understand the congruence between patients' perceived and calculated WSC, and to determine if there are differences in congruence between groups of pre- or postsurgery, male and female, and emerging/early adulthood and middle/late adulthood patients., Setting: University Hospital., Methods: Self-report measures., Results: Results indicate the presurgery patients were more congruent in their perceptions of WSC compared with their postsurgery peers and emerging/early adulthood patients were more congruent in their perceptions of WSC compared with middle/late adulthood patients. No gender differences emerged in the full sample, but when divided by surgical status, presurgery females reported more congruent perceptions of WSC compared with their postsurgery peers. Males did not differ in their rates of congruence., Conclusion: These rates of incongruence may suggest a need for assessment of patients' perceived WSC, particularly postsurgery., (Published by Elsevier Inc.)

Introduction: In 2015, about 1.5 million adults in Mississippi were overweight or obese. Obesity is associated with increased risk for diabetes and cardiovascular problems. We examined trends in the prevalence of overweight, obesity, and extreme obesity from 2001 through 2010 and 2011 through 2015., Methods: We used data from the Mississippi Behavioral Risk Factor Surveillance System to analyze trends in the prevalence of overweight, obesity, and extreme obesity among adults from 2001 through 2010 and 2011 through 2015. Joinpoint software was used to examine annual percentage change (APC) in the prevalence of each condition overall and by sex and race., Results: We observed a significant decrease in overweight prevalence from 2001 to 2010, both overall (APC, -1.3%) and among men (APC, -2.0%), blacks (APC, -1.0%), and whites (APC, -1.5%), but not among women. The overall prevalence of both obesity (APC, 2.9%) and extreme obesity (APC, 3.6%) increased significantly, and these increases occurred across all subgroups for both obesity (men APC, 3.5%; women APC, 2.5%; blacks APC, 1.9%; and whites APC, 3.8%) and extreme obesity (men APC, 6.7%; women APC, 2.5%; blacks APC, 2.2%; and whites APC, 5.0%). From 2011 to 2015, the only significant change was an increase in the prevalence of extreme obesity among whites (APC, 2.6%)., Conclusion: The increasing proportion of adult Mississippians in the 2 highest-risk BMI categories warrants urgent community and clinical obesity interventions. Community-tailored and sustained obesity prevention, treatment, and control programs that include diet and physical activity are needed to address the obesity epidemic.

To classify children as overweight or obese, their body mass index (BMI) must be compared with a growth reference and be accompanied by a clinical assessment. In Denmark, there is a lack of consensus on which BMI reference to use; a mix of national and international references are used in clinics, hospitals and research institutions. In this article, the implications of using different references are illustrated with Danish data. The comparisons show that the references yield different prevalences of overweight in a non-predictable way, making comparisons and monitoring challenging.

Purpose: We aimed to compare preschool-age Chinese children's weight status based on the WHO guidelines with parental ratings on their children's body type, and child/family demographic characteristics., Method: The sample included 171 preschool-age children (M=60.5months, SD=6.7; boys: 46.8%) randomly selected from 23 classrooms. Based on BMIs from their height and weight from physical examinations, the children were divided into three groups using the 2006 WHO guidelines: underweight (n=46), normal weight (n=65), and overweight (n=60). Data on the parental ratings of children's current body type, ideal body type and child/family demographic characteristics were collected with surveys., Results: Parents' accurately classified 91.1% of the underweight children, 52.3% of the normal weight children, and 61.7% of the overweight children. In terms of ideal body shape for their children, parents typically wanted their children to have normal weight or to remain underweight. Most of the child and family demographic characteristics were not different across children who were underweight, had normal weight, and were overweight., Conclusion: Because parents tended to underestimate their children's weight status, it is important to increase Chinese parents' knowledge on what constitutes healthy weight, as well as the potential harm of overweight status for children's development. Training healthcare providers in kindergartens and pediatric clinics to work with parents to recognize unhealthy weight status in children is valuable., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Body Mass Index Italian reference data are available for clinical and/or epidemiological use, but no study compared the ability of this system to classify overweight and obesity and detect subjects with clustered cardiometabolic risk factors with international standards. Therefore our aim was to assess 1) the agreement among the Italian Society for Pediatric Endocrinology and Diabetology (ISPED), the World Health Organisation (WHO) and the International Obesity Task Force (IOTF) Body Mass Index cut-offs in estimating overweight or obesity in children and adolescents; 2) the ability of each above-mentioned set of cut-points to detect subjects with cardiometabolic risk factors., Methods: Data of 6070 Italian subjects aged 5-17 years were collected. Prevalence of normal-weight, overweight and obesity was determined using three classification systems: ISPED, WHO and IOTF. High blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and impaired fasting glucose were considered as cardiometabolic risk factors., Results: ISPED and IOTF classified more subjects as normal-weight or overweight and less subjects as obese as compared to WHO (p <0.0001) in the whole sample and in groups divided by gender and age. The strength of agreement between the three methods compared to each other was excellent for overweight (including obesity) definition (k > 0.900), while it differed for obesity definition, ranging from the highest agreement between ISPED and IOTF (k 0.875) to the lowest between ISPED and WHO (k 0.664). WHO had the highest sensitivity, while ISPED and IOTF systems had the highest specificity, in identifying obese subjects with clustered cardiometabolic risk factors. Analogous results were found in subjects stratified by gender or age., Conclusions: ISPED and IOTF systems performed similarly in assessing overweight and obesity, and were more specific in identifying obese children/adolescents with clustered cardiometabolic risk factors; on the contrary, the WHO system was more sensitive. Given the seriousness of the obesity epidemic, we wonder whether the WHO system should be preferable to the national standards for clinical practice and/or obesity screening.

Childhood overweight and obesity is a major public health challenge for policymakers in many countries. As the most common supervisors of children's activities, parents have a potentially important role to play in obesity prevention. However, a precondition for parents to improve their children's diets, encourage them to be more physically active, or take them to see a doctor about their weight is for the parent to first recognize that their child is overweight or obese. This paper examines the extent of parental misclassification of child weight status, and its correlates, focusing on the role of parental education and the parent's own obesity status. We find evidence that, among non-obese parents, those who are better-educated report their child's weight status more accurately, but among obese parents, the better-educated are 45.18% more likely than parents with lower secondary education to give a false negative report of their child's overweight/obesity; this may reflect social desirability bias., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: To evaluate the sensitivity and specificity of different cutoff points of body mass index for predicting overweight/obesity according to body fat values estimated by DEXA among Brazilian adolescents., Methods: Cross-sectional study including 229 male adolescents aged 10-15 years, in which body adiposity and anthropometric measures were assessed. Nutritional status was classified by BMI according to cutoff points described in scientific literature., Results: Moderate agreements were observed between body fat estimated by DEXA and cutoffs proposed by Cole et al. (K=0.61), Conde and Monteiro (K=0.65), Must et al. (K=0.61) and WHO (K=0.63). The BMI in continuous form showed good agreement with the Dexa (ICC=0.72). The highest sensitivity was observed for cutoff by Conde and Monteiro (0.74 [0.62, 0.84]) and the highest specificity by Cole et al. (0.98 [0.94, 0.99]). For the areas under the ROC curve of cutoff points analyzed, significant difference comparing the cutoff points by Cole et al. and Conde and Monteiro (0.0449 [0.00294, 0.0927]) was observed., Conclusions: The cutoff proposed by Conde and Monteiro was more sensitive in identifying overweight and obesity when compared to the reference method, and the cutoff proposed by Cole et al. presented the highest specificity for such outcomes., (Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Purpose: This study aims to examine whether body mass index (BMI) overestimates the prevalence of overweight or obese firefighters when compared to waist circumference (WC) and skinfold-based percent body fat (PBF) and to investigate differential relationships of the three adiposity measures with other biological cardiovascular disease (CVD) risk factors., Methods: The adiposity of 355 (347 males and eight females) California firefighters was assessed using three different measures. Other CVD risk factors (high blood pressure, high lipid profiles, high glucose, and low VO2 max) of the firefighters were also clinically assessed., Results: The prevalence of total overweight and obesity was significantly (p < 0.01) higher by BMI (80.4 %) than by WC (48.7 %) and by PBF (55.6 %) in male firefighters. In particular, the prevalence of overweight firefighters was much higher (p < 0.01) by BMI (57.3 %) than by WC (24.5 %) and PBF (38.3 %). 60-64 % of male firefighters who were assessed as normal weight by WC and PBF were misclassified as overweight by BMI. When overweight by BMI was defined as 27.5-29.9 kg/m(2) (vs. the standard definition of 25.0-29.9 kg/m(2)), the agreement of the adiposity classification increased between BMI and other two adiposity measures. Obese firefighters had the highest CVD risk profiles across all three adiposity measures. Only when overweight by BMI was defined narrowly, overweight firefighters had substantially higher CVD risk profiles. Obesity and overweight were less prevalent in female and Asian male firefighters., Conclusions: BMI overestimated the prevalence of total overweight and obesity among male firefighters, compared to WC and skinfold-based PBF. Overweight by BMI needs to be more narrowly defined, or the prevalence of BMI-based overweight (27.5-29.9 kg/m(2)) should be reported additionally for prevention of CVD among male firefighters.

US schools increasingly report body mass index (BMI) to students and their parents in annual fitness "report cards." We obtained 3,592,026 BMI reports for New York City public school students for 2007-2012. We focus on female students whose BMI puts them close to their age-specific cutoff for categorization as overweight. Overweight students are notified that their BMI "falls outside a healthy weight" and they should review their BMI with a health care provider. Using a regression discontinuity design, we compare those classified as overweight but near to the overweight cutoff to those whose BMI narrowly earned them a "healthy" BMI grouping. We find that overweight categorization generates small impacts on girls' subsequent BMI and weight. Whereas presumably an intent of BMI report cards was to slow BMI growth among heavier students, BMIs and weights did not decline relative to healthy peers when assessed the following academic year. Our results speak to the discrete categorization as overweight for girls with BMIs near the overweight cutoff, not to the overall effect of BMI reporting in New York City.

Background: Discussing obesity with the patient without this being perceived as offensive may represent a challenge. Prevention of lifestyle diseases requires that this topic be addressed with those concerned. In this study, we investigate the patients' sensitivity to expressions, i.e. their notions of appropriateness or inappropriateness regarding various terms for obesity, and what patient characteristics are associated with such sensitivity to expressions., Material and Method: The investigation is part of a five-year study of patients in Central Norway who were treated for morbid obesity. The terms used in the study had been suggested by the Overweight Patients' Association. Data on sensitivity to expressions were collected with the aid of a questionnaire one year after completion of the treatment., Results: Altogether 157 out of 206 participants completed the questionnaire. Their average body mass index (BMI) (SD) amounted to 37.6 kg/m² (7.3 kg/m²). Their sensitivity to 14 different designations varied. «Weight», «overweight» and «weight problem» returned the best scores, whereas «obesitas», «obese» and «fat» were deemed least appropriate. The highest sensitivity to expressions was found among women, those who developed overweight early in life, those who had higher education and those who were dissatisfied with their weight., Interpretation: The perceptions of various expressions for overweight and obesity varied considerably. Knowledge about this topic may be relevant for doctors and other health personnel in prevention and treatment of obesity.

Background: Although paediatric growth charts are recommended for weight assessment prior to age 20, many teenagers transition earlier to adult care where absolute body mass index (BMI) is used. This study examines concordance of weight classification in older teenagers using paediatric percentiles and adult thresholds., Methods: BMI from 23 640 US teens ages 18-19 years were classified using paediatric BMI percentile criteria for underweight (< 5th), normal (5th to < 85th), overweight (85th to < 95th), obesity (≥ 95th) and severe obesity (≥ 120% × 95th percentile) and adult BMI (kg m(-2) ) criteria for underweight (< 18.5), normal (18.5-24.9), overweight (25-29.9) and obesity: class I (30-34.9), class II (35-39.9) and class III (≥ 40). Concordance was examined using the kappa (κ) statistic. Blood pressure (BP) from the same visit was classified hypertensive for BP ≥ 140/90., Results: The majority of visits (72.8%) occurred in adult primary care. Using paediatric/adult criteria, 3.4%/5.2% were underweight, 66.6%/58.8% normal weight, 15.7%/21.7% overweight, 14.3%/14.3% obese and 4.9%/6.0% severely/class II-III obese, respectively. Paediatric and adult classification for underweight, normal, overweight and obesity were concordant for 90.3% (weighted κ 0.87 [95% confidence interval, 0.87-0.88]). For severe obesity, BMI ≥ 120% × 95th percentile showed high agreement with BMI ≥ 35 kg m(-2) (κ 0.89 [0.88-0.91]). Normal-weight males and moderately obese females by paediatric BMI percentile criteria who were discordantly classified into higher adult weight strata had a greater proportion with hypertensive BP compared with concordantly classified counterparts., Conclusions: Strong agreement exists between US paediatric BMI percentile and adult BMI classification for older teenagers. Adult BMI classification may optimize BMI tracking and risk stratification during transition from paediatric to adult care., Competing Interests: OF POTENTIAL CONFLICTS OF INTEREST: L.Greenspan has received payment for a manuscript unrelated to the current study. R.Prineas has received payment for consultancy to Health Partners, Inc. J.Lo has received grant funding from Sanofi unrelated to the current study. J.Lo, M.Chandra, L. Greenspan, M.Daley and K.Margolis have received funding from the National Institutes of Health. The remaining authors have no potential conflicts of interest to disclose., (© 2015 World Obesity.)

The prevalence of obesity presents serious public health challenges worldwide and is most commonly estimated by the categorization of body mass index (BMI). The purpose of this study was (i) to describe the sensitivity of BMI, waist circumference (WC) and fat mass percentage in the classification of overweight and obesity and (ii) to describe the prevalence of overweight and obesity using different measurement methods in a national sample of Norwegians. A total of 904 Norwegians (20-85 years) were randomly enrolled. Body weight, height, WC and skinfold thickness were measured; BMI and fat mass percentage (FP(skf) ) were calculated. The sensitivity and specificity varied from 77.0% to 86.9% and from 60.6% to 82.3%, respectively. Area under the curve was 0.837 (95% confidence interval [CI]: 0.801-0.872) for the ability of BMI to predict obesity by FP(skf) and 0.811 (95% CI: 0.770-0.852) for WC. A total of 12.7% (male: 12.1%, female: 13.4%) were obese based on BMI classifications, 29.1% (male: 36.5%, female: 20.0%) of the sample were obese based on FP(skf) and 24.3% of men and 37.8% of women were abdominally obese by WC. The agreement between selected measuring methods was fair to good, although the variation in obesity prevalence rates between the different assessments methods varied markedly., (© 2015 World Obesity.)

Purpose: Little is known about the suitability of three commonly used body mass index (BMI) classification system for Indigenous children. This study aims to estimate overweight and obesity prevalence among school-aged Nunavik Inuit children according to International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) BMI classification systems, to measure agreement between those classification systems, and to investigate whether BMI status as defined by these classification systems is associated with levels of metabolic and inflammatory biomarkers., Methods: Data were collected on 290 school-aged children (aged 8-14 years; 50.7% girls) from the Nunavik Child Development Study with data collected in 2005-2010. Anthropometric parameters were measured and blood sampled. Participants were classified as normal weight, overweight, and obese according to BMI classification systems. Weighted kappa (κw) statistics assessed agreement between different BMI classification systems, and multivariate analysis of variance ascertained their relationship with metabolic and inflammatory biomarkers., Results: The combined prevalence rate of overweight/obesity was 26.9% (with 6.6% obesity) with IOTF, 24.1% (11.0%) with CDC, and 40.4% (12.8%) with WHO classification systems. Agreement was the highest between IOTF and CDC (κw = .87) classifications, and substantial for IOTF and WHO (κw = .69) and for CDC and WHO (κw = .73). Insulin and high-sensitivity C-reactive protein plasma levels were significantly higher from normal weight to obesity, regardless of classification system. Among obese subjects, higher insulin level was observed with IOTF., Conclusions: Compared with other systems, IOTF classification appears to be more specific to identify overweight and obesity in Inuit children., (Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: In 2013, the American Medical Association classified obesity as a disease. This study assessed public opinions about this disease classification., Methods: In January 2014, a national sample of 1118 adults completed surveys assessing their agreement with 33 statements in support of and against the disease classification of obesity, as well as measures assessing sociodemographic characteristics., Results: The majority of participants (51-61.7%) agreed with 11 of 17 statements in support of the disease classification of obesity (average agreement across all statements = 51%), including views that it will help people gain access to obesity treatment. A minority of participants (31-47.3%) agreed with 15 of 16 statements against the disease classification (average agreement across statements = 39.5%), including views that it will increase overreliance on medications or surgery to treat obesity (47.3%). Participants' attitudes were unaffected by sex, income, education, or health status but were related to causal beliefs about obesity. The disease classification received more support from African Americans and more opposition by individuals with higher weight stigma., Conclusions: This study found more public agreement supporting the disease classification of obesity than opposing it. Further work should identify whether this classification affects health behaviors among individuals with obesity or societal weight stigmatization., (© 2015 The Obesity Society.)

Objective: To compare the two anthropometric standards for screening of overweight and cardio-metabolic risk in 6-10-year-old children., Subjects and Methods: This cross-sectional study included 175 subjects attending the Referral Center for the Treatment of Children and Adolescents in Campos, Rio de Janeiro. They were classified according to CDC and WHO BMI z scores as normal-weight (z-score > -1 and < 1), overweight (z-score ≥ 1 and < 2) or obese (z-score ≥ 2). Sensitivities and specificities in predicting systolic (SBP), diastolic (DBP) blood pressure and homeostatic model assessment insulin resistance index (HOMA-IR) alterations were calculated., Results: There was a major difference in 11 children who rated overweight by the CDC but were reclassified as obese by the WHO. Their mean z-scores for SBP (1.71 ± 1.54), DBP (2.64 ± 1.83) and HOMA-IR (1.84 ± 0.98) were higher than those classified as overweight by both references (SBP = 0.49 ± 1.34, p < 0.023, DBP = 1.45 ± 0.97, p < 0.04 and HOMA = 1.24 ± 0.67, p < 0.04), but were similar to those classified as obese by both criteria (SBP = 1.25 ± 2.04, p = 0.60, DBP = 1.94 ± 1.19, p = 0.50 and HOMA = 2.09 ± 1.12, p = 0.76)., Conclusion: The 2007 WHO reference was the most sensitive in screening for overweight and alterations in blood pressure and HOMA-IR in 6-10-year-old children.

Background: In Saudi Arabia, where childhood obesity is a major public health issue, it is important to identify the best tool for obesity classification. Hence, we compared two field methods for their usefulness in epidemiological studies., Methods: The sample consisted of 874 primary school (grade I-IV) children, aged 6-10 years, and was obtained through a multi-stage random sampling procedure. Weight and height were measured, and BMI (kg/m(2)) was calculated. Percent body fat was determined with a Futrex analyzer that uses near infrared reactance (NIR) technology. Method specific cut-off values were used for obesity classification. Sensitivity, specificity, positive and negative predictive values were determined for BMI, and the agreement between BMI and percent body fat was calculated., Results: Compared to boys, the mean BMI was higher in girls whereas the mean percent body fat was lower (p-values < 0.0001). According to BMI, the prevalence of overweight or obesity was significantly higher in girls (34.3% vs. 17.3%); as oppose to percent body fat, which was similar between the sexes (6.6% vs. 7.0%). The sensitivity of BMI to classify overweight or obesity was high (boys = 93%, girls = 100%); and its false-positive detection rate was also high (boys = 63%, girls = 81%). The agreement rate was low between these two methods (boys = 0.48, girls =0.24)., Conclusions: There is poor agreement in obesity classification between BMI and percent body fat, using NIR method, among Saudi school children.

Objectives: The purpose of the current study was to evaluate how weight classification influences safety by examining adults' ability to meet a timing constraint: walking to the pace of an audio metronome., Methods: With a cross-sectional design, walking parameters were collected as 55 adults with normal (n=30) and overweight (n=25) body mass index scores walked to slow, normal, and fast audio metronome paces., Results: Between group comparisons showed that at the fast pace, those with overweight body mass index (BMI) had longer double limb support and stance times and slower cadences than the normal weight group (all ps<0.05). Examinations of participants' ability to meet the metronome paces revealed that participants who were overweight had higher cadences at the slow and fast paces (all ps<0.05)., Conclusions: Findings suggest that those with overweight BMI alter their gait to maintain biomechanical stability. Understanding how excess weight influences gait adaptation can inform interventions to improve safety for individuals with obesity.

Background: Physical inactivity has been associated with poor oral health. The aim of this study is to assess whether periodontal disease is a risk indicator for poor physical fitness., Methods: This cross-sectional study included 111 males who performed a physical fitness test (PFT) composed of four exercises: 1) push-ups conducted by pushing the body up and lowering it down using the arms; 2) pull-ups with the body suspended by the arms gripped on a bar; 3) sit-ups in which the upper and lower vertebrae are lifted from the floor; and 4) running for 12 minutes. A PFT score (range of 1 to 300) was determined for each participant, with higher scores indicating better physical fitness. One periodontist assessed attachment loss (AL) and probing depth (PD). Physical fitness was dichotomized according to whether the highest PFT score was "achieved" or "not achieved." Multivariable logistic models were fitted adjusting for age, overweight (body mass index of 25 to 29.9 kg/m(2)), and frequency of daily exercise., Results: The mean age of the sample was 34.8 ± 10.3 years. Overweight individuals demonstrated significantly lower PFT scores (276.9 ± 24.1 points) than normal-weight individuals (289.3 ± 16.8 points). Individuals presenting at least one tooth with AL ≥ 4 mm had significantly lower PFT scores (277.8 ± 23.6 points) compared with those without this status (285.9 ± 20.2 points). A 1-mm increment in PD or AL significantly decreased the chance of reaching the highest PFT score by 69% or 75%, respectively., Conclusion: Periodontal disease may be considered a risk indicator for poor physical fitness in males.

To assess the association of baseline cardiorespiratory fitness (CRF) with incidence of overweight over a 4.6-year period in adolescence. In a cohort of 4878 adolescents, we assessed body mass index in years 2001-2003 and 2007. CRF was assessed at baseline as maximal oxygen consumption (VO2max , mL/kg/min) using the 20-m shuttle run test and was examined against incidence of overweight at follow-up. Estimated VO2max at baseline was higher in males than in females, P < 0.001, and was lower in overweight and obese than in non-overweight subjects. The incidence of overweight at follow-up among non-overweight participants at baseline was 15.5% [95% confidence interval (CI) 13.7% to 17.3%] in males and 5.6% (95% CI 4.9% to 7.0%) in females, P < 0.001. Adjusted odds ratio for incidence of overweight in participants in the fourth quartile of VO2max was 0.40 (95%CI 0.26 to 0.61) in males and 0.57 (95% CI 0.33 to 0.99) in females in comparison with participants in the first quartiles of VO2max . Incidence of overweight was three times more frequent in males than in females. Among non-overweight at baseline, high fitness levels were inversely associated with incidence of overweight at follow-up, suggesting that interventions aiming to increase CRF in early childhood might help reverse increasing trends in obesity., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: The aims of this cross-sectional statistical study were to evaluate the association between obesity and dental caries and to assess the impact of food intake, oral hygiene and lifestyle on the incidence of dental caries in obese paediatric patients, analysed by Dual X-ray Absorptiometry (DXA)., Materials and Methods: A sample of 96 healthy patients, aged between 6 and 11 years (mean age 8.58±1.43) was classified in relation to body composition assessment and McCarthy growth charts and cut- offs. Body composition analysis, to obtain body fat mass (FM) and body fat free mass (FFM) measurements, was determined by means of a DXA fan beam scanner. The subjects underwent dental examination to assess the dmft/DMFT, and completed a questionnaire on food intake, oral hygiene habits and lifestyle. The sample was subsequently subdivided into four groups: Group A (normal weight - caries-free), Group B (normal weight with caries), Group C (pre-obese/obese - caries-free), Group D (pre-obese/obese with caries)., Statistics: The statistical analysis was performed using SPSS software (version 16; SPSS Inc., Chicago IL, USA). Spearman's correlation was performed to evaluate the correlation between dmft/DMFT and FM%. The chi-square test was performed to assess the categorical variables, while the non-parametric Kruskal Wallis test and the Mann Whitney test were employed for the quantitive variables. Statististical significance was set at a P-value of 0.05., Results: The preobese-obese children had higher indexes of dental caries than normal weight subjects, both for deciduous teeth (dmft 2.5 ± 0.54 vs 1.4 ± 0.38; p=0.030) and permanent teeth (DMFT 2.8 ± 0.24 vs 1.93 ± 1.79; p=0.039). The correlations between dmft/DMFT indexes and body composition parameters were analysed and a significant correlation between dmft/DMFT indexes and FM% was observed (p=0.031 for dmft, p=0.022 for DMFT). According to the data recorded, there was no statistically significant difference between Groups A, B, C and D in terms of food intake between meals (p=0.436), frequency of starch intake limited to the main meals (p=0.867), home oral hygiene (p=0.905), dental hygiene performed at school (p=0.389), habit of eating after brushing teeth (p=0.196), participation in extracurricular sport activities (p=0.442) and educational level of parents: father (p=0.454), mother (p=0.978). In contrast, there was a statistically significant difference between Groups A, B, C and D in terms of intake of sugar-sweetened drinks (p=0.005), frequency of sugar intake limited to the main meals (p<0.001), frequency of food intake between meals (p=0.038) and sedentary lifestyle (p=0.012). Successive analysis revealed a statistically significant difference between Group A and D in terms of intake of sugar-sweetened drinks (p=0.001), frequency of sugar intake limited to the main meals (p=0.008), and frequency of food intake between meals (p=0.018), and between Group C and D in terms of frequency of sugar intake limited to the main meals (p<0.001), and frequency of food intake between meals (p=0.040)., Conclusion: This study shows a direct association between dental caries and obesity evident from a correlation between prevalence of dental caries and FM%. The analysis of food intake, dmft/DMFT, FM%, measured by DXA, demonstrates that specific dietary habits (intake of sugar-sweetened drinks, frequency of sugar intake limited to main meals, frequency of food intake between meals) may be considered risk factors that are common to both dental caries and childhood obesity.

Objectives: Health behaviours including diet, smoking, alcohol consumption, and physical activity, predict health risks at the population level. We explored health behaviours, barriers to healthy eating and self-rated health among individuals of retirement age. Study design 82 men and 124 women participated in an observational, cross-sectional online survey. Main outcome measures A 14-item Mediterranean diet score (MDPS), perceived barriers to healthy eating (PBHE), self-reported smoking, physical activity habits, and current and prior perceived health status (PHS) were assessed. A health behaviours score (HBS) including smoking, physical activity, body mass index (BMI) and MDPS was created to evaluate associations with PHS. Two-step cluster analysis identified natural groups based on PBHE. Analysis of variance was used to evaluate between group comparisons., Results: PBHE number was associated with BMI (r=0.28, P<0.001), age (r=-0.19; P=0.006), and MDPS (r=-0.31; P<0.001). PHBE cluster analysis produced three clusters. Cluster-1 members (busy lifestyle) were significantly younger (57 years), more overweight (28kg/m(2)), scored lower on MDPS (4.7) and reported more PBHE (7). Cluster-3 members (no characteristic PBHE) were leaner (25kg/m(2)), reported the lowest number of PBHE (2), and scored higher on HBS (2.7) and MDPS (6.2). Those in PHS categories, bad/fair, good, and very good, reported mean HBS of 2.0, 2.4 and 3.0, respectively (P<0.001). Compared with the previous year, no significant associations between PHS and HBS were observed., Conclusions: PBHE clusters were associated with BMI, MDPS and PHS and could be a useful tool to tailor interventions for those of peri-retirement age., (Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Objectives: This study compared the criteria or classification of Body Mass Index (BMI) by Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF) and World Health Organization (WHO) references and by waist circumference (WC)., Methods: The sample involved 966 students aged 10 to 16 years. The evaluation of weight status was verified according to CDC, IOTF, WHO criteria and WC curves for Portuguese adolescents., Results: For classification of overweight and obesity, the agreement between the criteria of CDC and IOTF was the and WC (K = 0.34). In regard to evaluation of thinness, the agreement between all criteria of BMI was considered moderated to fair (K = 0.33-0.51) and a poor level of agreement between the BMI and WC (K = 0.14-0.16)., Conclusion: The highest level of agreement for thinness, overweight and obesity classification in adolescents was obtained with the IOTF and CDC criteria.

Aim: The purpose of this prospective cohort study was to investigate whether body mass index (BMI) and oral health behaviour are related to changes in periodontal status in Japanese university students., Materials and Methods: Students (n = 224) who were interested in receiving oral health examinations before entering university and before graduation were included in the analysis. Subjects were investigated regarding the correlations of oral health behaviours and increases in BMI with the percentage of bleeding on probing (%BOP) and Community Periodontal Index (CPI) scores as indicators of changes in periodontal status., Results: The risk of increased %BOP was associated with the non-use of dental floss (adjusted odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.31-7.37; p < 0.05), whereas the risk of increased CPI score was associated with increases in BMI (OR: 1.95; 95% CI: 1.05-3.65; p < 0.05) and simplified oral hygiene index score (OR: 2.28; 95% CI: 1.23-4.22; p < 0.01)., Conclusion: Increases in BMI were associated with worsening of periodontal status, defined as increased CPI score in Japanese university students, whereas lack of inter-dental cleaning was associated with exacerbated gingival bleeding., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Asian Americans have low prevalence of overweight/obesity based on standard BMI cut points yet have higher rates of diabetes. We examined the prevalence of overweight/obesity, using lower BMI cut points recommended by the World Health Organization (WHO) for Asians, and diabetes in Asian American subgroups in California., Method: Secondary analysis of the 2009 adult California Health Interview Survey (n=45,946) of non-Hispanic Whites (NHW), African Americans, Hispanics and Asians (Vietnamese, Chinese, Korean, Filipino, South Asian and Japanese). WHO Asian BMI cut points (overweight=23-27.5kg/m(2); obese≥27.5kg/m(2)) were used for Asian subgroups. Standard BMI cut points (overweight=25-29.9kg/m(2); obese≥30kg/m(2)) were applied for other groups., Results: Among Asian subgroups, overweight/obesity was highest among Filipinos (78.6%), which was higher than NHWs (p<0.001) but similar to African Americans and Hispanics. Compared to NHW, diabetes prevalence was higher for Vietnamese, Koreans, Filipinos and South Asians with BMI=23-24.9kg/m(2) and Koreans, Filipinos and Japanese with BMI=27.5-29.9kg/m(2), the ranges WHO recommends as overweight or obese for Asians but not for other groups., Conclusions: Filipinos should be a priority population for overweight/obesity screening. Filipinos, Vietnamese, Korean, South Asians and Japanese have higher diabetes prevalence at lower BMI cut points. WHO Asian BMI cut points may have clinical utility to identify at-risk Asian Americans., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: The purpose of the study was to examine potential differences between two approaches to defining adolescent weight misperception. Specifically, weight status perception was compared with self-reported weight status and actual weight status (based on body mass index percentiles calculated from self-reported and actual weights and heights, respectively). Furthermore, the accuracy of assigning weight status based on body mass index percentiles calculated from self-reported weights and heights was assessed by comparing them with actual weight status., Methods: Data were extracted from Team Up for Healthy Living, an 8-week, school-based obesity prevention program in southern Appalachia. Participants (N = 1509) were predominately white (93.4%) and ninth graders (89.5%), with approximately equivalent representation of both sexes (50.7% boys)., Results: The study revealed significant differences between the approaches to defining weight misperception (χ(2) = 16.2; P = 0.0003)., Conclusions: Researchers should interpret study findings with awareness of potential differences based on the method of calculating weight misperception.

Objectives: We examined the association of body mass index with all-cause and cardiovascular disease (CVD)-specific mortality risks among US adults and calculated the rate advancement period by which death is advanced among the exposed groups., Methods: We used data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to the National Death Index mortality file with follow-up to 2006 (n = 16 868). We used Cox proportional hazards regression to estimate the rate of dying and rate advancement period for all-cause and CVD-specific mortality for overweight and obese adults relative to their normal-weight counterparts., Results: Compared with normal-weight adults, obese adults had at least 20% significantly higher rate of dying of all-cause or CVD. These rates advanced death by 3.7 years (grades II and III obesity) for all-cause mortality and between 1.6 (grade I obesity) and 5.0 years (grade III obesity) for CVD-specific mortality. The burden of obesity was greatest among adults aged 45 to 64 years for all-cause and CVD-specific mortality and among women for all-cause mortality., Conclusions: These findings highlight the impact of the obesity epidemic on mortality risk and premature deaths among US adults.

Background: Several authors have correlated the increase of cardiovascular risk with the nutritional status, however there are different criteria for the classification of overweight and obesity in children., Objectives: To evaluate the performance of three nutritional classification criteria in children, as definers of the presence of obesity and predictors of high blood pressure in schoolchildren., Methods: Eight hundred and seventeen children ranging 6 to 13 years old, enrolled in public schools in the municipality of Vila Velha (ES) were submitted to anthropometric evaluation and blood pressure measurement. The classification of the nutritional status was established by two international criteria (CDC/NCHS 2000 and IOTF 2000) and one Brazilian criterion (Conde e Monteiro 2006)., Results: The prevalence of overweight was higher when the criterion of Conde e Monteiro (27%) was used, and inferior by the IOTF (15%) criteria. High blood pressure was observed in 7.3% of children. It was identified a strong association between the presence of overweight and the occurrence of high blood pressure, regardless of the test used (p<0.001). The test showing the highest sensitivity in predicting elevated BP was the Conde e Monteiro (44%), while the highest specificity (94%) and greater overall accuracy (63%), was the CDC criterion., Conclusions: The prevalence of overweight in Brazilian children is higher when using the classification criterion of Conde e Monteiro, and lower when the criterion used is IOTF. The Brazilian classification criterion proved to be the most sensitive predictor of high BP risk in this sample.

Introduction: Overweight in children is a serious public health problem. The use of different weight classification systems in research and clinical practice results in variable the estimate of prevalences of overweight, which complicates follow-up of this health problem in the population. The study compared three child body weight classification systems by estimating the prevalence of overweight established by each system., Method: In 2010, a study was conducted in 259 five-year-old children at the time of routine childhood vaccination. The children's height and weight were measured. The prevalence of overweight was determined and compared to the International Obesity Task Force (IOTF), the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) criteria., Results: According to the IOTF, 16.6% of children of the study were overweight (obesity 3.1%). According to the CDC, 24.3% of children were overweight (obesity 9.1%) and according to WHO, the prevalence was 26.3% (obesity 6.2%). According to the IOTF criteria, obesity affected more girls than boys (2.7% vs. 0.4%), whereas similar proportions were observed with the other two systems., Conclusion: This study demonstrates that the prevalence of overweight in children varies considerably depending on the classification system used. These results support the need to consider the system used in clinical practice and in research when monitoring the course of the prevalence of this health problem.

Importance: Preterm birth is a leading cause of infant mortality, morbidity, and long-term disability, and these risks increase with decreasing gestational age. Obesity increases the risk of preterm delivery, but the associations between overweight and obesity and subtypes of preterm delivery are not clear., Objective: To study the associations between early pregnancy body mass index (BMI) and risk of preterm delivery by gestational age and by precursors of preterm delivery., Design, Setting, and Participants: Population-based cohort study of women with live singleton births in Sweden from 1992 through 2010. Maternal and pregnancy characteristics were obtained from the nationwide Swedish Medical Birth Register., Main Outcomes and Measures: Risks of preterm deliveries (extremely, 22-27 weeks; very, 28-31 weeks; and moderately, 32-36 weeks). These outcomes were further characterized as spontaneous (related to preterm contractions or preterm premature rupture of membranes) and medically indicated preterm delivery (cesarean delivery before onset of labor or induced onset of labor). Risk estimates were adjusted for maternal age, parity, smoking, education, height, mother's country of birth, and year of delivery., Results: Among 1,599,551 deliveries with information on early pregnancy BMI, 3082 were extremely preterm, 6893 were very preterm, and 67,059 were moderately preterm. Risks of extremely, very, and moderately preterm deliveries increased with BMI and the overweight and obesity-related risks were highest for extremely preterm delivery. Among normal-weight women (BMI 18.5-<25), the rate of extremely preterm delivery was 0.17%. As compared with normal-weight women, rates (%) and adjusted odds ratios (ORs [95% CIs]) of extremely preterm delivery were as follows: BMI 25 to less than 30 (0.21%; OR, 1.26; 95% CI, 1.15-1.37), BMI 30 to less than 35 (0.27%; OR, 1.58; 95% CI, 1.39-1.79), BMI 35 to less than 40 (0.35%; OR, 2.01; 95% CI, 1.66-2.45), and BMI of 40 or greater (0.52%; OR, 2.99; 95% CI, 2.28-3.92). Risk of spontaneous extremely preterm delivery increased with BMI among obese women (BMI≥30). Risks of medically indicated preterm deliveries increased with BMI among overweight and obese women., Conclusions and Relevance: In Sweden, maternal overweight and obesity during pregnancy were associated with increased risks of preterm delivery, especially extremely preterm delivery. These associations should be assessed in other populations.

Background: The Body Mass Index (BMI) is widely used to diagnose overweight and obesity. However, there are limitations on the use of BMI and development of alternative measures can be of clinical importance. This study aimed to compare specificity and sensitivity of weight for height (W/H), waist circumference (WC) and waist-to-height ratio (WHTR) with BMI-for-age in diagnosing overweight and obesity in Thai school-age children., Methods: This was a cross-sectional study. Children between the ages of 6 and 13 who attended elementary schools were potential participants of the study. BMI, W/H, WC, and WHTR were calculated for each participant. The optimal cut-off points for the diagnosis of overweight and obesity by W/H, WC and WHTR were generated by the receiver operating characteristic curves (ROC)., Results: Using BMI cut-off points introduced by WHO, the overall prevalence of overweight and obesity in the study population was 24.6% and 12.9% respectively. W/H, WC, and WHTR all showed acceptable sensitivity and specificity in diagnosing overweight and obesity when compared to BMI-for-age results. W/H had a particularly high correlation with BMI-for-age., Conclusion: Cut-off points of 112% and 125% W/H are validated to determine overweight and obesity in Thai school-aged children.

Objective: To compare the International Obesity Task Force (IOTF) 2005, Centers for Disease Control and Prevention (CDC) 2000, and World Health Organization (WHO) 2007 body mass index (BMI) classification systems in terms of prevalence estimation and association with demographic factors., Methods: The 18 265 children and adolescents ages 5 to 18 years (mean = 11.2 years, standard deviation = 3.9 years) in the nationally representative Colombian National Nutrition Survey of 2005 were classified as overweight or obese according to IOTF, CDC, and WHO criteria. Prevalence estimates were compared according to each system and associations with age, sex, socioeconomic status, and population density were tested., Results: Prevalence estimates of combined overweight and obesity differed by system (males: IOTF = 8.5%, CDC = 10.8%, WHO = 14.1%; females: IOTF = 14.6%, CDC = 13.8%, WHO = 17.1%; P < 0.001). The association between combined overweight and obesity and age and sex varied by system. The odds of having overweight and obesity in children (5 to 10 years) compared with adolescents (11 to 18 years) were: IOTF, odds ratio (OR) = 0.87 and 95% confidence interval (CI) = 0.77-0.98; CDC, OR = 1.27 and CI = 1.14-1.42; WHO, OR = 1.21 and CI = 1.08-1.35. The values for females compared with males were: IOTF, OR = 1.84 and CI = 1.6-2.10; CDC, OR = 1.33 and CI = 1.17-1.51; WHO, OR = 1.25 and CI = 1.12-1.41., Conclusions: There is a lack of consistency among the three main international systems in assessing overweight and obesity in children and adolescents. Appreciably different estimates of prevalence and associations with age and sex are obtained depending on which system is used. Future studies should assess how well each system reflects valid measures of body composition.

Aim: This study was undertaken to evaluate the relationship between Severe Early Childhood Caries (S-ECC) and Body Mass Index (BMI) in the absence of any underlying medical condition for the school going (3 to 6 years old) children of Mathura city, India., Method: One hundred caries free children (50 boys and 50 girls) and one hundred children (50 boys and 50 girls) affected with S-ECC in the age range of 3-6 years without any contributing medical history were included in the study. Measurements of the weight (kg) and height (m) were done using a standard balanced beam scale and stadiometer. The BMI (kg/m2) was determined and the body weight status was evaluated using CDC based classification for each child. Independent t-test was used to evaluate whether the weight, height and BMI of S-ECC children is significantly different from caries free children., Result: Although the weight of the S-ECC children is more when compared to the normal children, the difference is not statistically significant. However, the mean BMI of S-ECC children is more when compared to the caries free children which was found to be statistically significant at p < 0.05. The body weight status of the Normal and S-ECC affected children based on the CDC classification revealed that 48% have been classified in underweight category and 43% in normal weight category and very few children are found to be at risk of overweight and overweight., Conclusions: A positive correlation between the BMI and S-ECC was observed in this study. 51% of caries free children and 45% of S-ECC children were classified in underweight category based on CDC classification.

Objective: To describe and compare the nutritional status of adolescents using three criteria for nutritional status classification (Conde & Monteiro, International Obesity Task Force - IOTF and Word Health Organization - WHO), to analyze the correlation between these three criteria as for the overweight proportion, and to investigate whether factors associated with overweight and obesity differ among the three criteria., Methods: Demographic (gender, age, geographic area) and anthropometric (body weight, height) variables were measured in 33.728 adolescents aged 11 to 17 years. The following criteria were investigated: IOTF (2000); Conde & Monteiro (2006); and WHO (2007)., Results: The overall overweight prevalence was 20.6% for the Conde & Monteiro criteria; 15.3% for the IOTF criteria and 20.1% for the WHO criteria. Both for boys and girls, the estimated overweight prevalence using the Conde & Monteiro and WHO criteria were higher than that using the IOTF criteria. Higher concordance was found between the Conde & Monteiro (2006) and WHO (2007) criteria for all age groups. Regarding associated factors, similar associations were found for the three criteria for higher BMI classification: being male, 11-12 and 13-14 years of age and living in the Midwestern, Southeastern and Southern regions of Brazil., Conclusion: The criteria for BMI classification estimate overweight prevalence in a different way, and the criteria proposed by Conde & Monteiro resulted in higher prevalence in both sexes. Higher concordance between the Conde & Monteiro and WHO criteria was found for all age groups. The groups most vulnerable to showing overweight and obesity for the three criteria for BMI classification were males, age 11-12 and 13-14 years, and living in the Midwestern, Southeastern and Southern regions of Brazil. Overweight and obesity are considered a public health problem prevalent among adolescents in Brazil, regardless of the criteria adopted.