Abstract
Simple SummaryThere are no agreed criteria that establish childhood obesity thresholds, based on BMI, which may be used to diagnose overweight/obesity in adolescents. This tool has been determined as the most practical and least costly method in classifying bodyweight status in adolescents. However, it is an indicator of bodyweight, and not fat mass. This study assessed and compared bodyweight status of Extremadura adolescents by sex and age using international (World Health Organization), national (Faustino Obergozo Foundation), and regional references (Extremadura). A single-measure descriptive study (bodyweight and height) was conducted in 4130 adolescents aged between 12–17 years. BMI was calculated to classify participants in the bodyweight categories. The WHO criteria classified 542 individuals in a different category compared to FO, and 1028 individuals with respect to EX. Moreover, FO classified 684 adolescents in a different category than EX. Despite the concordance in diagnostic overweight/obesity observed when comparing the three classifications, differences in percentage of participants for each category were found in all pairwise comparisons (WHO–FO, WHO–EX, and FO–EX). Thus, WHO, FO, and EX criteria differ when estimating overweight/obesity prevalence in adolescents, being able to fall into a wrong diagnosis of overweight or obese.Background: There is no agreed criteria that establishes childhood obesity thresholds based on BMI, which may be used to assess adolescent overweight/obesity. This tool has been determined at the most practical and least costly in classifying bodyweight status in adolescents. However, it is an indicator of bodyweight and not adiposity. Aims: To assess bodyweight status of Extremadura adolescents by sex and age using international, national, and regional reference criteria and comparing the different diagnoses criteria. Methods: A descriptive cross-sectional study was conducted with 4130 adolescents (12–17 years). Bodyweight and height were assessed. Results: Pairwise comparisons indicates that the World Health Organization (WHO) classified 542 individuals in a different category compared to Faustino Obergozo (FO), and 1028 individuals with respect to the Extremadura adolescents’ percentiles (EX). Moreover, FO classified 684 adolescents in a different category than EX. Despite the concordance in diagnostic criteria (by Cohen’s kappa test) reported between the WHO, FO, and EX for all bodyweight categories in both sexes and all age ranges, significant differences were found (assessed by Cochran Q test and McNemar test as post-hoc) between the WHO and FO for all bodyweight proportion except in the thinness category in girls (15–17 years) and boys (12–14 years). Meaningful differences were also obtained comparing WHO and EX for each bodyweight category in all ages and sexes. Comparisons between FO and EX revealed significant differences for all bodyweight categories in all participants except for overweight in girls (12–14 years) and boys (15–17 years) and normal weight and obesity in girls (15–17 years). Conclusions: the WHO, FO, and EX criteria present different outcomes estimating overweight and/or obesity prevalence in adolescents aged between 12 and 17 years. The change from Extremadura criteria to the WHO reference will result in more adolescents being diagnosed as overweight or obese.
Highlights
The World Health Organization (WHO) defines overweight and obesity as a chronic disease characterized by abnormal or excessive body fat accumulation that represents a risk for health [1]
The main finding of this study showed that the bodyweight status of adolescents varies according to the reference criteria used
Moderate to perfect agreement was obtained for all bodyweight status categories with some relevant exceptions: fair agreement for 15–17 years children in the WHO–Faustino Obergozo (FO) and FO–Extremadura adolescents’ percentiles (EX) comparisons for the thinness category; slight agreement in the WHO–EX for both age ranges in girls and 12–14 years boys for overweight; slight agreement in WHO-FO and FO-EX comparatives for boys aged 12–14 years in overweight category; a modest agreement in FO–EX comparative; and no agreement in the WHO–FO and WHO–EX comparisons for the obesity category
Summary
The World Health Organization (WHO) defines overweight and obesity as a chronic disease characterized by abnormal or excessive body fat accumulation that represents a risk for health [1]. Childhood obesity has increased ten-fold in the last 40 years, estimating that there were around 124 million obese children in 2016 [1] It constitutes one of the primary challenges and public health issues in advanced societies [2]. There is no agreed criteria that establishes childhood obesity thresholds based on BMI, which may be used to assess adolescent overweight/obesity. This tool has been determined at the most practical and least costly in classifying bodyweight status in adolescents. Results: Pairwise comparisons indicates that the World Health Organization (WHO) classified 542 individuals in a different category compared to Faustino Obergozo (FO), and 1028 individuals with respect to the Extremadura adolescents’ percentiles (EX). Comparisons between FO and EX revealed significant differences for all bodyweight categories in all participants except for overweight in girls (12–14 years) and boys (15–17 years) and normal weight and obesity in girls (15–17 years)
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