A method for calculating BMI z-scores and percentiles above the 95^th percentile of the CDC growth charts

Abstract

Background

The 2000 CDC growth charts are based on national data collected between 1963 and 1994 and include a set of selected percentiles between the 3^rd and 97^th and LMS parameters that can be used to obtain other percentiles and associated z-scores. Obesity is defined as a sex- and age-specific body mass index (BMI) at or above the 95^th percentile. Extrapolating beyond the 97^th percentile is not recommended and leads to compressed z-score values.

Aim

This study attempts to overcome this limitation by constructing a new method for calculating BMI distributions above the 95^th percentile using an extended reference population.

Subjects and methods

Data from youth at or above the 95^th percentile of BMI-for-age in national surveys between 1963 and 2016 were modelled as half-normal distributions. Scale parameters for these distributions were estimated at each sex-specific 6-month age-interval, from 24 to 239 months, and then smoothed as a function of age using regression procedures.

Results

The modelled distributions above the 95^th percentile can be used to calculate percentiles and non-compressed z-scores for extreme BMI values among youth.

Conclusion

This method can be used, in conjunction with the current CDC BMI-for-age growth charts, to track extreme values of BMI among youth.

Keywords:

• Childhood obesity
• body mass index
• growth percentiles
• Half Normal distribution

Acknowledgement

The authors thank Dr. Yulei He for his assistance in checking statistical models/errors and giving suggestions in the draft.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclaimer

The findings and conclusions in this report are those of the authors and not necessarily the official position of the Centers for Disease Control and Prevention.