Classification of Obesity and Severe Obesity in 18-19 Year Old Teens

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 677-696-Obesity Physiology & Epidemiology
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-691
Benjamin Maring*1, Louise C. Greenspan2, Malini Chandra3, Stephen R. Daniels4, Alan Sinaiko5, Ronald Prineas6, Matthew F. Daley7, Emily D. Parker8, Kenneth Adams8, Nancy E. Sherwood8, Elyse O. Kharbanda8, Karen L. Margolis8, David J. Magid7, Patrick J. O'Connor8 and Joan C. Lo1
1Kaiser Permanente Oakland Medical Center, Oakland, CA, 2Kaiser Permanente San Francisco Medical Center, San Francisco, CA, 3Kaiser Permanente Northern California, Oakland, CA, 4University of Colorado Denver School of Medicine, Denver, CO, 5University of Minnesota, Minneapolis, MN, 6Wake Forest University School of Medicine, Winston-Salem, NC, 7Kaiser Permanente Colorado, Denver, CO, 8HealthPartners Institute for Education and Research, Minneapolis, MN
Introduction:  The spectrum of obesity in adolescents is widening, especially for severe obesity.  Although supplemental growth charts have been proposed for more reliable tracking of high body mass index (BMI), the evaluation of weight status in the transition from teen to adult care is complicated by questions of whether to use pediatric or adult growth charts.  This study examines obesity in teens aged 18-19 years and the change from pediatric to adult BMI criteria in this population.

Methods:  A retrospective study was conducted using data from 20,321 teens aged 18-19 years with BMI measured during 2007-2012.  Demographic factors were ascertained using health plan databases.  Outcome measures included BMI percentile using pediatric criteria for underweight (<5th percentile), normal weight (5th - <85th percentile), overweight (85th - <95th percentile), obesity (>=95th percentile) and severe/extreme obesity (BMI >=120% of the 95th BMI percentile), and absolute BMI (kg/m2) using adult criteria for underweight (BMI <18.5), normal weight (BMI 18.5 - 24.9), overweight (BMI 25 - 29.9), class I obesity (BMI 30 - 34.9), class II obesity (BMI 35 - 39.9) and extreme (class III) obesity (BMI >=40).  Concordance between pediatric and adult BMI classification was also examined across the four primary weight categories using the Kappa statistic.

Results:  Comparing pediatric percentile criteria to adult criteria (pediatric / adult), 15.8% / 21.6% were overweight, 14.2% / 14.2% were obese and 4.9% / 2.3% were extremely obese.  The prevalence of obesity was highest in Hispanics followed by blacks among boys, and blacks followed by Hispanics among girls, regardless of criteria used. Concordance between pediatric and adult BMI classification for underweight, normal, overweight and obese categories was seen for nearly 90% of the cohort (weighted Kappa statistic 0.71, 95% CI 0.70-0.72).  For higher order obesity, a BMI >=120% of the 95th BMI percentile approximated a BMI of >=35 for boys and BMI >=37 for girls.

Conclusions:  This study shows that there is substantial agreement between pediatric and adult BMI categorization in 18-19 year old teens across underweight, normal weight, overweight and obese categories.  These data support the use of adult BMI classification for teens aged 18-19 years, promoting adult-based identification and tracking of high BMI beginning with the transition to adult medical care.

Nothing to Disclose: BM, LCG, MC, SRD, AS, RP, MFD, EDP, KA, NES, EOK, KLM, DJM, PJO, JCL

*Please take note of The Endocrine Society's News Embargo Policy at

Sources of Research Support: NIH (NHLBI) 1RO1HL093345