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Updated: Apr 5, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Should children with overweight or obesity be excluded from height references?
Pétur B Júlíusson1, Bente Brannsether2, Hege Kristiansen3
1Department of Clinical Science, University of Bergen, Bergen, Norway Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
Insights
Growth charts for children are largely unaffected by overweight or obese individuals. Current height references remain accurate, showing no need for revised charts excluding these children.
Area of Science:
- Pediatric endocrinology
- Growth and development studies
- Public health and nutrition
Background:
- Traditional growth reference charts rely on measurements from children without growth-affecting medical conditions.
- Recent decades have seen an increase in the proportion of overweight and obese children in collected samples.
- Obesity is known to influence linear growth, raising questions about its impact on standard growth charts.
Purpose of the Study:
- To assess the extent to which height-for-age percentile curves are affected by the inclusion of overweight and obese children.
- To determine if current growth references require revision due to the prevalence of childhood obesity.
Main Methods:
- Analysis of two large, cross-sectional datasets of children aged 2–18 years from Belgium (n=12,252) and Norway (n=6159).
- Utilized the LMS (Least Mean Squares) method to construct height-for-age curves.
- Estimated curves both with and without the inclusion of children classified as overweight or obese based on International Obesity Task Force (IOTF) criteria.
Main Results:
- Prevalence of overweight (including obesity) was 13.0% (Belgium) and 13.8% (Norway); obesity prevalence was 2.8% (Belgium) and 2.3% (Norway).
- Overweight and obese children were taller than their normal-weight peers (e.g., obese children were +0.73 SD taller in Belgium).
- Excluding overweight/obese children had a minimal impact on growth curves, with the largest difference in mean height SD scores being -0.12, and a slight increase in the number of children exceeding +2 SD (up to 1.2%).
Conclusions:
- Current Belgian and Norwegian growth references for length/height are robust and not significantly impacted by the proportion of overweight and obese children.
- No revision of existing height charts is necessary to exclude children who are overweight or obese.
- The findings support the continued use of current growth references for pediatric populations in these regions.
Background And Objectives:
Growth reference charts are usually based on measurements of children free from a medical condition that affects growth. However, samples collected during the past decades often contain a large proportion of overweight or obese children. Because obesity increases linear growth, the question arises to what extent the percentiles curves for length/height are affected by the presence of children with overweight or obesity.
Methods:
Data from two cross-sectional samples of 2-year-old to 18-year-old children were analysed: 12,252 Belgian children, measured in 2002-2004, and 6159 Norwegian children, measured in 2003-2006. The LMS method was used to estimate height-for-age curves with and without children considered overweight or obese according to the International Obesity Task Force thresholds.
Results:
The prevalence of overweight (including obesity) and obesity was 13.0% and 2.8% in the Belgian and 13.8% and 2.3% in the Norwegian sample. Children were taller when overweight (+0.49 and 0.43 SD, in the Belgian and Norwegian sample, respectively) or obese (+0.73 and 0.72 SD in the Belgian and Norwegian sample, respectively). Effect sizes were smaller in younger and older children, which points to an advanced age of maturation as a possible cause. Excluding overweight and obese children had only a minor impact on the growth curves with largest difference in mean height SD scores -0.09 in the Belgian and -0.12 in the Norwegian sample with a corresponding increase of up to 0.5% and 1.2% in number of children >+2 SD.
Conclusions:
Current Belgian and Norwegian growth references for length/height were found to be largely unaffected by the current proportion of overweight and obese children. There is, therefore, no need for revised height charts that exclude overweight or obese children.
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