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Updated: Mar 10, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
High Body Mass Index in Infancy May Predict Severe Obesity in Early Childhood
Allison Smego1, Jessica G Woo2, Jillian Klein3
1Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Infant body mass index (BMI) trajectories reveal differences by 4-6 months. A World Health Organization (WHO) BMI 85th percentile in infancy predicts severe childhood obesity by age 6 years.
Area of Science:
- Pediatric endocrinology
- Childhood obesity research
- Growth monitoring
Background:
- Severe childhood obesity is a growing public health concern.
- Early identification of at-risk infants is crucial for timely intervention.
- Understanding growth trajectories can inform preventative strategies.
Purpose of the Study:
- To characterize body mass index (BMI) growth trajectories in children who develop severe obesity by age 6 years.
- To identify clinical thresholds for early detection of high-risk infants before obesity onset.
Main Methods:
- Retrospective analysis of BMI data from pediatric cohorts.
- Utilized repeated-measures mixed modeling and logistic regression.
- Validated risk thresholds in an independent population-based cohort.
Main Results:
- Significant BMI differences observed between severely obese and normal-weight cohorts by 4 months of age.
- A World Health Organization (WHO) BMI ≥85th percentile at 6, 12, or 18 months strongly predicted severe obesity by age 6 years (sensitivity 51%-95%, specificity 95%).
- Infant BMI ≥85th percentile increased the risk of severe obesity by 2.5-fold and clinical obesity by 3-fold by age 6 years.
Conclusions:
- Body mass index (BMI) growth trajectories diverge in infants who later develop severe obesity as early as 4-6 months.
- Infants with a World Health Organization (WHO) BMI ≥85th percentile are at significantly increased risk for developing severe obesity by age 6 years.
Objective:
To characterize growth trajectories of children who develop severe obesity by age 6 years and identify clinical thresholds for detection of high-risk children before the onset of obesity.
Study Design:
Two lean (body mass index [BMI] 5th to ≤75th percentile) and 2 severely obese (BMI ≥99th percentile) groups were selected from populations treated at pediatric referral and primary care clinics. A population-based cohort was used to validate the utility of identified risk thresholds. Repeated-measures mixed modeling and logistic regression were used for analysis.
Results:
A total of 783 participants of normal weight and 480 participants with severe obesity were included in the initial study. BMI differed significantly between the severely obese and normal-weight cohorts by age 4 months (P < .001), at 1 year before the median age at onset of obesity. A cutoff of the World Health Organization (WHO) 85th percentile for BMI at 6, 12, and 18 months was a strong predictor of severe obesity by age 6 years (sensitivity, 51%-95%; specificity, 95%). This BMI threshold was validated in a second independent cohort (n = 2649), with a sensitivity of 33%-77% and a specificity of 74%-87%. A BMI ≥85th percentile in infancy increases the risk of severe obesity by age 6 years by 2.5-fold and the risk of clinical obesity by age 6 years by 3-fold.
Conclusions:
BMI trajectories in children who develop severe obesity by age 6 years differ from those in children who remain at normal weight by age 4-6 months, before the onset of obesity. Infants with a WHO BMI ≥85th percentile are at increased risk for developing severe obesity by age 6 years.
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