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Accuracy of body mass index in categorizing weight status in children with intellectual and developmental

Michele Polfuss1,2, Bethany Forseth1, Dale A Schoeller3

  • 1College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, USA.

Journal of Pediatric Rehabilitation Medicine
|September 20, 2021
PubMed

Insights

Body Mass Index (BMI) inaccurately categorizes body weight in children with disabilities like spina bifida and Down syndrome. This screening tool is not useful, necessitating alternative methods for assessing body fat in these populations.

Area of Science:

  • Pediatric endocrinology
  • Clinical pediatrics
  • Body composition analysis

Background:

  • Accurate body weight assessment is crucial for children's health.
  • Existing methods like Body Mass Index (BMI) may not be suitable for all pediatric populations.
  • Children with chronic conditions such as spina bifida and Down syndrome present unique physiological considerations.

Purpose of the Study:

  • To evaluate the accuracy of Body Mass Index (BMI) in classifying body weight status among children with spina bifida and Down syndrome.
  • To compare the effectiveness of BMI as a screening tool against body fat percentage measurements in these specific pediatric groups.
  • To identify potential discrepancies in weight categorization between children with and without disabilities.

Main Methods:

  • Secondary analysis of data from 32 children, including those with spina bifida, Down syndrome, and typically developing peers.
  • Calculation and plotting of BMI on Centers for Disease Control and Prevention (CDC) growth charts for weight status determination.
  • Measurement of body fat percentage using labeled water and comparison with dual-energy X-ray absorptiometry (DXA) and skin-fold derived reference curves.

Main Results:

  • Significant misclassifications of body fat were observed when using calculated BMI in children with disabilities compared to their typically developing peers.
  • The inaccuracy of BMI as a screening tool was more pronounced when compared against body fat percentile curves derived from skin-fold measures.
  • Children who primarily used wheelchairs exhibited increased BMI misclassifications.

Conclusions:

  • The current standard recommendation of using BMI to categorize weight status is not effective for many children with disabilities.
  • Further research is required to develop and validate alternative, pragmatic strategies for assessing body composition in pediatric populations with disabilities.
  • Rethinking standard anthropometric assessments is necessary for equitable health monitoring in diverse child populations.
Abstract

Keywords:
Developmental disabilitiesbody mass indexdown syndromeobesityspina bifida

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