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Differences in Classification Standards For the Prevalence of Overweight and Obesity in Children. A Systematic Review
Francisco Llorca-Colomer1,2, María Teresa Murillo-Llorente1, María Ester Legidos-García1
1SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia, Valencia, Spain.
Insights
Childhood obesity prevalence varies significantly based on the classification system used. A unified international standard is needed for accurate childhood overweight and obesity assessment.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Childhood obesity rates have surged globally.
- Accurate classification of overweight and obesity in children is complex and debated.
- Existing international BMI-based classification systems lack universal consensus.
Purpose of the Study:
- To systematically compare three major international classification systems for childhood overweight and obesity: WHO 2007, CDC 2000, and Cole-IOTF.
- To evaluate the impact of different classification systems on prevalence estimates in infant and adolescent populations.
- To identify discrepancies and the need for standardized criteria.
Main Methods:
- Systematic review conducted following PRISMA 2020 guidelines.
- Inclusion of studies comparing WHO 2007, CDC 2000, and Cole-IOTF classification systems.
- Analysis of prevalence data for overweight and obesity in pediatric populations.
Main Results:
- The WHO 2007 criteria indicated the highest prevalence of overweight and obesity in children and youth.
- Combined analysis showed higher prevalence in boys; however, CDC 2000 and Cole-IOTF alone suggested higher prevalence in girls.
- Significant heterogeneity was observed across studies and meta-analyses.
Conclusions:
- Current international standards for classifying childhood overweight and obesity are insufficient due to heterogeneity.
- There is a critical need to unify classification criteria, establishing a gold standard.
- Future standards should consider geographical, ethnic, and age-specific factors, including secular growth trends.
Abstract:
The prevalence of childhood obesity has increased dramatically all over the world in recent years. While obesity in adults can be easily measured using the BMI calculation, determining overweight and obesity in children is more controversial. The aim was to compare the three most used international classification systems (WHO 2007, CDC 2000 and Cole-IOTF) to determine overweight and obesity in infant and adolescent populations. We performed a systematic review in accordance with the PRISMA 2020 guidelines of articles comparing any of the three classification systems. The main findings were that the WHO 2007 criteria show the highest prevalence of overweight and obesity in the child and youth population. The prevalence of childhood overweight and obesity was determined to be higher in boys than in girls in most studies, when analysing the classifications of the WHO 2007, CDC 2000 and Cole-IOTF together. However, there was a higher prevalence of overweight and obesity in girls than in boys when only the CDC 2000 and Cole-IOTF criteria were considered. Both the results of the review and the great heterogeneity found in the meta-analysis show that it is necessary to unify the criteria for the classification of childhood overweight and obesity. International standards are insufficient for working with the current population. A working group should be created to address this issue and agree on the unification of a gold standard, taking into account the geographical region, the ethnic groups and the age groups of the child and youth population and above all, the secular growth.
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