In this volume of The Journal, Freedman et al1 address an important issue for the pediatric clinical care and research communities on how to quantify and monitor children and adolescents with very high body mass index (BMI) measurements.1 BMI is widely available, easily calculated, and a useful indicator of health risk across the life cycle. However, in children, the interpretation of BMI as an indicator of nutritional status and health risk is dependent on a comparison of an individual’s measurements with age and sex-specific reference ranges. In the US, the Centers for Disease Control and Prevention (CDC) 2000 BMI charts are recommended for use in children 2-20 years of age for evaluation of BMI. Few pediatricians and researchers appreciate the nuances of the design and statistical methods involved in the development of the BMI charts for children and the challenges of quantifying BMI status in children with very high BMI measurements. Freedman et al illustrate these challenges in children of different ages and compare alternative metrics to quantify BMI status in the upper extremes of BMI at different ages.

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