OBJECTIVE:

To explore the accuracy of various body mass index (BMI) cutpoints in identifying children who have excess adiposity (based on skinfold thicknesses), adverse levels of lipids, insulin, and blood pressures, and a high risk for severe adult obesity.

STUDY DESIGN:

Cross-sectional (n = 10,099) and longitudinal (n = 2392) analyses were performed among subjects who participated in the Bogalusa Heart Study.

RESULTS:

Of children with a BMI > or =95th percentile (P) of the Centers for Disease Control (CDC) growth charts, 39% had at least two risk factors, 65% had excess adiposity, and 65% had an adult BMI of > or =35 kg/m(2). Of those with a BMI > or =99th P, 59% had at least two risk factors, 94% had excess adiposity, and 88% had an adult BMI of > or =35 kg/m(2). About 4% of children in the US now have a BMI > or =99th P.

CONCLUSIONS:

The 99th P of BMI-for-age may be appropriate for identifying children who are at very high risk for biochemical abnormalities and severe adult obesity. More aggressive weight control strategies may be warranted for this subgroup.