Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children

FANG Qihuan; WANG Yuedong; ZHAO Min; YANG Lili; XI Bo

doi:10.16835/j.cnki.1000-9817.2025067

Volume 46 Issue 3

Mar. 2025

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FANG Qihuan, WANG Yuedong, ZHAO Min, YANG Lili, XI Bo. Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(3): 421-425. doi: 10.16835/j.cnki.1000-9817.2025067

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FANG Qihuan, WANG Yuedong, ZHAO Min, YANG Lili, XI Bo. Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(3): 421-425. doi: 10.16835/j.cnki.1000-9817.2025067

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Performance of body mass index, waist circumference and waist-to-height ratio in screening true obesity in children

doi: 10.16835/j.cnki.1000-9817.2025067

FANG Qihuan¹,
WANG Yuedong¹,
ZHAO Min²,
YANG Lili^{1
,
,},
XI Bo^{1
,
,}

1.
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine/Children Cardiovascular Research Center, Shandong University, Jinan(250012), Shandong Province, China

Received Date: 2024-12-02
Rev Recd Date: 2025-01-09

Available Online: 2025-04-03

Publish Date: 2025-03-25

Abstract

Abstract

Objective To evaluate the accuracy of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in screening true obesity among children, so as to provide a scientific basis for precise screening and early prevention and control of childhood obesity. Methods A total of 1 322 children aged 10-15 years old were surveyed by the Huantai Children Cardiovascular Health Cohort in 2021. Fat mass percentage (FMP) and fat mass index (FMI) were measured by bioelectrical impedance analysis, with FMP or FMI values at or above the age- and sex-specific 70th percentiles as the criteria for defining true obesity. BMI, WC and WHtR were used to define general obesity and central obesity. The accuracy of these measures in screening for true obesity was evaluated by calculating the missed diagnosis rate, misdiagnosis rate, area under the curve(AUC) for receiver operating characteristic and Kappa coefficient. Results Boys had higher BMI [(21.79±4.56) kg/m²], WC [(76.41±12.53) cm] and WHtR (0.47±0.07) than girls [(20.83±4.13) kg/m², (70.69±10.06) cm, (0.45±0.06)] (t=4.02, 9.19, 6.63), while boys had lower FMP [(18.29±8.35)%] and FMI [(4.35±2.79) kg/m²] than girls [(24.87±6.51)%, (5.44±2.53) kg/m²] (t=-16.10, -7.42) (P < 0.01). Using FMP as a reference standard, the diagnosis error rates of screening for true obesity based on BMI, WC and WHtR were 12.24%, 2.11% and 2.11%, respectively; the diagnosis error rates were 10.88%, 27.28% and 24.33%; the AUC values were 0.88, 0.85 and 0.87; the Kappa coefficients were 0.67, 0.48 and 0.52. Using FMI as a reference standard, rates of BMI, WC and WHtR screening for true obesity were 14.20%, 1.23% and 2.78%; the diagnosis error rates were 4.81%, 20.84% and 18.14%; the AUC values were 0.90, 0.89 and 0.90; the Kappa coefficients were 0.81, 0.64 and 0.67. Conclusions BMI has a higher diagnosis error rate in screening for true obesity in children, while WC and WHtR have higher diagnosis error rates. It is recommended to promote body fat assessment in clinical practice, so as to achieve more accurate prevention and control of chronic diseases.
- Body mass index,
- Waist circumference,
- Obesity,
- Area under curve,
- Child

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References(26)

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