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

Article type: Research Article

Authors: Polfuss, Michele^{a; b; *} | Forseth, Bethany^a | Schoeller, Dale A.^c | Huang, Chiang-Ching^d | Moosreiner, Andrea^e | Papanek, Paula E.^f | Sawin, Kathleen J.^{a; b} | Zvara, Kimberley^{g; h} | Bandini, Linda^{i; j}

Affiliations: [a] College of Nursing, University of Wisconsin – Milwaukee, Milwaukee, WI, USA | [b] Department of Nursing Research and Evidence-Based Practice, Children’s Wisconsin, Milwaukee, WI, USA | [c] Biotech Center and Nutritional Sciences, University of Wisconsin – Madison, Madison, WI, USA | [d] Joseph J. Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, WI, USA | [e] Clinical and Translational Science Institute of Southeastern, Medical College of Wisconsin, Wisconsin, Milwaukee, WI, USA | [f] Department of Physical Therapy, Marquette University, Milwaukee, WI, USA | [g] Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA | [h] Physical Medicine and Rehabilitation, Children’s Wisconsin, Milwaukee, WI, USA | [i] Pediatrics, Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Boston, MA, USA | [j] Department of Health Sciences, Boston University, Sargent College, Boston, MA, USA

Correspondence: [*] Corresponding author: Michele Polfuss, PhD, RN, CPNP-AC/PC, University of Wisconsin-Milwaukee, College of Nursing, 1921 E. Hartford Avenue, Milwaukee, WI 53211-3060, USA; and Children’s Wisconsin, Department of Nursing Research and Evidence-Based Practice, 8915 W. Connell Court, MS C140, Milwaukee, WI 53226, USA. Tel.: +1 414 2292609 / +1 414 2663187; E-mails: mpolfuss@uwm.edu / mpolfuss@chw.org.

Abstract: PURPOSE:To identify the accuracy of Body Mass Index (BMI) to categorize body weight in a sample of children with spina bifida and Down syndrome as compared to typically developing peers. METHODS:A secondary analysis of 32 children with spina bifida, Down syndrome or no chronic illness. A calculated BMI was plotted on the Centers for Disease Control and Prevention age- and sex-specific BMI growth charts to determine each child’s weight status. Percentage of body fat, obtained by labeled water, was plotted on two different body fat percentile reference curves, one derived from a whole body measure (DXA) of body fat and one by skin-fold measure. Differences in weight categories between calculated BMI and body fat percentile curves were reported. RESULTS:The calculated BMI for children with a disability had significant misclassifications as a screening tool for body fat when compared to children without a disability. Misclassifications were increased with the body fat percentile reference curve derived from skin-fold measures and for children who primarily used a wheelchair. CONCLUSION:The current recommendation to use BMI to categorize weight status is not useful for many children with disabilities. Further research to identify an alternative pragmatic strategy is necessary.

Keywords: Developmental disabilities, spina bifida, down syndrome, body mass index, obesity

DOI: 10.3233/PRM-200727

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 14, no. 4, pp. 621-629, 2021