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ADC Fetal and Neonatal Edition Letters and ADC Education and Practice Letters
Electronic Letters to:
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Electronic letters published:
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Growth charts
- Tam Fry (30 January 2002)
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Growth reference charts for use in the United Kingdom
- Roberto J Rona, Susan Chinn (4 February 2002)
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Tam Fry, Honorary Chairman Child Growth Foundation
Send letter to journal:
CGFLONDON{at}aol.com Tam Fry
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Dear Editor UK children are certainly better off with the UK90 charts [ArchDisChild 2002:86:11-14] but the Child Growth Foundation would like to know why it took the hospital-based medical profession nearly a decade to decide to use them. For the last eight years they have been in circulation in the community [Parent Child Health Records first featured them in 1993] and no end of bother has been caused by hospitals sticking to the "old" Tanner-Whitehouse charts for so long. Unfortunately, the confusion might well continue given that ADC failed to reference a source for the "new" charts. You can order them from Harlow Printing, Maxwell St, South Shields NE 33 4PU. Tel: +44 (0)191 455 4286, fax: +44 (0)191 427 0195] - and burn your current stock! |
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Roberto J Rona, Professor of Public Health Medicine King's College London, Susan Chinn
Send letter to journal:
roberto.rona{at}kcl.ac.uk Roberto J Rona, et al.
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Dear Editor Dr Wright and her colleagues are to be commended on their timely review of the growth reference charts for use in the United Kingdom [1]. However, in respect of body mass index (BMI) we are concerned that in their concise review of the evidence they omitted discussing two essential issues. Firstly, they do not mention the availability of the international definitions of obesity and overweight, published fairly recently [2]. While researchers may promote the use of centiles it is our experience that the press and public think in terms of obesity and overweight. The lack of discussion in appraising the role of the definitions in relation to the 1990 UK references is the more surprising given that the senior author proposing the international definitions was also an author of this review. Should we interpret this omission as a sign that the international definitions will be quietly dropped? And if so, why? Secondly, they may appear to endorse a definition of overweight and obesity by the choice of references to document the increasing trend of obesity and overweight, as the paper quoted research that defined overweight as children above the 85th centile and obese those above the 95th centile [3-4]. An advantageous feature of the international definitions is that they are based on unifying definitions of overweigh and obesity for adults and children. This was achieved by tracing back to childhood the centiles for BMI 25 kg/m2 and BMI of 30 kg/m2 at 18 years. The cut-off points for overweight and obesity obtained with this method are consistently above the 85th and 95th centiles. Using the tracing back procedure the cut-off point for overweight would be approximately the 91th centile and for obesity between the 98th and 99th centiles. The penalties for not choosing a unifying approach for adults and children are twofold. First the prevalences of overweight and obesity are falsely exaggerated in comparison to young adults, a point made by Jebb and Prentice [5]. Even worse, a child or adolescent who is defined as overweight or obese according to the 85th and 95th centiles may change status on his 18th birthday without decreasing his or her level of fatness. The panel of experts headed by Dr Wright has left the task inconclusive by advising us on the references to be used, but not indicating how to use them, or recommending whether or not we should disengage from having an international definition of overweight and obesity. References |
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