Jump to comment:

• Growth reference charts for use in the United Kingdom
  Roberto J Rona
  Published on: 4 February 2002
• Growth charts
  Tam Fry
  Published on: 30 January 2002

• Published on: 4 February 2002

  Growth reference charts for use in the United Kingdom

  • Roberto J Rona, Professor of Public Health Medicine
  • Other Contributors:
    • Susan Chinn

  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 f...

  Show More

  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
  (1) Wright CM, Booth IW, Buckler JMH et al. Growth reference charts for use in the United Kingdom. Arch Dis Child 2002; 86: 11-14.
  (2)Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 124-3.
  (3) Reilly JJ, Dorosty AR. Epidemic of obesity in UK children. Lancet 1999; 354: 1874-5.
  (4) Reilly JJ, Dorosty AR, Emmett PM. Prevalence of overweight and obesity in British children: cohort study. BMJ 1999; 319: 1039.
  (5) Jebb SA, Prentice AM. Single definition of overweight and obesity should be used (letter). BMJ 2001; 323: 999.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 30 January 2002

  Growth charts

  • Tam Fry, Honorary Chairman

  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...

  Show More

  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!

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top