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Comparative Study
. 2021 Apr:231:200-206.e1.
doi: 10.1016/j.jpeds.2020.12.038. Epub 2021 Jan 16.

Adjusting for Pubertal Status Reduces Overweight and Obesity Prevalence in the United States

Eric Morris Bomberg  1 , Oppong Yaw Addo  2 , Kyriakie Sarafoglou  3 , Bradley Scott Miller  4
Affiliations
Comparative Study

Adjusting for Pubertal Status Reduces Overweight and Obesity Prevalence in the United States

Eric Morris Bomberg et al. J Pediatr. 2021 Apr.

Abstract

Objective: To compare pediatric overweight and obesity prevalence among non-Hispanic white, Mexican American, and non-Hispanic black US youths before and after adjusting body mass index (BMI) for pubertal status, as assessed by Tanner stage.

Study design: We analyzed cross-sectional anthropometric and pubertal data from non-Hispanic white, Mexican American, and non-Hispanic black youths in the National Health and Nutrition Examination Survey (NHANES) III. We developed specialized Tanner stage and chronological age-adjusted models to establish Tanner-stage adjusted BMI z-scores, which were then used to determine adjusted overweight/obesity prevalence. We compared pediatric overweight/obesity prevalence before and after pubertal status adjustment.

Results: Among 3206 youths aged 8-18 years (50% male; 26% non-Hispanic white, 35% Mexican American, 39% non-Hispanic black), adjusting BMI for Tanner stage significantly reduced overweight (males, from 29% to 21%; females, from 29% to 17%) and obesity (males, from 14% to 7%; females, from 11% to 5%) prevalence across all races/ethnicities. The obesity prevalence reduction was more pronounced in Mexican Americans (males, 11% reduction; females, 9% reduction) and non-Hispanic blacks (males and females, 10% reduction) compared with non-Hispanic whites (males, 6% reduction; females, 5% reduction). Similar patterns were seen in overweight prevalence.

Conclusions: Adjusting for pubertal status reduced the prevalence of overweight/obesity in non-Hispanic white, Mexican American, and non-Hispanic black youth. This suggests that adjusting for puberty incorporates changes otherwise not captured when only considering the age of a child. Adjusting BMI for pubertal status may be important when interpreting a youth's weight status and consideration for obesity management, as well as when interpreting pediatric overweight/obesity prevalence data.

Keywords: body mass index; epidemiologic methods; ethnic groups; growth charts; health care surveys; pediatric obesity; puberty.

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Figures

Figure 1:
Figure 1:
Study cohort flow diagram. * Taner stage only perfomed in participants ages 2 through 18 years old † Analysis limited to non-Hispanic black due to sample size limitations
Figure 2:
Figure 2:
Numbers correspond to the percent prevalence in each category. The prevalence of overweight and obesity shown in this figure is chronological age- and sex-adjusted per the CDC 2000 growth charts per standard conventions. BMI = body mass index; NHW = non-Hispanic White; MA = Mexican American; NHB = non-Hispanic Black * Pubertal status categorized as early (Tanner stage 2), mid (Tanner stage 3–4), and pubertal (Tanner stage 5)
Figure 3:
Figure 3:
Numbers correspond to the percent prevalence difference that was calculated by substracting the prevalence obtained from chronological age-only adjusted BMI (CA-BMI) from that obtained by chronological and Tanner stage-adjusted BMI (TSA-BMI) in each category. NHW = non-Hispanic White, MA = Mexican American; NHB = non-Hispanic Black
Figure 4:
Figure 4:
This figure illustrates that, after adjusting for Tanner stage, BMI growth curves condense into similar curves. This suggests that adjusting BMI for Tanner stage corrects differences that pubertal status has on BMI among various races/ethnicities and much of the variability in current BMI-for-age reference data may be due to maturational progression differences across race/ethnicity. BMI =body mass index; SD=standard deviation; NHW= non-Hispanic White, MA = Mexican American; NHB = non-Hispanic Black
Figure 5:
Figure 5:
a) As an example of the clinical utility of our model, this figure depicts the TSA-BMI curves for Tanner stage II females (red dashed lines) superimposed on the CDC 2000 curves (black lines). Adjusting BMI by pubertal stage may allow a provider to avoid misclassifying an “early maturing” child as having a BMI in the overweight/obese category, or a “late maturing” child as having a BMI in the underweight category, when both actually have BMIs in the normal weight category after pubertal status is considered. b) Patient 1 (symbol: blue dot) is an 8.25 year old “earlier maturing” Tanner stage II female. She would be considered overweight according to the CDC 2000 BMI-for-age charts with a sex- and age-adjusted BMI ≥85th percentile. However, after adjusting for pubertal stage (TSA-BMI), her BMI is in the normal range. c) Patient 2 (symbol: green dot) is a 13.0 year old “late maturing” Tanner stage II female. She would be considered underweight according to the CDC 2000 BMI-for-age charts with a sex- and age-adjusted BMI <5th percentile. However, after adjusting for pubertal stage (TSA-BMI), her BMI is in the normal range. BMI = body mass index; TSA-BMI = Tanner stage adjusted body mass index; y = years
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