Body Composition versus BMI as Measures of Success in a Clinical Pediatric Weight Management Program

The high rates and long-term medical consequences of childhood obesity make it a public health crisis requiring effective diagnosis, treatment, and prevention. Although BMI is an adequate screening tool for obesity, monitoring BMI change is not always the best measure of success in treating patients in a pediatric weight management program. Our retrospective study evaluated the proportion of patients that achieved favorable changes in body composition by bioelectrical impedance analysis in the absence of improvements in BMI, BMI percentile, or percent of the 95th percentile for BMI. It was found that 30% of patients whose BMI increased by 1.0 kg/m2 or more, 31.6% of patients with stable or increasing BMI percentiles, and 28% with stable or increasing percent of the 95th percentile for BMI demonstrated an improvement in body composition (skeletal muscle mass and body fat percentage). Body composition is an important measure of success for a subset of patients who otherwise may believe that their efforts in lifestyle change have not been effective. Our results suggest that including body fat percentage as a measure of success in evaluating the progress of patients participating in a pediatric weight management program is appropriate and may more accurately track success than change in BMI or BMI percentile alone.