The Utility of Body Mass Index as a Measure of Body Fatness in Children and Adolescents: Differences by Race and Gender

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Abstract
Objective. To evaluate whether body mass index (BMI) is a representative equivalent measure of body fatness independent of age, race, gender, sexual maturation, and distribution of fat in children and adolescents. Study Design. Cross-sectional study of 192 healthy subjects (100 boys and 92 girls, 103 white and 89 black) age 7 to 17 years. Methods. Height and weight were measured in the standard fashion, and BMI (kg/m2) was calculated from these values. Fat mass and percent body fat were determined using dual-energy x-ray absorptiometry. Sexual maturation was evaluated by physical assessment. Distribution of fat was determined by the waist:hip ratio. Results. There were no significant differences by gender and ethnic group for any of the demographic or anthropometric variables, except waist:hip ratio, which was higher in white compared with black boys. BMI was significantly and positively correlated with age, stage of maturation, and all of the anthropometric variables in each race-sex group. The correlation of maturation stage with BMI was stronger than the correlation between age and BMI. A multiple regression analysis showed that BMI, gender, race, sexual maturation, and distribution of fat were all significant independent correlates of the percent body fat (multiple R2 = .77). The percent body fat-BMI relationship was dependent on the stage of sexual maturation, gender (for an equivalent BMI, girls have greater amounts of body fat than boys), race (for equivalent BMI, whites have higher body fat than blacks), and waist:hip ratio (for equivalent BMI, those with central obesity have greater body fatness than those with peripheral obesity). Conclusion. BMI is not an equivalent measure of the percent body fat for each race-sex group. When BMI is used as a measure of body fatness in a research or clinical setting, particularly when comparisons are made across race and gender, it may be important to consider the maturation stage, race, gender, and distribution of body fat in the interpretation of the results.

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