2022 CDC Extended BMI-for-Age Growth Charts for Children and Adolescents With Very High BMIs
Childhood obesity is a serious problem in the United States, putting children and adolescents at risk for poor health outcomes during childhood, adolescence, and adulthood. Severe obesity is defined as BMI at or above 120% of the 95th percentile for sex and age, or BMI at or above 35 kg/m2. Among children aged 2–19 years, the prevalence of severe obesity has increased from 1% in 1971–74 to 6.1% in 2017–18.
The 2000 CDC BMI-for-Age Growth Charts are based on reference data from 1963 to 1980, a period when the prevalence of obesity was lower than today and when growth data for children with severe obesity were sparse. The 2000 CDC BMI-for-Age Growth Charts have a maximum plottable BMI of 37 kg/m2 and no percentile lines above the 95th percentile, which makes them less useful as a visual growth tracking tool for children with severe obesity. Because of this, CDC expanded the growth charts using more recent data and methods, and added new percentile curves to the growth charts for tracking children and adolescents with very high BMIs.
The 2022 CDC Extended BMI-for-Age Growth Charts can help providers track growth and optimize care for children and adolescents with very high BMIs (above the 97th percentile). Growth charts for children and adolescents without obesity, and their recommended use, have not changed.
What has changed?
Obesity is a common, serious, and costly chronic disease of adults and children.
In December 2022, CDC extended the growth reference charts for children and adolescents aged 2–19 years with very high BMIs. The 2022 CDC Extended BMI-for-Age Growth Charts allow clinicians to visualize high BMIs with children and families, track their growth, and optimize care for this group. The 2022 CDC Extended BMI-for-Age Growth Charts include four additional percentile curves above the 95th percentile (the 98th, 99th, 99.9th, and 99.99th percentiles) and can plot BMI up to 60 kg/m2.
The 2022 CDC Extended BMI-for-Age Growth Charts are based on an updated reference population that includes children with obesity during 1999–2016 as well as updated statistical methods to calculate percentiles for children with very high BMIs. This allows for a continuous measure of growth to inform clinical care for children above the 97th percentile. The extended growth charts, coupled with high-quality treatment, can help optimize care for children with very high BMIs.
What is not changing?
The 2000 CDC BMI-for-Age Growth Charts have not changed and should continue to be used for monitoring growth among children without obesity. The BMI categories, including the threshold for severe obesity, remain unchanged.
| BMI Category | BMI Range |
|---|---|
| Underweight | < 5th percentile |
| Healthy Weight | 5th percentile to < 85th percentile |
| Overweight | 85th to < 95th percentile |
| Obesity | ≥ 95th percentile |
| Severe Obesity | ≥ 120% of the 95th percentile, OR ≥ 35 kg/m2 |
How can health systems and clinicians use these new charts compared to previously published severe obesity growth charts?
The new growth charts coupled with high-quality treatment help optimize care for children with severe obesity. Learn more about CDC-Recognized Family Healthy Weight Programs which are ready-to-use, evidence-based child obesity programs.
Severe obesity growth charts previously published by others were based on a measure called percent of the 95th percentile—a statistical calculation—and not on actual growth data of children with very high BMIs. Though these charts filled an important data and clinical gap, the 2022 CDC Extended BMI-for-Age Growth Charts can add to or replace the severe obesity growth charts currently used in clinical care and displayed in electronic health records (EHRs) to become the default percentiles and z-scores reported for children with BMIs above the 97th percentile. The color shading in the 2022 CDC Extended BMI-for-Age Growth Charts provides a printable visual aid for clinicians when discussing very high BMI, and needed care, with families.
Tables, computer programs, and instructions for calculating percentiles and z-scores are available at https://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm to help with EHR integration.
Images of the 2000 CDC and 2022 CDC Extended BMI-for-Age Growth Charts images can be downloaded at www.cdc.gov/growthcharts.
How were the 2022 CDC Extended BMI-for-Age Growth Charts created?
CDC explored different options for monitoring children with very high BMIs. Findings [PDF-3.2MB] suggested that the best option was to provide extended reference curves or percentiles to monitor severe obesity in children and adolescents. The 2022 CDC Extended BMI-for-Age Growth Charts are based on recent data from a nationally representative sample of children and adolescents with obesity and severe obesity.
For discussing topics like obesity and other chronic diseases, we encourage the use of person-first language (such as “adults with obesity” or “20% of children ages 12–19 have obesity” and not “obese adults” or “20% of children are obese”), as well as respectful images.
The Obesity Action Coalition has more information – please see the Guidelines for Media Portrayals of Individuals Affected by Obesity [PDF-1.68MB].