2022 CDC Extended BMI-for-Age Growth Charts for Children and Adolescents with Severe Obesity
Childhood obesity is a serious problem in the United States, putting children and adolescents at risk for poor health in childhood and as they age. Severe obesity is characterized by very high BMI’s and among children aged 2-19 the prevalence has increased from 1% in 1971-74 to 6.1% in 2017-18.
The 2000 BMI-for-Age CDC Growth Charts are based on reference data from 1963 to 1980 for most children and adolescents, a period when the prevalence of obesity was lower than today, and 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 has expanded the growth charts using more recent data and methods, and extended percentile curves in the BMI-for-age growth charts for tracking children and adolescents aged 2 to 19 years with severe obesity.
The 2022 CDC Extended BMI-for-Age Growth Charts will allow providers to 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.
CDC has extended the growth reference charts for children and adolescents 2-19 years old with very high BMIs. The 2022 CDC Extended BMI-for-Age Growth Charts will allow clinicians to track growth, visualize high BMIs with children and families, and optimize care for this group. The 2022 CDC Extended BMI-for-Age Growth Charts include four additional percentile curves above the 95th percentile (i.e., 98th, 99th, 99.9th, and 99.99th percentiles), can plot BMI up to 60 kg/m2, and differ by gender.
The 2022 CDC Extended BMI-for-Age Growth Charts are based on an updated reference population that includes children with obesity from 1999 – 2016 and updated statistical methods to calculate percentiles for children with very high BMI’s. 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 severe obesity.
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 threshold for severe obesity has not changed. The BMI categories remain unchanged.
| BMI Category | BMI Range |
|---|---|
| Underweight | Less than the 5th percentile |
| Healthy Weight | 5th percentile to less than 85th percentile |
| Overweight | 85th to less than 95th percentile |
| Obesity | 95th percentile or greater |
| Severe Obesity | 120% of the 95th percentile or greater OR 35 kg/m2 or greater |
How can health systems and clinicians use these 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.
Previously published severe obesity growth charts 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’s Extended BMI-for-Age Growth Charts can replace the severe obesity growth charts currently used in clinical care and displayed in Electronic Health Records (EHRs) to be the default percentiles and z-scores reported for children with BMIs above the 97th percentile. The colored shading in the 2022 CDC Extended BMI-for-Age Growth Charts provides a printable visual aid for clinicians when discussing very high BMI with families and the care needed.
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 providing extended reference curves or percentiles to monitor severe obesity in children and adolescents was the best option. 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.
We encourage the use of person-first language (e.g., “adults with obesity” or “20% of children ages 12–19 have obesity” and not “obese adults” nor “20% of children are obese”) when discussing topics like obesity and other chronic diseases, 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].