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Assessing BMI change in Research

Although extended bmiz should work well in most analyses, the best metric for assessing BMI change is uncertain. Several studies (1–6) have shown that expressing BMI relative to the CDC 50th or 95th percentile is better than the LMS-based version of BMIz in assessing changes in adiposity. This is because of the curvilinear relation of BMI to BMIz, but would likely apply to both the original and extended (7) versions of BMIz. Further, a recent commentary (8) suggested that until consensus is reached, “investigators can consider consistently reporting more metrics (e.g., absolute and percentage of change in BMI, change in percentage of the 95th BMI percentile, change in percentage of the median).”

As of December 15, 2022, the SAS program includes 2 additional variables for assessing BMI change:
(1) bmip95: BMI expressed as a percentage of the 95th percentile of the CDC growth charts.
(2) bmip50: BMI expressed as a percentage of the 50th percentile (median) of the CDC growth charts. If desired, 100 can be subtracted from bmip50 so that it is the %distance from the median (9).

Note that some care should be taken in using these metrics as it is likely that their interpretations differ by age. Because the dispersion of BMI values is much greater at age 18 y than at age 2 y, it is possible that a bmip50 value of 150, for example, should be interpreted differently at these two ages. These metrics can be adjusted for differences by sex and age by specifying the ‘all=TRUE’ option in the R program.


  1. Cole TJ, Faith MS, Pietrobelli A, Heo M. What is the best measure of adiposity change in growing children: BMI, BMI%, BMI z-score or BMI centile? European Journal of Clinical Nutrition 2005;59:419–25.
  2. Barlow SE, Salahuddin M, Durand C, Pont SJ, Hoelscher DM, Butte NF. Evaluation of BMI Metrics to Assess Change in Adiposity in Children with Overweight and Moderate and Severe Obesity. Obesity 2020;28:1512–8.
  3. Berkey CS, Colditz GA. Adiposity in adolescents: change in actual BMI works better than change in BMI z score for longitudinal studies. Annals of epidemiology 2007;17:44–50.
  4. Kakinami L, Henderson M, Chiolero A, Cole TJ, Paradis G. Identifying the best body mass index metric to assess adiposity change in children. Archives of disease in childhood 2014;99:1020–4.
  5. Freedman DS, Woo JG, Daniels SR. Longitudinal changes in various BMI metrics and adiposity in 3- to 7-year-olds. Pediatrics In Press 2022;
  6. Paluch RA, Epstein LH, Roemmich JN. Comparison of methods to evaluate changes in relative body mass index in pediatric weight control. American journal of human biology : the official journal of the Human Biology Council 2007;19:487–94.
  7. Freedman DS, Goodwin Davies AJ, Phan T-LT, Cole FS, Pajor N, Rao S, Eneli I, Kompaniyets L, Lange SJ, Christakis DA, et al. Measuring BMI change among children and adolescents. Pediatr Obes 2022;e12889.
  8. Ryder JR, Kelly AS, Freedman DS. Metrics matter: Toward consensus reporting of BMI and weight-related outcomes in pediatric obesity clinical trials. Obesity (Silver Spring) 2022;30:571–2.
  9. Hales C, Freedman DS, Akinbami L, Wei R, Ogden CL. Using CDC growth charts to assess and monitor weight status in children and adolescents with extremely high BMI. National Center for Health Statistics Vital Health Stat 2 2022;197.
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