HKOS Paediatric Consensus Statements
The definition of obesity in children is controversial as the level of excess adiposity that leads to increased risk of poor health is not well defined as in adults; terminology and measures used in studies of weight and adiposity in children can be complex.
BMI-for-age instead of weight-for-height is used to assess overweight and obesity which is consistent with growth assessment in many countries.
Further studies are required to determine whether overseas guidelines on growth faltering are applicable to the HK population.
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Statement 1: Definition of Obesity in 0-2 years
There is a lack of evidence to define excess adiposity in children 0–2 years so we cannot make any definitive guidance for obesity evaluation and treatment in this age group; however, as a practical approach, we recommend using the HKGS 2020 and WHO 2006 standards as guidance points for tracking weight status.
WHO 2006
HKGS 2020
Overweight
BMI-for-age >2 SD above the growth standard median
BMI-for-age >98th centile and ≤99.6th centile
Obese
BMI-for-age >3 SD above the growth standard median
BMI-for-age >99.6th centile
Reason for Change:
Please indicate your level of agreement with the above statement:
Statement 2: Definition of Obesity in 2–5 years
We suggest using the new BMI centile chart from the 2020 Hong Kong Growth Study for children aged 2–5 years, with overweight defined as 99.6th centile ≥ BMI > 98th centile and obesity as >99.6th centile
99.6th centile (2.67 SD) ≥ BMI > 98th centile (2.01 SD)
> 99.6th centile (2.67 SD)
Reason for removal of statement
Statement 3: Definition of Obesity in 2–18 years
We recommend using the new BMI-for-age centile chart from the HKGS 2020 to define overweight and obesity in children aged >2 to <18 years.
In clinical assessment, for ease of practical implementation with the HKGS 2020 growth charts, we recommend defining:
BMI-for-age >91st centile and ≤98th centile
BMI-for-age >98th centile (2.01 SD) or BMI ≥27.5 kg/m2 (whichever is lower)
We recognise some countries (eg. the UK) use lower cut-offs than clinical cut-offs for population monitoring purposes (≥85 and <95th centile for overweight, ≥95th centile for obesity), This is to capture children in the population at risk of moving into clinical overweight or obesity categories, to help service planning for the whole population. These lower cut-offs may be useful for public health purposes.
Reason for revision
Statement 4: Other anthropometric measures
We suggest using other anthropometric measures such as waist circumference (WC) and waist-to-height ratio (WHtR) in children as adjuncts to the BMI to evaluate adiposity-related disease risk
Subtext: BMI is the standard method for screening and other anthropometric measures e.g., WC/WHR/WHtR can be used to supplement BMI because they measure central/abdominal obesity, which is linked to high risk of cardiovascular disease