A method for calculating BMI z-scores and percentiles above the 95 th percentile of the CDC growth charts

Background The 2000 CDC growth charts are based on national data collected between 1963 and 1994 and include a set of selected percentiles between the 3rd and 97th and LMS parameters that can be used to obtain other percentiles and associated z-scores. Obesity is defined as a sex- and age-specific body mass index (BMI) at or above the 95th percentile. Extrapolating beyond the 97th percentile is not recommended and leads to compressed z-score values.Aim This study attempts to overcome this limitation by constructing a new method for calculating BMI distributions above the 95th percentile using an extended reference population.Subjects and methods Data from youth at or above the 95th percentile of BMI-for-age in national surveys between 1963 and 2016 were modelled as half-normal distributions. Scale parameters for these distributions were estimated at each sex-specific 6-month age-interval, from 24 to 239 months, and then smoothed as a function of age using regression procedures.Results The modelled distributions above the 95th percentile can be used to calculate percentiles and non-compressed z-scores for extreme BMI values among youth.Conclusion This method can be used, in conjunction with the current CDC BMI-for-age growth charts, to track extreme values of BMI among youth.