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nature publishing group

Pediatric Obesity

Similarity of the CDC and WHO Weight-forLength Growth Charts in Predicting Risk of
Obesity at Age 5 Years
Sheryl L. Rifas-Shiman1, Matthew W. Gillman1,2, Emily Oken1, Ken Kleinman1 and Elsie M. Taveras1,3
The World Health Organization (WHO) 2006 weight-for-length (WFL) or BMI growth charts are now recommended
as the new standard for children under 24 months. The objective of this study was to examine associations of ever
being overweight during 124 months, based on the older Centers for Disease Control and Prevention (CDC) and
WHO cutpoints, with risk of obesity at age 5 years. From well-child visits to a Massachusetts multi-site group practice
during 19802008, we studied 15,488 children with length/height and weight measurements at 1, 6, 12, 18, and
24 months, and at 5 years. The main exposures were ever being overweight during 124 months using each of three
cutpoints: CDC WFL 95th percentile, WHO WFL or BMI 97.7th percentile. The main outcome was obesity at 5 years
(CDC BMI 95th percentile). We calculated multivariable odds ratios (ORs), adjusted for age, sex, race/ethnicity, and
year. At 5 years, 10.8% of participants were obese. During 124 months, 21.3, 18.3, and 20.2% were ever overweight
using CDC WFL, WHO WFL, and WHO BMI cutpoints, respectively. ORs (95% confidence interval (CI)) for associations
of ever being overweight during 124 months with obesity at 5 years were 6.0 (5.4, 6.6), 6.3 (5.7, 7.0), and 6.0 (5.4, 6.7),
respectively. Ever being overweight in the first 2 years of life is a strong predictor of obesity at 5 years. CDC WFL,
WHO WFL, and WHO BMI cutpoints for overweight in early childhood provided similar estimates of later obesity risk.
Obesity (2012) 20, 12611265. doi:10.1038/oby.2011.350

Introduction

Pediatric health care providers routinely use the Centers for

Disease Control and Prevention (CDC) 2000 growth charts
to document serial measures of weight and length (1). The
CDC 2000 charts, a growth reference, are based on data from
a series of cross-sectional, nationally representative surveys
between the 1960s and early 1990s in the United States (13).
The World Health Organization (WHO) 2006 growth charts, a
growth standard, pooled data from six relatively high-income
sites around the world (4,5). The children on whom the WHO
charts are based were selected from healthy singletons with
nonsmoking mothers and no economic constraints on growth
and were fed according to specified guidelines for breastfeeding and complementary feeding. On the basis of an expert
panel, the CDC now recommends that clinicians in the United
States use the WHO 2006 weight-for-length (WFL) growth
charts, rather than the CDC growth charts, for children under
24 months of age (6).
Because both the CDC 2000 and the WHO 2006 growth
charts are available, providers of pediatric health care and
pediatric researchers now have a choice of growth charts to

use. Using CDC 2000 growth charts, the CDC defines overweight among children 024 months as WFL 95th percentile. Using WHO 2006 growth charts, the WHO defines
overweight among children 024 months as WFL or BMI
2 s.d. (z-scores) above the median, which corresponds to
the 97.7th percentile. Mei et al. compared the prevalence of
overweight using CDC and WHO growth charts among US
children participating in the National Health and Nutrition
Examination Survey 19992004 (7). Among children 023
months, 9.6% of participants were overweight using CDC
WFL 95th percentile, 7.5% using WHO WFL 97.7th percentile, and 8.1% using BMI 97.7th percentile. Although
Mei et al. found that these approaches provided similar prevalence of overweight, it is important to understand how the
CDC and WHO growth charts compare in predicting later
clinical outcomes.
To our knowledge, no studies have compared the two growth
charts in predicting later obesity. The purpose of this study was
to examine associations of ever being overweight in the first
2years of life, based on CDC vs. WHO cutpoints, with risk of
obesity at age 5 years.

Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts,USA;
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA; 3Division of General Pediatrics, Childrens Hospital Boston, Boston,
Massachusetts, USA. Correspondence:Sheryl L. Rifas-Shiman (Sheryl_rifas@hphc.org)
1
2

Received 15 April 2011; accepted 10 October 2011; advance online publication 8 December 2011. doi:10.1038/oby.2011.350
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articles
Pediatric Obesity
Methods and Procedures
Setting and subjects
We culled a longitudinal dataset from a clinical surveillance database
of 2,121,511 well-child visits by 312,857 children. The study population consisted of children <18 years of age who were seen for well-child
visits to a multi-site group practice in Eastern Massachusetts between
1980 and 2008. Throughout the study period, the sites used a completely
electronic medical record system that contained demographic and
growth data. We have previously published details of the data collection
methods in one of our analyses of a smaller version of this database
(120,000 children, age 1 month to <5 years, seen for well-child visits
between 1980 and 2001) (8). To be included in the analyses, children
needed length and weight measurements at 1, 6, 12, 18, and 24 months
and height and weight measurements at 5 years. At each time point we
allowed 30 days. Among 312,857 children, 28,991 had data at all five
timepoints in the first 24 months of life, of whom 15,488 children also
had outcome data at 5 year of age. Thus, the sample size for our final
analyses included 15,488 children. The study protocol was approved by
the institutional review board of Harvard Pilgrim Health Care.
Measurements
Medical assistants measured length or height and weight according
to the written protocol of the health centers. Weight was measured to
the nearest 0.25 pounds on a pediatric scale. Using a paper-and-pencil
technique, medical assistants measured recumbent length in children
younger than 24 months. At age 5 years, they measured height standing, without shoes.
In a validation study among 024 month-old infants conducted at one
of the participating health centers, we found that the paper-and-pencil
method systematically overestimated childrens length compared with a
reference method. Thus, as in our previous work, we used a regressionbased correction formula to adjust for this systematic overestimation:
corrected length = (0.953 length measured by paper-and-pencil
method) + 1.8cm (9).

Main exposures
We used length and weight measurements at 1, 6, 12, 18, and 24 months
to derive age- and sex-specific CDC WFL, WHO WFL, and WHO BMI
percentiles. The main exposures were being overweight at atleast one of
these five ages (timepoints) during 124 months using each of three
cutpoints: CDC WFL 95th percentile, WHO WFL 97.7th percentile,
or WHO BMI 97.7th percentile. We refer to our exposures as ever
overweight.
In secondary analysis, we used the number of timepoints overweight
during 124 months (range 05) for each of the three cutpoints. We collapsed four to five timepoints since the prevalence of being overweight at
all five timepoints was less than 1%. We also examined overweight status
at each of the five timepoints during 124 months.
Outcome measures
From heights and weights at age 5 years, we calculated BMI as kg/m2.
Our main outcome at age 5 was obesity, defined as an age- and sexspecific BMI 95th (vs. BMI <95th percentile) based on the CDC reference population (10).
Other measures
From enrollment records, we extracted information on childs date of
birth, sex, visit dates, and race/ethnicity. Parental or clinician report
of childs race/ethnicity was documented in the record as white, black,
Hispanic, American Indian/Alaska Native, Asian, or Other. Race/
ethnicity was missing for 3,568 participants (23%). Comparison of
children missing race/ethnicity data with the 11,920 participants not
missing race/ethnicity data showed a slightly lower proportion of
females (46.2 vs. 48.4%, P = 0.02) but the two groups did not differ by
prevalence of ever overweight during 124 months using CDC WFL
95th percentile (21.9 vs. 21.1%, P = 0.33), WHO WFL 97.7th percentile (19.0 vs. 18.1%, P = 0.23), or WHO BMI 97.7th percentile
(20.6 vs. 20.1%, P = 0.53).

Table 1Characteristics of 15,488 children who were seen at 92,928 well-child visits in a multi-site group practice in Massachusetts
from 1980 through 2008
Characteristics

N (%)

Sex
Boy

8,066 (52.1)

Girl

7,422 (47.9)

Race/ethnicity
White

9,411 (60.8)

Black

1,175 (7.6)

Hispanic

333 (2.2)

Other

1,001 (6.5)

Missing

3,568 (23.0)

CDC BMI 95th percentile at age 5 years

1,675 (10.8)
CDC weight-for-length 95th

WHO weight-for-length 97.7th

WHO BMI 97.7th

3,291 (21.3)

2,835 (18.3)

3,130 (20.2)

12,197 (78.7)

12,653 (81.7)

12,358 (79.8)

1,917 (12.4)

1,709 (11.0)

1,922 (12.4)

722 (4.7)

620 (4.0)

707 (4.6)

420 (2.7)

335 (2.2)

336 (2.2)

4 or 5

232 (1.5)

171 (1.1)

165 (1.1)

Ever overweight 124 months

Number of timepoints overweight 124 months

CDC, Centers for Disease Control and Prevention.

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articles
Pediatric Obesity
Methods and Procedures
Setting and subjects
We culled a longitudinal dataset from a clinical surveillance database
of 2,121,511 well-child visits by 312,857 children. The study population consisted of children <18 years of age who were seen for well-child
visits to a multi-site group practice in Eastern Massachusetts between
1980 and 2008. Throughout the study period, the sites used a completely
electronic medical record system that contained demographic and
growth data. We have previously published details of the data collection
methods in one of our analyses of a smaller version of this database
(120,000 children, age 1 month to <5 years, seen for well-child visits
between 1980 and 2001) (8). To be included in the analyses, children
needed length and weight measurements at 1, 6, 12, 18, and 24 months
and height and weight measurements at 5 years. At each time point we
allowed 30 days. Among 312,857 children, 28,991 had data at all five
timepoints in the first 24 months of life, of whom 15,488 children also
had outcome data at 5 year of age. Thus, the sample size for our final
analyses included 15,488 children. The study protocol was approved by
the institutional review board of Harvard Pilgrim Health Care.
Measurements
Medical assistants measured length or height and weight according
to the written protocol of the health centers. Weight was measured to
the nearest 0.25 pounds on a pediatric scale. Using a paper-and-pencil
technique, medical assistants measured recumbent length in children
younger than 24 months. At age 5 years, they measured height standing, without shoes.
In a validation study among 024 month-old infants conducted at one
of the participating health centers, we found that the paper-and-pencil
method systematically overestimated childrens length compared with a
reference method. Thus, as in our previous work, we used a regressionbased correction formula to adjust for this systematic overestimation:
corrected length = (0.953 length measured by paper-and-pencil
method) + 1.8cm (9).

Main exposures
We used length and weight measurements at 1, 6, 12, 18, and 24 months
to derive age- and sex-specific CDC WFL, WHO WFL, and WHO BMI
percentiles. The main exposures were being overweight at atleast one of
these five ages (timepoints) during 124 months using each of three
cutpoints: CDC WFL 95th percentile, WHO WFL 97.7th percentile,
or WHO BMI 97.7th percentile. We refer to our exposures as ever
overweight.
In secondary analysis, we used the number of timepoints overweight
during 124 months (range 05) for each of the three cutpoints. We collapsed four to five timepoints since the prevalence of being overweight at
all five timepoints was less than 1%. We also examined overweight status
at each of the five timepoints during 124 months.
Outcome measures
From heights and weights at age 5 years, we calculated BMI as kg/m2.
Our main outcome at age 5 was obesity, defined as an age- and sexspecific BMI 95th (vs. BMI <95th percentile) based on the CDC reference population (10).
Other measures
From enrollment records, we extracted information on childs date of
birth, sex, visit dates, and race/ethnicity. Parental or clinician report
of childs race/ethnicity was documented in the record as white, black,
Hispanic, American Indian/Alaska Native, Asian, or Other. Race/
ethnicity was missing for 3,568 participants (23%). Comparison of
children missing race/ethnicity data with the 11,920 participants not
missing race/ethnicity data showed a slightly lower proportion of
females (46.2 vs. 48.4%, P = 0.02) but the two groups did not differ by
prevalence of ever overweight during 124 months using CDC WFL
95th percentile (21.9 vs. 21.1%, P = 0.33), WHO WFL 97.7th percentile (19.0 vs. 18.1%, P = 0.23), or WHO BMI 97.7th percentile
(20.6 vs. 20.1%, P = 0.53).

Table 1Characteristics of 15,488 children who were seen at 92,928 well-child visits in a multi-site group practice in Massachusetts
from 1980 through 2008
Characteristics

N (%)

Sex
Boy

8,066 (52.1)

Girl

7,422 (47.9)

Race/ethnicity
White

9,411 (60.8)

Black

1,175 (7.6)

Hispanic

333 (2.2)

Other

1,001 (6.5)

Missing

3,568 (23.0)

CDC BMI 95th percentile at age 5 years

1,675 (10.8)
CDC weight-for-length 95th

WHO weight-for-length 97.7th

WHO BMI 97.7th

3,291 (21.3)

2,835 (18.3)

3,130 (20.2)

12,197 (78.7)

12,653 (81.7)

12,358 (79.8)

1,917 (12.4)

1,709 (11.0)

1,922 (12.4)

722 (4.7)

620 (4.0)

707 (4.6)

420 (2.7)

335 (2.2)

336 (2.2)

4 or 5

232 (1.5)

171 (1.1)

165 (1.1)

Ever overweight 124 months

Number of timepoints overweight 124 months

CDC, Centers for Disease Control and Prevention.

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Statistical analysis

We first ran univariate analyses of our main exposures, outcome, and covariates. Next we calculated unadjusted positive and negative predictive value, sensitivity, and specificity
of obesity at age 5 years among children who were ever overweight during 124 months using CDC and WHO cutpoints.
To examine the odds of obesity at age 5 years, we used multivariable logistic regression adjusted for childs sex, race/ethnicity,
and exact age and visit year of outcome. We report odds ratios
(ORs) and 95% confidence intervals (CIs). We conducted all
analyses using SAS, version 9.2 (SAS Institute, Cary, NC).
Results

Table1 shows characteristics of the 15,488 participating children. Obesity prevalence was 10.8% at age 5 years. During
124 months, 21.3% of participants were ever overweight

WHO WFL
97.7th

CDC WFL
95th
169
322

14

2,630
170

22
WHO BMI
97.7th
308

Figure 1 Venn diagram of the 3,635 participants who were ever

overweight during 124 months using CDC and WHO cutpoints. Data
from 15,488 children. CDC, Centers for Disease Control and Prevention;
WFL, weight-for-length.

using CDC WFL 95th percentile, 18.3% using WHO WFL

97.7th percentile, and 20.2% using BMI 97.7th percentile.
For the most part, the three indicators identified the same children as having ever been overweight. Or 3,635 children identified by any indicator, 2,630 (72%) were identified by all three
(Figure1).
Using WHO BMI 97.7th percentile, 898 children were
ever overweight during 124 months among 1,675 children
who were obese at age 5 years, for a sensitivity of 54%. On the
other hand, 12,358 children were never overweight during
124 months among 13,813 children who were not obese at
age 5years, for a specificity of 84%. Among 3,130 children who
were ever overweight during 124 months, 898 were obese at
age 5 years, for a positive predictive value of 29%. Among those
who were not overweight in the first 2 years, 11,581 remained
so at 5 years (negative predictive value 94%). Using CDC WFL
95th percentile or WHO WFL 97.7th percentile to define
ever being overweight during 124 months provided similar
test characteristics (Table2).
Multivariable ORs (95% CI) for associations of ever being
overweight during 124 months with obesity at age 5 years
were 6.0 (5.4, 6.6) using CDC WFL, 6.3 (5.7, 7.0) using WHO
WFL, and 6.0 (5.4, 6.7) using WHO BMI (Table3). These ORs
and CIs were no different from the unadjusted estimates.
As shown in Figure2, we found steeply increasing odds of
obesity at age 5 years for each additional timepoint that the
child was overweight in during 124 months. For example, the
OR (95% CI) for being overweight at three timepoints vs. 0
timepoints during 124 months was 12.6 (10.0, 15.8) using
WHO BMI, and for being overweight at 45 timepoints, the
OR was 32.1 (22.9, 45.0). Estimates using CDC WFL or WHO
WFL were similar (Figure2).
In Table4 we show how being overweight at each of the five
timepoints during 124 months predicts obesity at age 5 years.
At 1 month the prevalence of overweight was similar using
CDC WFL, WHO WFL, and WHO BMI cutpoints (2.4, 2.3, and

Table 2Unadjusted positive and negative predictive values, sensitivity, and specificity of obesity at age 5 years among children
who were ever overweight during 124 months, according to CDC and WHO cutpoints (data from 15,488 children)
Obesity at age 5 yearsa
BMI 95th
percentile

BMI <95th
percentile

Test characteristics
Positive
predictive value

Negative
predictive value

Sensitivity

Specificity

28%

94%

55%

83%

30%

94%

51%

86%

29%

94%

54%

84%

Cutpoint percentile, 124 months

CDC weight-for-length 95th
Yes

925

2,366

No

750

11,447

Yes

860

1,975

No

815

11,838

WHO weight-for-length 97.7th

WHO BMI 97.7th

Yes

898

2,232

No

777

11,581

CDC, Centers for Disease Control and Prevention.

a
Obesity at age 5 years defined as BMI 95th based on the CDC growth charts.
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2.3%, respectively). At 6 and 12 months the prevalence of overweight was highest using CDC WFL (e.g., 7.0, 4.4, and 3.9% at
6 months) but again at 18 and 24 months the prevalences were
similar (e.g., 8.5, 7.6, and 8.7% at 24 months). The prevalence of
overweight increased from 1 to 18 months and then decreased
slightly at 24 months. The positive predictive values and the ORs
for obesity at age 5 years were higher at increasing age (from 1 to
24 months) of being overweight. For example, using WHO BMI,
the ORs (95% CI) of being obese at age 5 years was 8.5 (7.5, 9.6)
if overweight at 24 months, but only 2.3 (1.8, 3.0) if overweight
at 1 month. Test characteristics and ORs were similar across the
CDC and WHO cutpoints (Table4).
Discussion

In this study of 15,488 children and 77,440 well-child care

visits during 124 months and at 5 years, we found that ever
being overweight in the first 2 years of life is a strong predictor of obesity at age 5 years. The prevalence of ever being
overweight during 124 months was similar using CDC WFL
Table 3Unadjusted and multivariable adjusted odds ratios
(95% CI) for associations of ever being overweight during
124 months using CDC and WHO cutpoints with obesity at
age 5 years (data from 15,488 children)
Multivariable
adjusteda

Unadjusted

OR (95% CI)
Ever overweight 124 months
CDC weight-for-length 95th

6.0 (5.4, 6.6)

6.0 (5.4, 6.6)

WHO weight-for-length 97.7th

6.3 (5.7, 7.0)

6.3 (5.7, 7.0)

WHO BMI 97.7th

6.0 (5.4, 6.7)

6.0 (5.4, 6.7)

CDC, Centers for Disease Contol and Prevention; CI, confidence interval; OR,
odds ratio.
a
Adjusted for childs sex, race/ethnicity, and exact age and visit year of outcome
measurement.

95th percentile, WHO WFL 97.7th percentile, and WHO

BMI 97.7th percentile. In addition, the ORs for obesity at
age 5 years and the predictive values were also similar across
the CDC and WHO cutpoints. Thus our results suggest that
if pediatric clinicians were to switch from using CDC WFL
95th percentile to WHO WFL or BMI 97.7th percentile in
the first 2 years of life, the percent of children defined as overweight would not be greatly affected nor would their ability to
predict later obesity status.
One exception to this inference is that CDC WFL 95th
percentile classified more children as overweight at 6 months
than either WHO WFL or BMI 97.7th percentile (7.0, 4.4,
and 3.9%, respectively). Nevertheless, the resulting ability of
6-month overweight status to predict 5-year obesity was not
terribly different across the three cutpoints (ORs 4.0, 4.8, and
5.0, and positive predictive values 30, 35, and 36, respectively).
In addition, the positive predictive values and the ORs for
obesity at age 5 years were higher at increasing age of being
overweight during 124 months.
Clinicians and child health care providers use growth charts
to document serial measures of weight and length and screen
for growth abnormalities; researchers use growth charts to better understand growth and its association with various predictors and consequences. The CDC recently recommended that
clinicians use the WHO 2006 growth charts rather than the
CDC 2000 growth charts for children aged <24 months (6).
The rationale for use of the WHO growth charts for this age
group includes the following: (i) the recognition that breastfeeding is the recommended standard for infant feeding and,
unlike the CDC charts, the WHO charts reflect growth patterns among children who were predominantly breastfed for
at least 4 months and still breastfeeding at age 12 months; (ii)
clinicians already use growth charts as a standard for normal
growth; and (iii) the WHO charts are based on a high-quality
study, the Multicentre Growth Reference Study (6).

Odds ratio for obesity at age 5

100.0

31.6

10.0

9.0

7.5
3.6

3.4

14.3

11.9

30.4

32.1

12.6

8.5

3.6

CD
9 C W
5t F
h L
W
HO
9
7. W
7 t FL
h
W
H
9 O
7. BM
7t
h I

CD
9 C W
5t F
h L
W
HO
9
7. W
7 t FL
h
W
H
9 O
7. BM
7t
h I

CD
9 C W
5t F
h L
W
HO
9
7. W
7 t FL
h
W
H
9 O
7. BM
7t
h I

CD
9 C W
5t F
h L
W
HO
9
7. W
7 t FL
h
W
H
9 O
7. BM
7t
h I

1.0

45

Number of timepoints overweight 1 24 months using CDC and WHO cutpoints

Figure 2 Multivariable adjusted odds ratios (95% CI) for obesity at age 5 years, according to the number of timepoints overweight in the first 2 years
of life using CDC or WHO cutpoints. The five timepoints were 1, 6, 12, 18, and 24 months. Referent is 0 timepoints overweight. Data from 15,488
children. Adjusted for childs sex, race/ethnicity, and exact age and visit year of outcome measurement. CDC, Centers for Disease Control and
Prevention; CI, confidence interval; WFL, weight-for-length.
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Pediatric Obesity
Table 4 N (%) overweight at each of five timepoints during 124 months using CDC and WHO cutpoints, positive predictive value,
and multivariable adjusted odds ratios (95% CI) for obesity at age 5 years (data from 15,488 children)
CDC weight-for-length 95th

WHO weight-for-length 97.7th

Obesity at age 5 years

N (%) overweight

PPV

OR (95% CI)

WHO BMI 97.7th

Obesity at age 5 years

N (%) overweight

Obesity at age 5 years

PPV

OR (95% CI)

N (%) overweight

PPV

OR (95% CI)

Month of age
1

375 (2.4)

18%

1.9 (1.4, 2.5)

352 (2.3)

17%

1.8 (1.3, 2.3)

360 (2.3)

21%

2.3 (1.8, 3.0)

1,081 (7.0)

30%

4.0 (3.5, 4.7)

674 (4.4)

35%

4.8 (4.1, 5.7)

603 (3.9)

36%

5.1 (4.3, 6.1)

12

1,336 (8.6)

34%

5.6 (4.9, 6.4)

1,052 (6.8)

37%

6.0 (5.2, 6.9)

1,138 (7.3)

33%

5.1 (4.5, 5.9)

18

1,446 (9.3)

40%

7.6 (6.7, 8.6)

1,390 (9.0)

40%

7.7 (6.8, 8.7)

1,571 (10.1)

36%

6.6 (5.8, 7.4)

24

1,324 (8.5)

45%

9.6 (8.5, 10.9)

1,181 (7.6)

46%

10.1 (8.8, 11.5)

1,345 (8.7)

42%

8.5 (7.5, 9.6)

Adjusted for childs sex, race/ethnicity, and exact age and visit year of outcome measurement.
CDC, Centers for Disease Contol and Prevention; CI, confidence interval; OR, odds ratio; PPV, positive predictive value.

When interpreting our study, readers should consider several limitations. All subjects in this study had health insurance
and access to primary care. Our results may not be generalizable to socio-economically disadvantaged populations with less
access to primary care. The prevalence of overweight in infancy
(124 months) or obesity in childhood (5 years) may be higher
among poorer families and the trajectory of obesity may differ.
Also, we employed clinically measured lengths, which we know
from our previous validation study tend to overestimate actual
length (9). However, we used the regression estimate from that
study to statistically correct for this systematic overestimation.
It is important for clinicians to measure infant length accurately or they will tend to underestimate the number of infants
who are overweight, no matter which growth chart they use.
Because we focused on obesity in this study, we did not
address the prevalence of underweight in the first 2 years of
life. Among children 023 months, Mei et al. found substantial
differences in the prevalence underweight using CDC WFL
<5th percentile (4.0%) vs. WHO WFL <2.3rd percentile (0.8%)
(6). Further research would be helpful to understand the clinical significance of differences in CDC vs. WHO underweight
cutpoints.
Conclusion

In conclusion, ever being overweight in the first 2 years of life

is a strong predictor of obesity at age 5 years. CDC and WHO
growth charts provide similar estimates. Switching from CDC
WFL 95th percentile to WHO WFL or BMI 97.7th percentile to define overweight in the first 2 years of life would not
greatly affect the percent of children defined as overweight and
thus would not have a strong impact on preventing later obesity. These results support the recommendation to adopt the
WHO growth charts for children under 2 years of age.

obesity | VOLUME 20 NUMBER 6 | june 2012

Acknowledgments
This work was supported by the National Center for Chronic Disease
Prevention and Health Promotion (CCDPH) (Contract No. 200-2008M-26882). This work is solely the responsibility of the authors and does not
represent official views of the CCDPH.

Disclosure
The authors declared no conflict of interest.
2011 The Obesity Society

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