Rethinking the Use of Body Mass Index z-Score in Children and Adolescents with Severe Obesity: Time to Kick It to the Curb?

As the prevalence of pediatric severe obesity continues to increase,1 it has become apparent that some of the "tried and true" body mass index (BMI) metrics many researchers and clinicians have become accustomed to using, such as BMI z-score, are proving less reliable in certain circumstances and in many cases can be misleading.2 Two reports from Freedman et al, the most recent published in the current volume of The Journal,3 raise important concerns about the use of BMI z-score in studies that include children with severe obesity.

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