[Federal Register Volume 83, Number 5 (Monday, January 8, 2018)]
[Notices]
[Page 818]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-00060]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Docket No. CDC-2018-0001]


CDC Sex-Specific Body Mass Index (BMI)-For-Age Growth Charts

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Notice with comment period.

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SUMMARY: The National Center for Health Statistics (NCHS), Centers for 
Disease Control and Prevention (CDC) in the Department of Health and 
Human Services (HHS) announces the opening of a docket to obtain public 
comment on the production of sex-specific body mass index (BMI)-for-age 
growth charts for children and adolescents aged 2-19 years specifically 
designed for tracking extremely high values of BMI. The 2000 CDC growth 
charts include sex-specific BMI-for-age percentile charts based on data 
representative of the United States (US) population from the National 
Health Examination Survey (NHES) and National Health and Nutrition 
Examination Survey (NHANES). In US children and adolescents, obesity is 
defined as at or above the sex-specific 95th percentile on the CDC BMI-
for-age growth charts. Severe obesity is often defined as at or above 
120% of the sex-specific 95th percentile on the CDC BMI-for-age growth 
charts. Currently, the highest percentile displayed is the 97th 
percentile. Therefore, it is difficult to assess changes in weight 
status in children with very high BMIs that exceed this level. The new 
charts will provide additional lines representing 120%, 130%, 140%, and 
150% of the 95th percentile. The intent of these charts is to provide a 
mechanism for documenting BMI percentiles for children and adolescents 
with severe obesity in both clinical and research settings.

DATES: Written comments must be received on or before March 9, 2018.

ADDRESSES: You may submit comments, identified by Docket No. CDC-2018-
0001 by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Verita C. Buie, DrPH, Office of Planning, Budget, 
and Legislation, National Center for Health Statistics, Centers for 
Disease Control and Prevention, 3311 Toledo Road, MS-08, Hyattsville, 
MD 20782.
    Instructions: All submissions received must include the agency name 
and Docket Number. All relevant comments received will be posted 
without change to http://regulations.gov, including any personal 
information provided. For access to the docket to read background 
documents or comments received, go to http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Cynthia Ogden, Ph.D., Division of 
Health and Nutrition Examination Survey, National Center for Health 
Statistics, 3311 Toledo Road, MS-P08, Hyattsville, MD 20782-2064, 
phone: (301) 458-4405.

SUPPLEMENTARY INFORMATION: The National Center for Health Statistics 
(NCHS) is congressionally mandated by the National Health Survey Act of 
1956 to monitor the health of the nation. The National Health and 
Nutrition Examination Survey (NHANES), part of NCHS, is a nationally 
representative health survey designed to assess the health and 
nutritional status of adults and children in the United States. The 
survey is unique in that it combines interviews with physical 
examinations and laboratory studies. NHANES data are used throughout 
Department of Health and Human Services (HHS) agencies in addition to 
public health researchers world-wide. NHANES data have been used to 
determine national obesity estimates, produce pediatric growth and BMI 
charts, and monitor prevalence of infectious diseases such as the human 
papillomavirus (HPV).
    Body mass index (BMI) is calculated as weight in kilograms divided 
by height in meters squared and is used in the diagnosis, clinical 
management, and estimation of population prevalence of obesity and 
severe obesity. Among adults, obesity is defined by an absolute BMI 
value (>=30). Among children, BMI varies with age as well as sex. 
Therefore, to classify obesity among children and adolescents aged 2-19 
years, measurements are standardized by age and sex using BMI-for-age 
growth charts. The 2000 CDC growth charts include smoothed percentiles 
of BMI-for-age based on data representative of the US population. In 
the US, obesity is defined as at or above the sex-specific 95th 
percentile for BMI-for-age. However, categorizing severe obesity 
(defined in adults as BMI>=40) is problematic given specific measures 
are not available in standard CDC growth charts for values beyond the 
97th percentile. Researchers have proposed using percent of the 95th 
percentile as a flexible, stable measure for extreme BMI values. 
Consequently, severe obesity in children is often defined as a BMI at 
or above 120% of the sex-specific 95th percentile of BMI-for-age.
    Prevalence of severe obesity has increased among children and 
adolescents and very high BMI has been shown to increase risk for 
obesity in adulthood in addition to adverse health outcomes such as 
diabetes, abnormal cholesterol levels, and high blood pressure and 
behavioral health and social victimization impacts. Recent research has 
focused on effective management and treatment of children and 
adolescents with severe obesity, but researchers and clinicians lack a 
tool to determine BMI percentiles for these individuals. Specialized 
growth charts with lines reflecting 120%, 130%, 140% and 150% will 
provide an improved tool for documenting BMI in the clinical and 
research settings. Please see the draft example chart for boys 
(Attachment 1) and girls (Attachment 2).

    Date: January 2, 2018.
Lauren Hoffmann,
Acting Executive Secretary, Centers for Disease Control and Prevention.
[FR Doc. 2018-00060 Filed 1-5-18; 8:45 am]
 BILLING CODE 4163-18-P