Thibault H, Rolland-Cachera M F
Direction générale de la santé, ministère de la santé, 8, avenue de Ségur, 75007 Paris, France.
Arch Pediatr. 2003 Dec;10(12):1100-8. doi: 10.1016/j.arcped.2003.07.008.
Considering the high prevalence and the increasing trends, obesity is now considered as a public health problem in numerous countries. The main aim of the National Program of Nutrition and Health is to stop the increasing prevalence of childhood obesity. In this frame work, a group of experts has established a new presentation of the corpulence curves, adapted for clinical practice, to define normal weight and obesity. Weight status is now currently assessed on the basis of weight and height measurements, after computing the Quetelet index or body mass index (BMI) corresponding to weight (m) divided by square of height (weight/height2). As body proportion varies during growth, age must be taken into account. Various curves were published. In 1982, based on the French sample of the international growth study, BMI curves were published. They were revised in 1991. The third and 97th centiles define the normal weight range. Overweight is defined by BMI values greater than the 97th centile. In the year 2000, a new international definition was established. Two centiles were constructed to define overweight and obesity. The new BMI charts adapted for clinical practice, proposed by the French National program of nutrition and health, include the French reference curves plus the centile defining obesity in the international definition. Thus, in the new French charts, the area above the 97th centile is split in two levels (degree 1 obesity and degree 2 obesity). Drawing the BMI curve for each child, like drawing weight and height curves, is a simple act which can be done routinely. The age at adiposity rebound (an indicator predicting the risk of adult obesity) can be read from the curve. It allows to identify an early phase of obesity development, even at the time when overweight is not yet clinically visible. When obesity appears clearly, the identification is easy. The use of BMI curves is particularly useful in two situations: (1) in very young overweight children, the curves allow to identify children who have a real risk of developing obesity. (2) By the age of 6 years, when due to normal physiological variations, clinical assessment can be misleading. The BMI curves allow to identify children at risk. When a child is identified as having a real risk of obesity, simple preventive measures, adapted for each subject, could avoid a development toward massive obesity, which may become difficult to reduce if managed too late.
鉴于肥胖症的高患病率及其上升趋势，现在许多国家都将其视为一个公共卫生问题。国家营养与健康计划的主要目标是遏制儿童肥胖症患病率的上升。在此框架下，一组专家制定了一种适用于临床实践的肥胖曲线新表示法，用于界定正常体重和肥胖。目前，体重状况是在计算对应于体重（千克）除以身高平方（体重/身高²）的奎特列指数或体重指数（BMI）之后，根据体重和身高测量值来评估的。由于身体比例在生长过程中会发生变化，所以必须考虑年龄因素。已经公布了各种曲线。1982年，基于国际生长研究的法国样本公布了BMI曲线。这些曲线在1991年进行了修订。第三百分位数和第九十七百分位数界定了正常体重范围。超重的定义是BMI值大于第九十七百分位数。2000年，确立了一个新的国际定义。构建了两个百分位数来界定超重和肥胖。法国国家营养与健康计划提出的适用于临床实践的新BMI图表，包括法国参考曲线以及国际定义中界定肥胖的百分位数。因此，在新的法国图表中，第九十七百分位数以上的区域被分为两个级别（一级肥胖和二级肥胖）。为每个孩子绘制BMI曲线，就像绘制体重和身高曲线一样，是一项简单的操作，可以常规进行。可以从曲线上读取肥胖反弹年龄（预测成人肥胖风险的一个指标）。这有助于识别肥胖发展的早期阶段，即使在临床上尚未出现超重的时候。当肥胖明显出现时，识别就很容易了。BMI曲线的使用在两种情况下特别有用：（1）对于非常年幼的超重儿童，这些曲线有助于识别有真正肥胖发展风险的儿童。（2）到6岁时，由于正常的生理变化，临床评估可能会产生误导。BMI曲线有助于识别有风险的儿童。当确定一个孩子有真正的肥胖风险时，针对每个个体采取简单的预防措施，可以避免发展为重度肥胖，如果管理过晚，可能会变得难以减轻。
