The WHO, IOTF, and Brazilian Reference (Conde and Monteiro) BMI classifications showed excellent agreement in adolescents, but the BR reference showed a stronger association with cardiometabolic risk, suggesting its inclusion may optimize early detection of CMR in Brazilian health services.
The three BMI classification systems (WHO, IOTF, and Brazilian Reference) showed excellent agreement for classifying overweight and obesity in adolescents.
Agreement was highest between the WHO and IOTF references and lowest between the WHO and Brazilian Reference.
Obesity diagnosed by the Brazilian Reference was associated with an 8.51-fold higher prevalence of cardiometabolic risk in adolescents.
The Brazilian Reference showed a stronger association with cardiometabolic risk than the other classifications.
This study of 823 schoolchildren and teenagers (ages 10-19) in Fortaleza, Brazil compared three commonly used ways of deciding whether an adolescent is overweight or obese based on body mass index: the World Health Organization (WHO) charts, the International Obesity Task Force (IOTF) cut-offs, and a Brazilian reference developed by Conde and Monteiro. The three methods largely agreed on who was overweight or obese, with the closest match between WHO and IOTF and a slightly lower, but still excellent, match between WHO and the Brazilian reference. The researchers also looked at cardiometabolic risk, defined as having both signs of insulin resistance (assessed by waist-to-height ratio) and abnormal blood fats (dyslipidemia). Adolescents classified as obese by the Brazilian reference had about 8.5 times the prevalence of this combined risk, and this reference showed a stronger link to risk than the other two. This research suggests that, although the classification systems mostly agree, the Brazilian reference may be useful for spotting adolescents at higher metabolic risk in Brazilian health services. As a cross-sectional study, it shows association rather than cause and effect, and it was carried out in one city's municipal schools.
Nogueira M, Oliveira L, Martins G, Braga R, Lourenço E, Bezerra I, et al.. (2026). Excess weight and its association with cardiometabolic risk in adolescents: comparative analysis of national and international classifications.. Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo. https://doi.org/10.1590/1984-0462/2026/44/2025342