6 Understanding Weight Control incorrectly classified as obese or overweight. Similarly, children’s height and weight and the rate at which they put on weight and store it can vary a lot as a result of normal growth and development. While there are normal ranges for BMI in children that vary with age and sex, the calcula- tions for any one child can vary a lot over the years.10 The BMI of children is compared with other children in the same way as height is by ranges of percentage of children in the same group (called percentiles). To determine overweight or obesity, a child is compared with other children. Overweight children have a BMI between the 85th and the 95th percentiles of the normal range for their age and sex. Obese children have a BMI at or greater than 95th per- centile for age and sex. Severe obesity in childhood is defined at a BMI at or greater than 120% of the 95th percentile. Besides muscle-to-fat ratio, cultural differences, and childhood varia- tions, there are other reasons that we can’t yet explain to suspect that BMI might not tell the whole story. For example, some people have all the health problems associated with obesity—such as diabetes, high blood pressure, arthritis, and depression—but have normal weight. Conversely, there are obese individuals with no other health problems who have a BMI above 30 kg/m2.11 These exceptions to the BMI ranges make it difficult to use BMI as an ongoing measurement of how we are going in our weight disruption jour- ney, because our starting points are so variable but the ranges are very fixed for example, we could start on the upper limit of overweight (29.9), lose 4.5 kg (10 lb), and still be in the overweight category for our height and age. So it is not surprising that ranges are interpreted differently by clinicians and the general public. Surveys suggest that 60% of men believe that a BMI greater than 28 is a sign of overweight. However, 30% of men with a BMI of 30–31 (i.e., the lower end of the obese range) consider their weight acceptable. Older women also think that a BMI of 30–31 is accept- able, whereas younger women view the upper part of the normal range of BMI as overweight. Once we have established that we need to work on our weight, there are many other ways to assess ongoing changes in body weight and fat. Some methods are quite simple and have been around for a long time, such as scales. Other methods are quite new and technical such as Muscle weighs more than fat. So our weight may not change as we get fitter, even though there may be a great improve- ment in appearance.
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