In Reply.—We agree with Dr Hergenroeder's contention that pediatricians should become more involved in problems of clinical nutrition. In our article, we chose not to recommend a specific BMI or percentile of BMI as a criterion for the diagnosis of obesity. Until a level of BMI is identified that is either associated with an increase in morbidity, or predictive of later morbidity or mortality, the specification of a diagnostic cutoff point for obesity during childhood remains somewhat arbitrary.1 Rather than emphasizing the diagnosis of obesity, we recommend that clinicians use longitudinal assessments of BMI to monitor changes in weight relative to height and age, and that investigators continue to study the pattern of development of BMI and its relevance as a predictor of obesity. For example, Rolland-Cachera et al2 have identified the timing of the adiposity rebound as a predictor of later obesity.
Further research is needed to demonstrate
HAMMER LD, WILSON DM, KRAEMER HC, RITTER PL, DORNBUSCH SM. Obesity and Body-Mass Index-Reply. Am J Dis Child. 1991;145(9):972. doi:10.1001/archpedi.1991.02160090022013