Body Fat Percentile Curves for
U.S. Children and Adolescents
Kelly R. Laurson, PhD, Joey C. Eisenmann, PhD, Gregory J. Welk, PhD
Background: To date, several studies have been published outlining reference percentiles for BMI
in children and adolescents. In contrast, there are limited reference data on percent body fat (%BF) in
U.S. youth.
Purpose: The purpose of this study was to derive smoothed percentile curves for %BF in a nationally
representative sample of U.S. children and adolescents.
Methods: Percent fat was derived from the skinfold thicknesses of those aged 5–18 years from three
cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES) IV
(1999–2000, 2001–2002, and 2003–2004; N⫽8269). The LMS (L⫽skewness, M⫽median, and
S⫽coeffıcient of variation) regression method was used to create age- and gender-specifıc smoothed
percentile curves of %BF.
Results: Growth curves are similar between boys and girls until age 9 years. However, whereas %BF
peaks for boys at about age 11 years, it continues to increase for girls throughout adolescence. Median
%BF at age 18 years is 17.0% and 27.8% for boys and girls, respectively.
Conclusions: Growth charts and LMS values based on a nationally representative sample of U.S.
children and adolescents are provided so that future research can identify appropriate cut-off values
based on health-related outcomes. These percentiles are based on skinfolds, which are widely
available and commonly used. Using %BF instead of BMI may offer additional information in
epidemiologic research, fıtness assessment, and clinical settings.
(Am J Prev Med 2011;41(4S2):S87–S92) © 2011 American Journal of Preventive Medicine
Introduction
T
he increasing prevalence
1–6
and adverse medical,
7
economic,
8
and psychosocial
9,10
consequences of
childhood obesity have been well documented.
The majority of studies that identify the magnitude and
consequences of this health problem rely on the classifı-
cation of overweight or obesity using age- and gender-
specifıc thresholds or reference values of BMI. Several
sets of reference values for BMI in children and adoles-
cents have been published, with the most widely recog-
nized being the international thresholds by Cole et al.
11
and the CDC thresholds.
12
Although these reference val-
ues are widely used, a major limitation of BMI is its
inherent inability to differentiate between fat mass and
fat-free mass.
13
Similar sets of reference values are needed
for body fatness to improve public health surveillance,
facilitate clinical screening, and advance obesity preven-
tion research.
Despite the importance of body fatness to health, there
are limited reference data available on percent body fat
(%BF). Percentiles for body fat have been developed us-
ing bioelectrical impedance analysis (BIA)-derived %BF
values in British children
14
and skinfold-derived %BF
values in Spanish adolescents.
15
Both BIA and measuring
skinfold thickness are simple and feasible methods to
assess adiposity. In children and adolescents, skinfold
thickness values are often converted to %BF using the
Slaughter equation,
16
as in the aforementioned study by
Moreno et al.
15
Rodriguez et al.
17
specifıcally recom-
mended the use of the Slaughter equation for male and
female adolescents after reviewing several skinfold-to-
%BF prediction equations. Reference data are not cur-
rently available using skinfold-derived %BF in U.S.
youth. Therefore, this paper presents smoothed percen-
tile curves for %BF using LMS (L⫽skewness, M⫽
median, and S⫽coeffıcient of variation) regression in a
From the School of Kinesiology and Recreation, Illinois State University
(Laurson), Normal, Illinois; the Department of Kinesiology, Michigan State
University (Eisenmann), East Lansing, Michigan; The Healthy Weight
Center at Helen DeVos Children’s Hospital (Eisenmann), Grand Rapids,
Michigan; and the Department of Kinesiology, Iowa State University
(Welk), Ames, Iowa
Address correspondence to: Kelly R. Laurson, PhD, School of Kinesiol-
ogy and Recreation, Illinois State University, Campus Box 5120, 250
0749-3797/$17.00
doi: 10.1016/j.amepre.2011.06.044
© 2011 American Journal of Preventive Medicine • Published by Elsevier Inc. Am J Prev Med 2011;41(4S2):S87–S92 S87
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