title: Using different growth references to measure thinness and overweight among Swedish primary school children showed considerable variations.
abstract: OBJECTIVE
  The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.
  
  
  METHODS
  The height and weight measurements of 4518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight was calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.
  
  
  RESULTS
  Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5% to 16.9% for the boys and 6.9% to 13.7% for the girls, while the prevalence of overweight, including obesity and severe obesity, varied from 16.5% to 25.7% for the boys and 18.2 to 25.2% for the girls. There were also significant gender differences depending on the growth reference we used.
  
  
  CONCLUSIONS
  Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references.
authors.affiliation: School of Hospitality, Culinary Arts and Meal Science, Örebro University, Örebro, Sweden. bente.nilsen@oru.se.|Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway. bente.nilsen@oru.se.
authors.forename: Bente B
authors.initials: BB
authors.lastname: Nilsen
authors.affiliation: School of Hospitality, Culinary Arts and Meal Science, Örebro University, Örebro, Sweden.|Sophiahemmet University, Stockholm, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Yngve
authors.affiliation: Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Sjöberg
authors.affiliation: Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Moraeus
authors.affiliation: Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lauren
authors.initials: L
authors.lastname: Lissner
authors.affiliation: School of Hospitality, Culinary Arts and Meal Science, Örebro University, Örebro, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Werner
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000175:diagnosis*; D012015:Reference Standards; D013548:Sweden; D013851:Thinness / Q000175:diagnosis*
keywords: Body mass index cut-off levels; Childhood; Growth surveillance; Obesity; Underweight