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Exploratory Study Examining Clinical Measures of Adiposity Risk for Predicting Obesity in Adolescents with Physical Disabilities

Wingo, Brooks C. PhD; Mehta, Tapan PhD; Qu, Peng PhD; Vogel, Larry C. MD; Rimmer, James H. PhD

American Journal of Physical Medicine & Rehabilitation: August 2015 - Volume 94 - Issue 8 - p 585–594
doi: 10.1097/PHM.0000000000000323
Original Research Articles: CME Article . 2015 Series . Number 8

Objective The purposes of this study were to assess the accuracy of clinical measures for predicting adiposity when compared with a criterion standard of body fat percentage measured by dual-energy X-ray absorptiometry and to determine the most appropriate cut points for classifying obesity for each measure in adolescents with physical disability.

Design Body mass index, triceps skinfolds, and waist, arm, and leg circumferences were collected on 29 adolescents aged 14–17 yrs with spinal cord injury, cerebral palsy, or spina bifida. Percentage of body fat was measured using dual-energy X-ray absorptiometry. Multiple linear regression models were used to assess the ability of measures to predict percentage of body fat. Receiver operating characteristic curves were used to identify optimal cut points for each measure.

Results Although all clinical measures correlated with body fat as measured by dual-energy X-ray absorptiometry, current cut points are not adequate in this group. Using a body mass index of 20 kg/m2 (boys) and 19 kg/m2 (girls) was optimal but still misclassified a significant number of participants as nonobese in this group. Using the optimal cut points for waist circumference, which were 83 cm (boys) and 78 cm (girls), was the best predictor.

Conclusions Body mass index, triceps skinfolds, and waist, leg, and arm circumferences are valid measures for estimating obesity in adolescents with physical disability, but further research is needed to validate disability-specific cut points.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at

CME Objectives: Upon completion of this article, the reader should be able to: (1) Understand disparities in obesity rates among adolescents with mobility disabilities; (2) Describe limitations of current clinical screening methods of obesity in children with mobility disabilities; and (3) Identify potential alternatives for obesity screening in children with mobility disabilities.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for amaximumof 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Departments of Occupational Therapy (BCW), Physical Therapy (TM), and Biostatistics (PQ), University of Alabama at Birmingham, Birmingham, Alabama; UAB/Lakeshore Research Collaborative, Birmingham, Alabama (BCW, TM, JHR); Shriners Hospital for Children, Chicago, Illinois (LCV); and Rush University, Chicago, Illinois (LCV).

All correspondence and requests for reprints should be addressed to: Brooks C. Wingo, PhD, SHPB 339, 1702 2nd Ave S, Birmingham, AL 35294.

The contents of this publication were developed under a grant from the Department of Education, National Institute for Disability and Rehabilitation Research grant number H133A120102.

Portions of the results of this study have been presented as poster presentations at national conferences.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.