The archetypal BMI distribution is symmetrical
DOI:
https://doi.org/10.52905/hbph2026.121Keywords:
BMI, normal dsitribution, skewness, obesity, historicAbstract
Background Currently used global standards and references for BMI are skewed to the right. We question that this feature reflects an archetypal human norm.
Sample and Methods We reanalysed 501 BMI distributions of 21 historic and contemporary populations from Westernized, Educated, Industrialized, Rich, Democratic (WEIRD) and Low- and Middle-Income Countries (LMIC) (Germany, Poland, Hungary, Kenia, South Africa, Indonesia, India, Guatemala) with altogether 111.197 boys and 101.688 girls aged 3 to 18 years. We tested age- and sex-specific skewness of these distributions.
Results Symmetrical BMI distributions were prevalent in European populations before the 1960s, and were found in children and adolescents from Kenya (1982), and contemporary Sikkim/India, rural Guatemala, and rural Indonesia. Right-skewed distributions are found in contemporary WEIRD countries and also prevail in contemporary urban children from LMICs. BMI distributions of girls are less skewed in the urban samples from Indonesia, Kolkata, rural Guatemala, and rural South Africa.
Conclusions Currently used growth charts suggest right-skewed distributions as a general feature of BMI at all ages. Yet, this feature is limited to contemporary WEIRD and urban LMIC societies and first occurred during the social and economic transition of the second half of the 20th century. Right-skewed BMI distributions capture a transient historic snapshot, with uncertain relevance for permanent global use. Right-skewness overestimates thinness and underestimates overweight and obesity in societies where symmetrical BMI distributions are still prevalent. We are concerned that the Global Burden of Diseases is much higher than currently rated and a serious future public health issue.
References
Abiri, B./Ahmadi, A. R./Valizadeh, A./Akbari, M./Hosseinpanah, F./Nikoohemmat, M./Valizadeh, M./Vafa, M. (2024). Trend analysis, gender-specific patterns, and age dynamics of childhood and adolescent obesity: insights from the Tehran lipid and glucose study. BMC Public Health 24 (1), 2764. https://doi.org/10.1186/s12889-024-20307-0.
Bodzsar, E. B./Zsakai, A./Mascie-Taylor, N. (2016). Secular Growth and Maturation Changes in Hungary in Relation to Socioeconomic and Demographic Changes. Journal of Biosocial Science 48 (2), 158–173. https://doi.org/10.1017/S0021932015000061.
Bogin, B. (2018). The Universidad del Valle de Guatemala Longitudinal Study of Child and Adolescent Development: History, Description, and Research Prospectus. https://doi.org/10.13140/RG.2.2.31468.00644.
Bogin, B. (2021). Social-Economic-Political-Emotional (SEPE) factors regulate human growth. Human Biology and Public Health 1, 1–20. https://doi.org/10.52905/hbph.v1.10.
Bogin, B./Varea, C./Hermanussen, M./Scheffler, C. (2018). Human life course biology: A centennial perspective of scholarship on the human pattern of physical growth and its place in human biocultural evolution. American Journal of Physical Anthropology 165 (4), 834–854. https://doi.org/10.1002/ajpa.23357.
Cole, T. J. (1990). The LMS method for constructing normalized growth standards. European Journal of Clinical Nutrition 44 (1), 45–60.
Dikanski, M. (1914). Über den Einfluss der sozialen Lage auf die Körpermaße von Schulkindern. München, Universitäts-Kinderklinik, München. Universitäts-Kinderklinik, München.
Dorje, B. (2020). Anthropometric Data of Children from Sikkim. xls-File, 2020.
Dribbisch, P. (1969). Die Robustizitätsindizes aus den Bikondylarbreiten als Hilfsmittel der Körperbaudiagnose. Biologische Rundschau 8, 112–113.
Eiben, O. G./Barabas, A./Panto, E. (1991). The Hungarian national growth study. ITC plantin.
Flügel, B./Greil, H./Sommer, K. (1986). Anthropologischer Atlas. Grundlagen und Daten ; Alters- und Geschlechtsvariabilität des Menschen ; 238 Tabellen. Frankfurt/Main, Wötzel.
GBD 2019 Risk Factors Collaboration (2020). Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396 (10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2.
Greil, H. (1988). Der Körperbau im Erwachsenenalter, DDR-repräsentative anthropologische Querschnittstudie 1982/84. Habilitationsschrift. Berlin, Medizinische Fakultät Humboldt University.
Greil, H./Wustmann, I. (1996). In memoriam Hans Grimm. Anthropologischer Anzeiger 54 (2), 163–166. https://doi.org/10.1127/anthranz/54/1996/163.
Groth, D. (2024). Statistics for Human Biologist - Introduction. Human Biology and Public Health 2. https://doi.org/10.52905/hbph2024.2.92.
Groth, D. (2025). Tutorial: Statistics for Human Biologists - Terminology and Univariate Statistics. Human Biology and Public Health 2. https://doi.org/10.52905/hbph2025.2.113.
Henneberg, M./Louw, G. J. (1998). Cross-sectional survey of growth of urban and rural “cape coloured” schoolchildren: anthropometry and functional tests. American Journal of Human Biology 10 (1), 73–85. https://doi.org/10.1002/(SICI)1520-6300(1998)10:1<73::AID-AJHB9>3.0.CO;2-D.
Henrich, J./Heine, S. J./Norenzayan, A. (2010). The weirdest people in the world? The Behavioral and Brain Sciences 33 (2-3), 61-83; discussion 83-135. https://doi.org/10.1017/S0140525X0999152X.
Jahn, Y./Kirchengast, S. (2024). Low for age weight status is not significantly associated with short-for-age body height in Kenyan schoolchildren – a pilot study. Human Biology and Public Health 2. https://doi.org/10.52905/hbph2024.2.88.
Lebel, A./Subramanian, S. V./Hamel, D./Gagnon, P./Razak, F. (2018). Population-level trends in the distribution of body mass index in Canada, 2000-2014. Canadian Journal of Public Health 109 (4), 539–548. https://doi.org/10.17269/s41997-018-0060-7.
Martin, R. (1914). Lehrbuch der Anthropologie in systematischer Darstellung. Jena. https://doi.org/10.11588/DIGLIT.37612.
NCD-RisC (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 390 (10113), 2627–2642. https://doi.org/10.1016/S0140-6736(17)32129-3.
NCD-RisC (2021). Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLife 10. https://doi.org/10.7554/eLife.60060.
Neuhauser, H./Schienkiewitz, A./Rosario-Schaffrath, A./Dortschy, R./Kurth, B.-M. (2013). Referenzperzentile für anthropometrische Maßzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS). https://doi.org/10.25646/3179.
Peeters, A./Gearon, E./Backholer, K./Carstensen, B. (2015). Trends in the skewness of the body mass index distribution among urban Australian adults, 1980 to 2007. Annals of Epidemiology 25 (1), 26–33. https://doi.org/10.1016/j.annepidem.2014.10.008.
Rösler, A./Scheffler, C./Hermanussen, M. (2023). No evidence of growth impairment after forced migration in Polish school children after World War II. Human Biology and Public Health 1. https://doi.org/10.52905/hbph2023.1.68.
Scheffler, C./Hermanussen, M./Bogin, B./Liana, D. S./Taolin, F./Cempaka, P. M. V. P./Irawan, M./Ibbibah, L. F./Mappapa, N. K./Payong, M. K. E./Homalessy, A. V./Takalapeta, A./Apriyanti, S./Manoeroe, M. G./Dupe, F. R./Ratri, R. R. K./Touw, S. Y./K, P. V./Murtani, B. J./Nunuhitu, R./Puspitasari, R./Riandra, I. K./Liwan, A. S./Amandari, P./Permatasari, A. A. I./Julia, M./Batubara, J./Pulungan, A. (2020). Stunting is not a synonym of malnutrition. European Journal of Clinical Nutrition 74 (3), 377–386. https://doi.org/10.1038/s41430-019-0439-4.
Scheffler, C./Krützfeldt, L.-M./Dasgupta, P./Hermanussen, M. (2018). No association between fat tissue and height in 5019 children and adolescents, measured between 1982 and in 2011 in Kolkata/India. Anthropologischer Anzeiger 74 (5), 403–411. https://doi.org/10.1127/anthranz/2018/0827.
Schilitz, A. (2001). Körperliche Entwicklung und Körperzusammensetzung von Brandenburger Schulkindern im Geschlechter- und Altersgruppenvergleich. Zugl.: Potsdam, Univ., Diss, 2001. Aachen, Shaker.
Shah, B./Tombeau Cost, K./Fuller, A./Birken, C. S./Anderson, L. N. (2020). Sex and gender differences in childhood obesity: contributing to the research agenda. BMJ Nutrition, Prevention & Health 3 (2), 387–390. https://doi.org/10.1136/bmjnph-2020-000074.
Trippo, U. (2005). Körperbau, Körperzusammensetzung und Ernährungsgewohnheiten bei Erwachsenen in Abhängigkeit von Alter und Geschlecht. Doctoral thesis. Universität Potsdam.
UN News (2025). Child obesity level surpasses underweight cases worldwide for the first time, UNICEF warns. Available online at https://news.un.org/en/story/2025/09/1165797.
WHO (2006a). Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age; methods and development. Geneva, WHO Press.
WHO (2006b). World Health Organization releases new Child Growth Standards. Available online at https://www.who.int/news/item/27-04-2006-world-health-organization-releases-new-child-growth-standards (accessed 4/19/2024).
WHO (2007). Growth reference data for 5-19 years. Available online at https://www.who.int/tools/growth-reference-data-for-5to19-years (accessed 4/22/2024).
WHO (2024). Obesity and overweight. Available online at https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed 4/19/2024).
Wilke, L./Boeker, S./Mumm, R./Groth, D. (2022). Social status influences human growth: A summary and analysis of historical data from German school girls in 1914 with comparison to modern references. Human Biology and Public Health 3. https://doi.org/10.52905/hbph2021.3.22.
World Medical Association (2013). Declaration of Helsinki. Medical Research Involving Human Participants. Available online at https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/ (accessed 7/1/2025).
Zorlu, G. (2011). New WHO child growth standards catch on. Bulletin of the World Health Organization 89 (4), 250–251. https://doi.org/10.2471/BLT.11.040411.
Zsakai, A./Bodzsar, E. B. (2012). The 2nd Hungarian National Growth Study (2003-2006). Annals of Human Biology 39 (6), 516–525. https://doi.org/10.3109/03014460.2012.717965.
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