Obesity, endocrinologists: “The body mass index ‘wrong’ half of the diagnoses”
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After half a century of honorable service, the Body Mass Index, the most used mathematical formula in the world to evaluate the body weight of men and women, invented in the 1800s by the Belgian mathematician Adolphe Quetelet, could retire soon or at least be joined by other parameters. The experts of the Italian Society of Endocrinology (SIE) asked for the revision of the Italian guidelines, in light of the recent changes to the American guidelines, on the occasion of the national congress, on the basis of a recent American study presented at the annual meeting of the Endocrine Society just closed in Chicago.
“According to research data, the exclusive use of the BMI would lead to the misclassification of millions of Americans as not ‘obese’ because basing the diagnosis of obesity only on this biometric parameter, expressed as the ratio between weight and height, leads to half of the diagnosis and to underestimate the weight in 53% of cases and, consequently, to neglect therapeutic interventions and lifestyle changes necessary for health – declares Anna Maria Colao, president of SIE and full professor of Endocrinology at the Federico II University of Naples -. For this reason, the specialists of the Italian Society of Endocrinology propose integrating the BMI with other parameters, in particular with the evaluation of visceral fat through the measurement of the waistline and the estimation of body composition measured by the fat caliper”.
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Research
The limitations and the enormous number of blunders of the BMI as the only parameter for the diagnosis of obesity were highlighted by a study by Rutgers University on 9,784 adults aged between 20 and 59, classified as obese on the basis of the results of a A test called dual-energy x-ray absorptiometry (DEXA), which can accurately estimate body composition. The results showed that as many as 53% of subjects “escaped” the diagnosis when evaluated with BMI alone. In practice, basing the evaluation on BMI alone, over half of the obese participants obtained a “false negative” result.
“When the researchers then added only the waist circumference parameter to the BMI assessment, incorrect assessments were reduced by 23% – underlines Colao -. In practice, once both criteria, BMI and waist circumference, have been considered, only 31% of obese people ‘escaped’ the diagnosis.The main limitation of the BMI is that it does not distinguish between water, bone mass, muscle mass and fat tissue nor between the accumulation of visceral fat, the so-called ‘bacon’, and subcutaneous fat , thus not taking into account the influence of gender.Women, in fact – specifies the expert -, have more subcutaneous fat than men, located on the hips and thighs, which is less harmful to health than abdominal fat, which males accumulate more easily in the central sections of the body.It is therefore evident that using a single parameter that does not take into account these substantial differences leads both to erroneously overestimating obesity in women and to underestimating it in men, with a dangerous distortion of understanding from part of physicians of the risk of obesity-related disease and mortality.
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The limits of the BMI
For several years, experts have wondered about the reliability and accuracy of the BMI in classifying obese people. “Using DEXA as a screening tool – concludes the expert – is unrealistic because it is economically unsustainable. For this reason, scientists have long been engaged in the search for new simple, economic and more reliable criteria. This does not mean that we must definitively give up the BMI , which may have a certain degree of reliability and utility in population-based studies for obesity screening.But it is important that specialists understand the limitations of using BMI in a single individual and that other parameters be added to this parameter. BMI, together with measurements of visceral fat and relative fat mass, could reduce errors, allowing for a more precise identification of obese people.”
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