For years, however, doctors have found that BMI isn’t the best measure of obesity-related health, since it can’t distinguish between fat and muscle weight.
The study included more than a decade's worth of data from more than 844,000 people in China, Spain, the U.K., and the U.S. The scientists compared determinations of obesity calculated by either BMI alone or by the new combined framework, which includes BMI along with a person's waist circumference or their waist-to-height ratio. They found that using only BMI missed diagnosing obesity in nearly 9% of people and misdiagnosed 3% as having obesity when their body weight wasn’t an immediate reason for concern.
“The scale of the problem with BMI is beyond what we imagined,” says Rubino. “We all know that BMI doesn’t represent health accurately. But the scale of the problem is concerning because of the number of people it misclassifies, by misdiagnosing in both directions. This is dozens of millions of people in the large countries we studied, and across the world, we’re talking many, many more—so it’s really a concern.”
In the study, about 5% to 11% of people in the general population were determined to have clinical obesity; their risk of dying during the study was 69% higher than people without excess fat. For those with preclinical obesity, the mortality risk was 19% higher than that of those without excess fat. Distinguishing clinical from preclinical obesity, therefore, “allows doctors to triage and treat people differently, because the two groups are meaningfully different and the difference in mortality is quite obvious,” says Rubino. “All in all, [the study results provide] quite a robust level of evidence to say that the old system of BMI is something that is unsustainable in the clinic.”
The results should provide further support for shifting away from relying solely on BMI to assess obesity risk, says Rubino. In taking into account a number of related measurements, the new framework, he says, “is no different than the standards used to diagnose other conditions in medicine.”
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