According to data presented at ENDO 2023, Chicago, Ill. According to the Endocrine Society Annual Meeting, body mass index (BMI) is not an absolute indicator of metabolic health, and a substantial proportion of Americans with normal BMIs are still obese. The latest research highlights the importance of what percentage of the body is fat, muscle, bone and water, and how much fat is in the abdomen versus thighs, to fully understand the drivers for cardio-metabolic disease.
“We show that there are racial/ethnic differences in body fat, BMI and body fat distribution that may provide evidence for future studies to determine whether these differences are similar to those seen in cardio-metabolic diseases.” are potential drivers of racial disparities,” said Ayush, MD, MPH, an internal medicine resident at Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ.
Visaria and colleagues identified non-pregnant US adults aged 20-59 with whole-body DEXA scan data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES). Their BMI was classified by ethnicity (Non-Asian: underweight<18.5, normal=18.5-24.9, overweight=25-29.9, obese>=30 kg/m2, Asian: <18.5, 18.5-22.9, 23- 27.4, 27.5+).
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Researchers estimated the odds of obesity as normal/overweight among adults based on BMI or total body fat percentage (BF%) == 25% in male and >= 32% in female, race (non-Hispanic white) by [NHW]non-hispanic black [NHB], Asian, Hispanic and others). He also speculated that DEXA measures viscosity based on race.
They found that approximately 36% had a BMI >=30 (the traditional definition of obesity), but 74% had obesity per BF. Among normal BMI adults, 44% of non-Hispanic whites, 27% of NHB, 49% of Hispanics and 49% of Asians were obese according to BF%. In normal BMI adults, the mean android-to-gynoid fat ratio was 0.84 for NHWs, 0.85 for NHBs, 0.89 for Hispanics, and 0.91 for Asians.
About 3 in 4 young- to middle-aged US adults were considered obese according to BF% from the DEXA scan. Asian Americans and Hispanics with a seemingly normal BMI were more likely to be obese, and more likely to have a higher proportion of abdominal fat than non-Hispanic whites. Non-Hispanic blacks were significantly less likely to be obese in the normal/overweight BMI range and with a lower proportion of abdominal fat.
“We hope this research will add to the idea of weight-inclusive care and encourage clinicians to 1) routinely use complementary measures of waist circumference or bioimpedance-based body fat measurements (such as smart scales) in addition to BMI.” ) engage in practices to prevent unconscious biases that may occur when caring for a patient with an obese BMI, and 3) engage in clinical decision making that is not solely dependent on BMI calculation but rather an overall idea of body composition and body fat distribution,” Visaria said.