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Body Mass Index: Differential Misclassification of Under and Over-Fatness

 

Practical Implications:

  • Misclassification of fatness by BMI may occur in over 25% of healthy adults
  • In this study 20.8% of women and 33.7% of males were misclassified by BMI

ABSTRACT

Objective: 

Body mass index (BMI) is now widely accepted as a means of classifying under, normal, and overweight (UW, NW & OW) (i.e., <18.5, 18.5 to <25, and >+25 kg/m²). As BMI is used as a proxy for body composition, we recently developed corresponding % fat ranges (Table 1) on 1129 subjects using a 4-compartment method as the reference for body fat.  Subjects below, within, or above the age-sex % fat ranges are under, normal, and over-fat (UF, NF, & OF), respectively. The aim of the present study was to examine in a healthy subject cohort the frequency of misclassified subjects based upon BMI. Subjects were excluded with extremes of physical activity and % fat was measured using DEXA.

BMI SUBJECTS MISCLASSIFICATIONS
N N UW NW NW OWA
(F) (M) NF UF OF NF
<18.5 11 2 3/0
>=18.5<=25 96 78 17/14 10/14
>=25 95 83 12/27
(female/male)
Table 2: Subjects misclassified by BMI
Results:

The subject pool consisted of 202 females and 163 Males (Table 2). Subjects were organized into one of a 4 misclassification groups: UW-NF, NAW-UF, NW-OF, OW-NF, 42/202 females (20.8%) and 55/163 males (33.7%) were misclassified on fatness according to BMI.  These observations suggest misclassification of fatness by BMI may occur in over one-fourth of healthy adults.  Future studies are needed to establish the clinical significance of these observations.

FEMALES AGE
BMI 20-39 40-59 50-79
18.5 19% 19% 20%
25 34% 35% 36%
MALES AGE
BMI 20-39 40-59 60-79
18.5 6% 8% 10%
25 20% 22% 24%
Table 1: Corresponding % fat ranges for BMI

*Reprinted from Tanita Corporation of America, Inc.


Source: D. Gallagher, C. Testolin, S. Heshka, S.B. Heymsfield
Obesity Research Center, St. Luke's-Roosevelt Hospital Center, Columbia University, New York City

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