Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity
Abstract
Context Body mass index (BMI) is widely used as a measure of overweight and obesity, but underestimates the prevalence of both conditions, defined as an excess of body fat. Objective We assessed the degree of misclassification on the diagnosis of obesity using BMI as compared with direct body fat percentage (BF%) determination and compared the cardiovascular and metabolic risk of non-obese and obese BMI-classified subjects with similar BF%. Design We performed a cross-sectional study. Subjects A total of 6123 (924 lean, 1637 overweight and 3562 obese classified according to BMI) Caucasian subjects (69% females), aged 18-80 years. Methods BMI, BF% determined by air displacement plethysmography and well-established blood markers of insulin sensitivity, lipid profile and cardiovascular risk were measured. Results We found that 29% of subjects classified as lean and 80% of individuals classified as overweight according to BMI had a BF% within the obesity range. Importantly, the levels of cardiometabolic risk factors, such as C-reactive protein, were higher in lean and overweight BMI-classified subjects with BF% within the obesity range (men 4.3 ± 9.2, women 4.9 ± 19.5 mg l(-1)) as well as in obese BMI-classified individuals (men 4.2 ± 5.5, women 5.1 ± 13.2 mg l(-1)) compared with lean volunteers with normal body fat amounts (men 0.9 ± 0.5, women 2.1 ± 2.6 mg l(-1); P<0.001 for both genders). Conclusion Given the elevated concentrations of cardiometabolic risk factors reported herein in non-obese individuals according to BMI but obese based on body fat, the inclusion of body composition measurements together with morbidity evaluation in the routine medical practice both for the diagnosis and the decision-making for instauration of the most appropriate treatment of obesity is desirable.
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BMI does not differentiate fat from muscle mass or reflect fat distribution, which limits its usefulness in disease screening.
“However, it does not differentiate fat from muscle mass or reflect fat distribution, which limits its usefulness in disease screening [6].”
From The discriminatory ability of the body roundness index and body mass index for metabolic diseases in Korean adults: a comparative study (2025) · cites this paper as [6]
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“However, it does not differentiate fat from muscle mass or reflect fat distribution, which limits its usefulness in disease screening [6].”
- Authors
- Gómez-Ambrosi, J., Silva, C., Galofré, J. C., Escalada, J., Santos, S., Millán, D., Vila, N., Ibañez, P., Gil, M. J., Valentí, V, Rotellar, F., Ramírez, B., Salvador, J., & Frühbeck, G.
- Affiliations
- Instituto de Salud Carlos III (ES)
- Clinica Universidad de Navarra (ES)
- Corresponding author
- Frühbeck, G
- Venue
- International Journal of Obesity
- Published
- 2011-05-17
- Volume
- 36
- Issue
- 2
- Pages
- 286-294
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- OpenAlex
- W2003408752
- Cited by
- 615
- References
- 7
- Citations by year
- 2026: 41 · 2025: 50 · 2024: 53 · 2023: 48 · 2022: 46 · 2021: 34 · 2020: 43 · 2019: 43 · 2018: 41 · 2017: 41 · 2016: 46 · 2015: 45 · 2014: 32 · 2013: 29 · 2012: 17
- FWCI
- 17.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gobierno de Navarra
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- body mass index, obesity misclassification, body fat percentage, adiposity, cardiometabolic risk factors, C-reactive protein, insulin sensitivity, body composition, overweight, air displacement plethysmography, cardiovascular risk
- MeSH terms
- Adipose Tissue, Adolescent, Adult, Aged, Aged, 80 and over, C-Reactive Protein, Cardiovascular Diseases, Cross-Sectional Studies, Decision Making, Female, Humans, Male, Middle Aged, Obesity, Plethysmography, Risk Factors, Spain, Biomarkers, Body Mass Index, Prevalence, Risk Assessment, Young Adult
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