Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004
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Background Body composition changes with aging lead to increased adiposity and decreased muscle mass, making the diagnosis of obesity challenging. Conventional anthropometry, including body mass index (BMI), while easy to use clinically may misrepresent adiposity. We determined the diagnostic accuracy of BMI using dual-energy X-ray absorptiometry (DEXA) in assessing the degree of obesity in older adults.Methods The National Health and Nutrition Examination Surveys 1999-2004 were used to identify adults aged ⩾60 years with DEXA measures. They were categorized (yes/no) as having elevated body fat by gender (men: ⩾25%; women ⩾35%) and by BMI ⩾25 and ⩾30 kg m(-)(2). The diagnostic performance of BMI was assessed. Metabolic characteristics were compared in discordant cases of BMI/body fat. Weighting and analyses were performed per NHANES (National Health and Nutrition Examination Survey) guidelines.Results We identified 4984 subjects (men: 2453; women: 2531). Mean BMI and % body fat was 28.0 kg m(-2) and 30.8% in men, and 28.5 kg m(-)(2) and 42.1% in women. A BMI ⩾30 kg m(-)(2) had a low sensitivity and moderately high specificity (men: 32.9 and 80.8%, concordance index 0.66; women: 38.5 and 78.5%, concordance 0.69) correctly classifying 41.0 and 45.1% of obese subjects. A BMI ⩾25 kg m(-2) had a moderately high sensitivity and specificity (men: 80.7 and 99.6%, concordance 0.81; women: 76.9 and 98.8%, concordance 0.84) correctly classifying 80.8 and 78.5% of obese subjects. In subjects with BMI <30 kg m(-)(2), body fat was considered elevated in 67.1% and 61.5% of men and women, respectively. For a BMI ⩾30 kg m(-)(2), sensitivity drops from 40.3% to 14.5% and 44.5% to 23.4%, whereas specificity remains elevated (>98%), in men and women, respectively, in those 60-69.9 years to subjects aged ⩾80 years. Correct classification of obesity using a cutoff of 30 kg m(-)(2) drops from 48.1 to 23.9% and 49.0 to 19.6%, in men and women in these two age groups.Conclusions Traditional measures poorly identify obesity in the elderly. In older adults, BMI may be a suboptimal marker for adiposity.
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In one study, BMI correctly classified 41.0% of men and 45.1% of women as obese, and waist circumference correctly classified 64.2% of men and 81.0% of women as obese.
“In one study, BMI correctly classified 41.0% of men and 45.1% of women as being obese and waist circumference correctly classified 64.2% of men and 81.0% ofwomen as being obese194.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [194]
The Abstract Results report that BMI ≥30 kg/m² correctly classified 41.0% of obese men and 45.1% of obese women. The Results say Table 2B assesses waist circumference, but the passages available in our copy do not give the claimed 64.2% and 81.0% figures, so that part is not verified. (LLM, conf=0.83)
Experimental — accuracy not yet measuredBMI has important limitations in the detection of fat distribution and body composition.
“while recognizing the important limitations of BMI in the detection of fat distribution and body composition [24, 25, 93].”
From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [24]
The ratio of body fat was not only associated with metabolic syndromes and adverse events but also with sarcopenia.
“The ratio of body fat was not only associated with metabolic syndromes and adverse events but also with sarcopenia (36, 37).”
From The role of obesity in sarcopenia and the optimal body composition to prevent against sarcopenia and obesity (2023) · cites this paper as [37]
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References 34 · Cited by 275
- Authors
- Batsis, J. A., Mackenzie, T. A., Bartels, S. J., Sahakyan, K. R., Somers, V. K., & Lopez-Jimenez, F.
- Affiliations
- Dartmouth College (US)
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Mayo Clinic (US)
- Corresponding author
- Batsis, J A
- Venue
- International Journal of Obesity
- Published
- 2015-12-01
- Volume
- 40
- Issue
- 5
- Pages
- 761-767
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- PMC
- PMC4854777
- OpenAlex
- W2187904129
- Cited by
- 275
- References
- 34
- Citations by year
- 2026: 20 · 2025: 33 · 2024: 29 · 2023: 30 · 2022: 28 · 2021: 27 · 2020: 34 · 2019: 32 · 2018: 17 · 2017: 16 · 2016: 9
- FWCI
- 10.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL065176, R01HL114024, R01HL114676)
- National Institute of Mental Health (R24MH102794, R01MH089811, T32MH073553, R01MH078052)
- National Center for Chronic Disease Prevention and Health Promotion (U48DP005018)
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- body mass index, obesity diagnosis, older adults, body fat percentage, dual-energy X-ray absorptiometry, diagnostic accuracy, adiposity, muscle mass, aging, sex differences, sensitivity and specificity
- MeSH terms
- Aged, Aged, 80 and over, Aging, Body Composition, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Nutrition Surveys, Obesity, United States, Reproducibility of Results, Absorptiometry, Photon, Body Mass Index, Metabolic Syndrome, Adiposity
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