Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin
Open accessAbstract
BACKGROUND: Obesity is a serious disease that is associated with an increased risk of diabetes, hypertension, heart disease, stroke, and cancer, among other diseases. The United States Centers for Disease Control and Prevention (CDC) estimates a 20% obesity rate in the 50 states, with 12 states having rates of over 30%. Currently, the body mass index (BMI) is most commonly used to determine adiposity. However, BMI presents as an inaccurate obesity classification method that underestimates the epidemic and contributes to failed treatment. In this study, we examine the effectiveness of precise biomarkers and duel-energy x-ray absorptiometry (DXA) to help diagnose and treat obesity. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study of adults with BMI, DXA, fasting leptin and insulin results were measured from 1998-2009. Of the participants, 63% were females, 37% were males, 75% white, with a mean age = 51.4 (SD = 14.2). Mean BMI was 27.3 (SD = 5.9) and mean percent body fat was 31.3% (SD = 9.3). BMI characterized 26% of the subjects as obese, while DXA indicated that 64% of them were obese. 39% of the subjects were classified as non-obese by BMI, but were found to be obese by DXA. BMI misclassified 25% men and 48% women. Meanwhile, a strong relationship was demonstrated between increased leptin and increased body fat. CONCLUSIONS/SIGNIFICANCE: Our results demonstrate the prevalence of false-negative BMIs, increased misclassifications in women of advancing age, and the reliability of gender-specific revised BMI cutoffs. BMI underestimates obesity prevalence, especially in women with high leptin levels (>30 ng/mL). Clinicians can use leptin-revised levels to enhance the accuracy of BMI estimates of percentage body fat when DXA is unavailable.
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The overweight BMI range included men with a low estimated body fat as well as men whose body fat percentage is compatible with obesity.
“Hence, the “overweight” range included men with a low estimated body fat as well as men whose body fat percentage is compatible with obesity [33].”
From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [33]
The Results (Table 2; page unavailable) report men with BMI below the obesity cutoff whose body-fat percentage met the obesity criterion, and Table 4 shows that BMI cutoffs within the overweight range do not cleanly separate obese from non-obese body-fat levels. The copy does not establish that men specifically in the overweight BMI range had *low* estimated body fat; its relevant category is the broader “non-obese” body-fat category. (LLM, conf=0.82)
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- Authors
- Shah, N. R., & Braverman, E. R.
- Affiliations
- New York University (US)
- Weill Cornell Medicine (US)
- Corresponding author
- Braverman, Eric R.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-04-02
- Volume
- 7
- Issue
- 4
- Pages
- e33308
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3317663
- OpenAlex
- W2163362890
- Cited by
- 554
- References
- 40
- Citations by year
- 2026: 16 · 2025: 34 · 2024: 33 · 2023: 42 · 2022: 39 · 2021: 38 · 2020: 45 · 2019: 30 · 2018: 52 · 2017: 45 · 2016: 38 · 2015: 50 · 2014: 41 · 2013: 37 · 2012: 14
- FWCI
- 30.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- New York State Department of Health
- Agency for Healthcare Research and Quality (R01HS018589, 1r01hs018589-01)
- 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
- obesity, body mass index, body fat percentage, leptin, adiposity measurement, dual-energy X-ray absorptiometry
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, False Negative Reactions, Female, Humans, Insulin, Male, Middle Aged, Obesity, ROC Curve, Absorptiometry, Photon, Body Mass Index, Leptin, Adiposity, Young Adult
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