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Cited by 210Body Composition Measurement TechniquesObesity, Physical Activity, DietObesity and Health Practices

Beyond BMI

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Bray, George A.·2023·Nutrients
DOI 10.3390/nu15102254PMC PMC10223432
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Abstract

This review examined the origins of the concept of the BMI in the work of Quetelet in the 19th century and its subsequent adoption and use in tracking the course of the pandemic of obesity during the 20th century. In this respect, it has provided a valuable international epidemiological tool that should be retained. However, as noted in this review, the BMI is deficient in at least three ways. First, it does not measure body fat distribution, which is probably a more important guide to the risk of excess adiposity than the BMI itself. Second, it is not a very good measure of body fat, and thus its application to the diagnosis of obesity or excess adiposity in the individual patient is limited. Finally, the BMI does not provide any insights into the heterogeneity of obesity or its genetic, metabolic, physiological or psychological origins. Some of these mechanisms are traced in this review.

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  • BMI does not inform practitioners of the origin or heterogeneity of obesity and its outcomes in specific individuals or populations.

    “BMI does not measure body fat distribution (e.g., it does not recognize more harmful abdominal fat), is a limited measure of body fat (inviting misclassification of persons who are muscular or have larger bone structures) [11], and does not inform practitioners of either the origin or the heterogeneity of obesity and its outcomes in specific individuals or populations.”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [10]

    The Abstract and Section 5 state that BMI does not reveal obesity’s underlying causes or heterogeneity. Section 8 says evaluating its impacts on an individual requires additional information. Our copy does not establish the further claim that BMI cannot inform practitioners about variation in outcomes across specific populations; it describes BMI as useful for tracking population trends. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • BMI is a limited measure of body fat and invites misclassification of persons who are muscular or have larger bone structures.

    “BMI does not measure body fat distribution (e.g., it does not recognize more harmful abdominal fat), is a limited measure of body fat (inviting misclassification of persons who are muscular or have larger bone structures) [11], and does not inform practitioners of either the origin or the heterogeneity of obesity and its outcomes in specific individuals or populations.”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [10]

    Section 4, “Anatomic Limitations” (page unavailable), says BMI has only a fair correlation with body fat and is limited for assessing an individual’s adiposity. The paper does not specifically say that BMI misclassifies muscular people or people with larger bone structures; its discussion of frame size in Section 2 concerns historical weight tables. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The current definition of obesity on the basis of BMI has several limitations.

    “The current definition of obesity on the basis of BMI has several limitations.38,39”

    From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [39]

  • BMI does not measure body fat distribution, such as more harmful abdominal fat.

    “BMI does not measure body fat distribution (e.g., it does not recognize more harmful abdominal fat), is a limited measure of body fat (inviting misclassification of persons who are muscular or have larger bone structures) [11], and does not inform practitioners of either the origin or the heterogeneity of obesity and its outcomes in specific individuals or populations.”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [10]

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Authors
Bray, G. A.
Affiliations
Pennington Biomedical Research Center (US)
Corresponding author
Bray, George A.
ORCID
Bray, George A.
Venue
Nutrients
Publisher
MDPI AG
Published
2023-05-10
Volume
15
Issue
10
Pages
2254
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu15102254
PMC
PMC10223432
OpenAlex
W4378516935
Cited by
210
References
8
Citations by year
2026: 50 · 2025: 83 · 2024: 66 · 2023: 11
FWCI
7.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
body mass index, obesity, excess adiposity, Adolphe Quetelet, history of obesity, body fat distribution, body fat measurement, obesity diagnosis, obesity epidemiology
MeSH terms
Adipose Tissue, Humans, Obesity, Body Mass Index, Adiposity

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