Top Things to Know: Assessing Adiposity
- Based on 2007-2008 National Health and Nutrition Examination Survey, 72.3% of men, 64.1% of women, and 68% of adults in the United States have a body mass index (BMI) greater than 25 kg/m2, with non-Hispanic blacks having the highest rate among races (44.1%).
- There is a clear association between excess adiposity and adverse health consequences such as cardiovascular disease, stroke, type 2 diabetes mellitus, and overall mortality.
- Prior to any recommendations for weight loss, health providers should assess adiposity-related risk among high-risk individuals, focusing on body fat distribution and not necessarily total body fat.
- BMI may be simple to calculate, body weight in kilograms divided by height in meters squared, but does fail to distinguish between types of fat, which leads to a low sensitivity among men (36%) and women (49%).
- Computed tomography and magnetic resonance imaging are particularly useful in distinguishing subcutaneous adipose tissue from the more harmful visceral adipose tissue.
- Measuring waist circumference (WC) is simple, inexpensive, and effective, but has not been adapted into clinical practice partly because there are eight different measurement locations. Measurement at the ileac crest is recommended since bony structures are stable landmarks not changed by weight.
- Hydrostatic weighing is the only practical method for measuring body fat in very obese subjects who cannot be evaluated by other methods.
- The waist-to-height-ratio and waist-to-thigh-ratio are promising measures when adjusting for ethnic differences in body shape when determining metabolic risk, even though ratios are not generally recommended for assessing adiposity.
- BMI is the recommended starting point for assessing adiposity, followed by WC as a necessary additional measurement, since a higher WC correlates with a higher risk for obesity-related metabolic disorders, warranting more aggressive intervention.
- Healthy lifestyle and body weight maintenance should be recommended to all individuals, but a more aggressive form of intervention should be recommended to those with excess abdominal fat.
Citation
Cornier M-A, Després J-P, Davis N, Grossniklaus DA, Klein S, Lamarche B, Lopez-Jimenez F, Rao G, St-Onge M-P, Towfighi A, Poirier P; on behalf of the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Lifelong Congenital Heart Disease and Heart Health in the Young, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, Council on the Kidney in Cardiovascular Disease, and Stroke Council. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. 2011: published online before print September 26, 2011, 10.1161/CIR.0b013e318233bc6a.
http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e318233bc6a