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Body Mass Index, or BMI, is a common measure of weight status in adults. BMI can be calculated by multiplying weight in pounds by 703, divided by height in inches squared, and it serves as an index of weight-for-height measured in kg/m2. BMI indicates overweight between 30 kg/m2 and 34.9 kg/m2; obesity between 35 kg/m2 and 39.9 kg/m2; and clinically severe obesity above 40 kg/m2. BMI is an indirect estimate of body fat and is highly correlated with body fat at about .7 (Gray and Fujioka 1991). Although there are more accurate measures of body fat (e.g., underwater weighing and DXA), they are more expensive, inaccessible, and cumbersome compared to BMI (Blew et al. 2002). The widespread use of BMI is likely due to its cost-effectiveness and ease of calculation.
The measurement and definition of overweight and obesity has varied over time. For much of the twentieth century, physicians and researchers referenced Metropolitan Life Insurance Company (MLIC) tables, which recommended ideal weight-for-height. The MLIC tables suffered from limitations (e.g., unstandardized and inaccurate measurement protocols) that prompted the government to adjust the weight guidelines in the 1980s (Kuczmarski and Flegal 2000). In the mid-1980s BMI became the preferred measurement of weight status, and recommendations were based upon data from national epidemiological surveys such as the National Health and Nutrition Examination Survey. BMI emerged in the first annual federal report on the prevalence of obesity in the United States, and a National Institutes of Health (NIH) panel defined overweight in terms of sex-specific BMI cutoffs (Kuczmarski and Flegal 2000; National Center for Health Statistics 1984; National Institutes of Health Consensus Development Panel 1985).
The current classification system adopted by the National Heart, Lung, and Blood Institute uses BMI to determine weight category. Classification of weight status is important because numerous medical comorbidities are associated with increased BMI. The BMI cutoff for overweight has decreased over time from 30 to 27, and most recently 25. Further, BMI provides a relative index of growth stunting, a condition that may result in significant developmental delays and adverse physiological effects (Dickerson 2003).
There is empirical evidence that BMI may be more predictive of body fatness in certain subgroups (e.g., younger adults, Caucasians) than others (Baumgartner, Heymsfield, and Roche 1995; Gallagher et al. 1996). Thus, two individuals with an identical BMI may have a different percentage of body fat depending on factors such as age, gender, body shape, and ethnicity (Prentice and Jebb 2001). BMI also overestimates body fat in persons who are very muscular (e.g., athletes), does not distinguish lean mass (muscle and bone) from fat mass, and does not determine the distribution of body fat. In children, BMI must be adjusted for growth. Despite these shortcomings, BMI classifications are still valuable for research and health care.
BMI is used to diagnose and make treatment recommendations. Epidemiological studies measure BMI to identify population trends in growth retardation and obesity along with associated adverse health consequences. Mounting evidence indicates an increased risk of mortality among obese individuals. Increased BMI has been associated with medical comorbidities including cardiovascular disease, reduced fertility, sleep apnea, metabolic syndrome, hypertension, type 2 diabetes, and certain cancers. In addition to medical risks, evidence suggests that there is a powerful social stigma associated with obesity. Discrimination affects overweight individuals in numerous facets of life, including employment, education, and psychological well-being (Friedman et al. 2005; Puhl and Brownell 2003).
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