Body Mass Index Research Paper

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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).

Bibliography:

  1. Baumgartner, Richard N., Steven B. Heymsfield, and Alex F. Roche. 1995. Human Body Composition and the Epidemiology of Chronic Disease. Obesity Research 3: 73–95.
  2. Blew, Robert M., Luis B. Sardinha, Laura A. Milliken, et al. Assessing the Validity of Body Mass Index Standards in Early Postmenopausal Women. Obesity Research 10: 799–808.
  3. De Onis, Mercedes. 2004. The Use of Anthropometry in the Prevention of Childhood Overweight and Obesity. International Journal of Obesity 28: 581–585.
  4. Deurenberg, Paul, Jan A. Weststrate, and Jaap C. Seidell. 1991. Body Mass Index as a Measure of Body Fatness: Age- and Sex-specific Prediction Formulas. British Journal of Nutrition 65: 105–114.
  5. Dickerson, John W. T. 2003. Some Aspects of the Public Health Importance of Measurement of Growth. The Journal of the Royal Society for the Promotion of Health 123: 165–168.
  6. Forbes, Gilbert B. 1999. Body Composition: Overview. Journal of Nutrition 129 (1): 270S–272S.
  7. Friedman, Kelli E., Simona K. Reichmann, Philip R. Costanzo, et al. 2005. Weight Stigmatization and Ideological Beliefs: Relation to Psychological Functioning in Obese Adults. Obesity Research 13: 907–916.
  8. Gallagher, Dympna, Marjolein Visser, Dennis Sepulveda, et al. 1996. How Useful is Body Mass Index for Comparison of Body Fatness Across Age, Sex, and Ethnic Groups? American Journal of Epidemiology 143: 228–239.
  9. Gray, David S., and Ken Fujioka. 1991. Use of Relative Weight and Body Mass Index for the Determination of Adiposity. Journal of Clinical Epidemiology 44: 545–550.
  10. Greenberg, Isaac, Frank Perna, Marjory Kaplan, and Mary Anna Sullivan. 2005. Behavioral and Psychological Factors in the Assessment and Treatment of Obesity Surgery Patients. Obesity Research 13: 244–249.
  11. Headley, Allison A., Cynthia L. Ogden, Clifford L. Johnson, et al. 2004. Prevalence of Overweight and Obesity Among U.S. Children, Adolescents, and Adults, 1999–2002. Journal of the American Medical Association 291: 2847–2850.
  12. Kuczmarski, Robert J., Katherine M. Flegal. 2000. Criteria for Definition of Overweight in Transition: Background and Recommendations for the United States. American Journal of Clinical Nutrition 72: 1074–1081.
  13. National Center for Health Statistics. 1984. Health, United States, 1984. Washington, DC: U.S. Government Printing Office.
  14. National Center for Health Statistics Consensus Development Panel on the Health Implications of Obesity. 1985. Health Implications of Obesity. Annals of Internal Medicine 103: 1073–1077.
  15. National Heart, Lung, and Blood Institute. 1998. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Rockville, MD: National Institutes of Health.
  16. Pietrobelli, Angelo, Steven B. Heymsfield, ZiMian M. Wang, and Dympna Gallagher. 2001. Multi-component Body Composition Models: Recent Advances and Future Directions. European Journal of Clinical Nutrition 55: 69–75.
  17. Prentice, Andrew M., and Susan A. Jebb. 2001. Beyond Body Mass Index. Obesity Reviews 2: 141–147.
  18. Puhl, Rebecca, and Kelly D. Brownell. 2003. Psychosocial Origins of Obesity Stigma: Toward Changing a Powerful and Pervasive Bias. Obesity Reviews 4: 213–227.
  19. Seidell, Jaap C., Henry S. Kahn, David F. Williamson, et al. 2001. Report from a Centers for Disease Control and Prevention Workshop on Use of Adult Anthropometry for Public Health and Primary Health Care. American Journal of Clinical Nutrition 73: 123–126.
  20. S. Department of Agriculture and U.S. Department of Health and Human Services. 1980. Nutrition and Your Health: Dietary Guidelines for Americans. Washington, DC: U.S. Government Printing Office.

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