Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations

Obesity, defined as excess fat (adipose) tissue accumulation that may impair health,1 is a highly prevalent and serious public health problem. Roughly 35.7% of American adults are obese.2 High rates of obesity are not limited to the United States or even to other highly developed countries. The prevalence of obesity in Mexico, for example, is comparable to that in the United States.3 Not surprisingly, rates of obesity-related illnesses including cardiovascular disease (CVD) are rising quickly worldwide. More than 25 million American adults have been diagnosed with diabetes mellitus.4 India is projected to have >100 million diabetic people by the year 2030.5 CVD is the number 1 cause of death worldwide.6 These grim statistics highlight the need for accurate identification of overweight and obese adults who are at high risk for obesity-related illnesses. Accurate identification of such people allows healthcare professionals, policymakers, and others to target prevention and treatment programs to those at the highest risk of morbidity and mortality. Unfortunately, the tools and measures currently available to identify obesity and associated risks are either impractical, inaccurate, or both. For example, the body mass index (BMI) is easy to calculate, and established cutoffs that define overweight (25 kg/m2) and obesity (30 kg/m2) are readily available and well known. The application of such cutoffs to a diverse population, as will be discussed, however, leads to misclassification of a large number of people. Many people with a normal BMI have high levels of adiposity and also are at high risk for obesity-related illness. Others with a high BMI have relatively normal levels of adiposity and are metabolically healthy. The problem of misclassification is especially important for racial and ethnic minorities, who make up nearly 40% of the American population today and will make up more …