Disparity in Adiposity among Adults with Normal Body Mass Index and Waist-to-Height Ratio

Summary Body mass index (BMI) is commonly used to define obesity. However, concerns about its accuracy in predicting adiposity have been raised. The feasibility of using BMI as well as waist-height ratio (WHtR) in assessing adiposity was examined in relation to a more direct measurement of percent body fat (%BF). We analyzed the relation between dual-energy X-ray absorptiometry (DXA)-measured fat mass and BMI and WHtR using the US 1999–2004 National Health and Nutrition Examination Survey (NHANES) data. A considerable proportion of subjects in the healthy BMI range 20–25 were found to have excess adiposity, including 33.1% of males and 51.9% of females. The use of WHtR also supports the notion of normal-weight central obesity (NWCO), which increases with age. These findings have important implications not only for clinical practice but also for many comparative studies where control subjects are usually selected based on age, sex, and BMI.
Graphical Abstract
Highlights • BMI > 30 reliably defines obesity regardless of age and sex • People with BMI of 20–25 and WHtR < 0.5 showed age-dependent hidden obesity • Subjects with excess body fat and BMI range of 20–25 showed increased WHtR with increased age • The present study supports the new notion of normal-weight central obesity
Public Health; Nutrition; Obesity Medicine