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A Good Way to Measure Obesity?

A report last week stated that, people who are slightly overweight have less chance of dying than those of normal weight. It had some researchers calling for further study of how a little extra fat can apparently be good for you. But others saw it as another sign that the standard way of measuring who is too heavy should be scrapped.

The report by scientists from the U.S. Centers for Disease Control and Prevention, the National Institutes of Health and the University of Ottawa combined the results of 97 prior studies to see how risk of death varied by body size. The researchers used a measure known as Body Mass Index—weight in pounds divided by the square of height in inches, multiplied by 703 for metric adjustment—to categorize 2.9 million people from those studies, then measured how likely they were to die while being tracked in the studies. Where possible, researchers controlled for factors such as age, sex and smoking.

A government study shows that people who are overweight are significantly less likely to die in any given period than people of normal weight.

The problem with the Body Mass Index, many scientists say, is that it lumps together all body mass, including bone, muscle and beneficial fat, rather than singling out the more dangerous abdominal fat.

The result, published in the Journal of the American Medical Association, appeared to undermine orthodoxy on the benefits of weight loss: People classified as overweight, which are those with a BMI greater than or equal to 25 and less than 30, had a 6% lower chance of dying than those with a BMI greater than or equal to 18.5 and less than 25, considered the normal range.

The finding, which compiled andreinforced similar ones from prior studies, says less about the health risks of being overweight, and more about BMI's flaws, according to some researchers. "I suspect it's primarily an issue with BMI being unable to measure the things it's intended to measure, or what really matters," said Francisco Lopez-Jimenez, a cardiologist and professor of medicine at the Mayo Clinic in Rochester, Minn.

A BMI Referendum
Based on work by a 19th-century Belgian scientist, BMI has been the standard way to define obesity in the U.S. since 1998 and was a clear improvement over its predecessors, researchers say. Those included reading an insurance company's mortality tables by height and weight, which was cumbersome and didn't boil down the numbers to a single indicator.

The problem with BMI, many scientists say, is that it lumps together all body mass, including bone, muscle and beneficial fat, rather than singling out the more dangerous abdominal fat, which most researchers see as the real threat to health.

Prof. Lopez-Jimenez and other researchers are hunting for alternatives to BMI, ranging from a simple waist-circumference measurement to a type of X-ray that measures body-fat content. The hold of BMI is powerful, however, and even if a low-cost alternative that better reflects people's health is devised, it could take a major investment to change practice.

One reason for BMI's tenacity can be seen in the availability of so many patients for the JAMA study, enough to provide the statistical power to detect 6% differences in mortality among groups. "In order to pool data across many studies to obtain large samples, BMI is conveniently available for these studies," said Barry I. Graubard, a senior investigator at the NIH's National Cancer Institute and co-author of the JAMA paper.

Charles Daniel BPS Book By Author Charles Daniel, DRC's Managing Partner

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