Is the current BMI obesity classification appropriate for black and white postmenopausal women?

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Abstract

Objective:

To evaluate the relation between body fatness (%Fat) and body mass index (BMI) and to evaluate the validity of the BMI standards for obesity established by the NIH in older black and white postmenopausal women.

Research methods:

Height, weight, BMI, and %Fat, assessed by DXA, were determined for 296 healthy, independently living women ranging in age from 50 to 80 years (M±s.d.; 64.4±7.8 years).

Results:

Per NIH guidelines, 32% were classified as obese (≥30 kg/m2, mean BMI = 28.1±5.5 kg/m2). In contrast, using the %Fat criterion of 38% advocated by Lohman to define obesity, 47% of our sample was obese (mean %Fat = 37.3±6.2%). A moderately high curvilinear relation existed between BMI and %Fat (R = 0.82, SEE = 3.57 %Fat, P<0.05). Race added meaningfully to the prediction of %Fat (P<0.05) such that for the same BMI, black women will have 1% lower body fatness than white women. Based on a %Fat ≥38 as the criterion for obesity, receiver operating characteristic (ROC) analysis, performed separately by race, indicated that the currently accepted BMI cutpoint for obesity produced low sensitivity (69% and 61% for black and white women, respectively). Alternatively, BMI values ≥28.4 kg/m2 for black women and ≥26.9 kg/m2 for white women to define obesity maximized classification accuracy.

Conclusion:

We conclude that current BMI categories may not be appropriate for identifying obesity among postmenopausal women. Furthermore, the relation between BMI and %Fat is different in black compared to white women but remains constant from the sixth through the eighth decade of life.

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