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Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012

A J Tomiyama1, J M Hunger2, J Nguyen-Cuu1

  • 1Department of Psychology, University of California, Los Angeles, CA, USA.

International Journal of Obesity (2005)
|February 5, 2016
PubMed

Insights

Body Mass Index (BMI) categories misclassify cardiometabolic health in millions of US adults. Many overweight or obese individuals are metabolically healthy, while normal-weight individuals can be unhealthy, highlighting BMI

Area of Science:

  • Public Health
  • Cardiology
  • Endocrinology

Background:

  • Proposed US regulations allow employers to penalize employees based on health criteria, including Body Mass Index (BMI).
  • Standard BMI categories are frequently used as a primary health indicator in clinical and policy settings.

Purpose of the Study:

  • To investigate the extent of cardiometabolic health misclassifications when using standard BMI categories.
  • To analyze the prevalence of metabolically healthy and unhealthy individuals across different BMI classifications.

Main Methods:

  • Utilized data from 40,420 adults (18+) from the 2005-2012 National Health and Nutrition Examination Survey.
  • Assessed cardiometabolic health using blood pressure, lipid profiles, glucose levels, insulin resistance, and C-reactive protein.
  • Stratified individuals by BMI categories to determine frequencies of metabolically healthy versus unhealthy status.

Main Results:

  • A significant proportion of individuals were misclassified: nearly half of overweight, 29% of obese, and 16% of severely obese (type 2/3) individuals were metabolically healthy.
  • Over 30% of normal-weight individuals were found to be cardiometabolically unhealthy.
  • An estimated 74.9 million US adults are misclassified based on BMI alone, with significant gender-by-BMI interactions observed.

Conclusions:

  • Relying solely on BMI for health assessments leads to widespread misclassification of cardiometabolic health.
  • Policymakers must consider the limitations of BMI and the potential negative consequences of weight-based health penalties.
  • Further research is needed to develop more accurate diagnostic tools for assessing weight-related cardiometabolic health.

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