Clinical implications of the new definition of obesity among persons with HIV

A new definition of obesity places emphasis on anthropometrics rather than BMI. We explored how people with HIV (PWH) shifted categories when using the new definition of obesity and the association with subclinical cardiovascular disease (CVD).

A secondary data analysis of a cross-sectional and longitudinal cohort from a completed trial focused on CVD among PWH.

Obesity was defined as two measures of abnormal anthropometrics, or one measure of abnormal anthropometrics and a BMI at least 30 kg/m 2 , or BMI at least 40 kg/m 2 . Obesity was further classified as clinical obesity if there was evidence of a clinical manifestation.

45% (33/74) vs. 78% (58/74) of PWH were categorized as having obesity based on the old vs. new definitions for obesity. Among PWH with BMI less than 30 kg/m 2 , 61% (25/41) were reclassified as having obesity based on the new definition. The proportion with coronary artery calcium (CAC) score more than 0 was increased among the clinical vs. preclinical obesity groups (83 vs. 50%). A higher proportion with CAC more than 0 was also detected comparing clinical obesity vs. the old definition of obesity (83 vs. 71%). In the longitudinal analysis, among those randomized to placebo in the parent study, CAC increased over a 12-month period among 100% with clinical obesity vs. 36% with preclinical obesity ( P  = 0.006). Change in CAC score was higher in the clinical vs. preclinical obesity group [9(6, 197) vs. 0(0, 5), P  = 0.02].

The new definition recategorizes more PWH with obesity not previously considered to have obesity using BMI alone, which may be useful for capturing those with abdominal adiposity. In addition, the recategorization may also have clinical implications for detecting more subclinical CVD.