Short Communication

International Journal of Obesity (2016) 40, 883–886; doi:10.1038/ijo.2016.17; published online 15 March 2016

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

A J Tomiyama1, J M Hunger2, J Nguyen-Cuu1 and C Wells3

  1. 1Department of Psychology, University of California, Los Angeles, CA, USA
  2. 2Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA
  3. 3Office of Information Technology, University of California, Los Angeles, CA, USA

Correspondence: Dr AJ Tomiyama, Department of Psychology, University of California, Los Angeles, 5625 Franz Hall 502 Portola Plaza, Los Angeles, CA 90095, USA. E-mail:

Received 16 September 2015; Revised 4 December 2015; Accepted 9 December 2015
Accepted article preview online 4 February 2016; Advance online publication 15 March 2016



The United States Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30% of health insurance costs if they fail to meet ‘health’ criteria, such as reaching a specified body mass index (BMI). Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40420) were individuals aged 18+ in the nationally representative 2005–2012 National Health and Nutrition Examination Survey. Using the blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI. Nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy. There was no significant race-by-BMI interaction, but there was a significant gender-by-BMI interaction, F(4,64)=3.812, P=0.008. Using BMI categories as the main indicator of health, an estimated 74936678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health.

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