We performed a systematic review and meta-analysis of studies that assessed the performance of body mass index (BMI) to detect body adiposity.
Data sources were MEDLINE, EMBASE, Cochrane, Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, and SCOPUS. To be included, studies must have assessed the performance of BMI to measure body adiposity, provided standard values of diagnostic performance, and used a body composition technique as the reference standard for body fat percent (BF%) measurement. We obtained pooled summary statistics for sensitivity, specificity, positive and negative likelihood ratios (LRs), and diagnostic odds ratio (DOR). The inconsistency statistic (I2) assessed potential heterogeneity.
The search strategy yielded 3341 potentially relevant abstracts, and 25 articles met our predefined inclusion criteria. These studies evaluated 32 different samples totaling 31 968 patients. Commonly used BMI cutoffs to diagnose obesity showed a pooled sensitivity to detect high adiposity of 0.50 (95% confidence interval (CI): 0.43–0.57) and a pooled specificity of 0.90 (CI: 0.86–0.94). Positive LR was 5.88 (CI: 4.24–8.15), I2=97.8%; the negative LR was 0.43 (CI: 0.37–0.50), I2=98.5%; and the DOR was 17.91 (CI: 12.56–25.53), I2=91.7%. Analysis of studies that used BMI cutoffs ⩾30 had a pooled sensitivity of 0.42 (CI: 0.31–0.43) and a pooled specificity of 0.97 (CI: 0.96–0.97). Cutoff values and regional origin of the studies can only partially explain the heterogeneity seen in pooled DOR estimates.
Commonly used BMI cutoff values to diagnose obesity have high specificity, but low sensitivity to identify adiposity, as they fail to identify half of the people with excess BF%.
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Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM . Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006; 295: 1549–1555.
Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American heart association scientific statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation 2006; 113: 898–918.
Colditz GA . Economic costs of obesity. Am J Clin Nutr 1992; 55: 503S–507S.
Quetelet A . A Treatise on a Man and the Development of His Faculties. Originally published in 1842 Reprinted by Burt Franklin: New York, 1968.
Behnke A, Wilmore J . Evaluation and Regulation of Body Build and Composition. Englewood Cliffs NJ: Prentice Hall, 1974.
Wellens RI, Roche AF, Khamis HJ, Jackson AS, Pollock ML, Siervogel RM . Relationships between the body mass index and body composition. Obes Res 1996; 4: 35–44.
Kontogianni MD, Panagiotakos DB, Skopouli FN . Does body mass index reflect adequately the body fat content in perimenopausal women? Maturitas 2005; 51: 307–313.
Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 2006; 368: 666–678.
Lopez-Jimenez F . Speakable and unspeakable facts about BMI and mortality. Lancet 2009; 373: 1055–1056.
Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 2009; e-pub ahead of print 20 November 2009.
Higgins JP, Thompson SG, Deeks JJ, Altman DG . Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.
Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM . The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 2003; 56: 1129–1135.
Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A . Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006; 6: 31.
Carroll JF, Chiapa AL, Rodriquez M, Phelps DR, Cardarelli KM, Vishwanatha JK et al. Visceral fat, waist circumference, and BMI: impact of race/ethnicity. Obesity (Silver Spring) 2008; 16: 600–607.
Araneta MR, Barrett-Connor E . Ethnic differences in visceral adipose tissue and type 2 diabetes: Filipino, African-American, and white women. Obes Res 2005; 13: 1458–1465.
Hill JO, Sidney S, Lewis CE, Tolan K, Scherzinger AL, Stamm ER . Racial differences in amounts of visceral adipose tissue in young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Clin Nutr 1999; 69: 381–387.
Israel RG, Pories WJ, O’Brien KF, McCammon MR . Sensitivity and specificity of current methods for classifying morbid obesity. Diabetes Res Clin Pract 1990; 10 (Suppl 1): S145–S147.
Smalley KJ, Knerr AN, Kendrick ZV, Colliver JA, Owen OE . Reassessment of body mass indices. Am J Clin Nutr 1990; 52: 405–408.
Hortobagyi T, Israel RG, O’Brien KF . Sensitivity and specificity of the Quetelet index to assess obesity in men and women. Eur J Clin Nutr 1994; 48: 369–375.
Curtin F, Morabia A, Pichard C, Slosman DO . Body mass index compared to dual-energy X-ray absorptiometry: evidence for a spectrum bias. J Clin Epidemiol 1997; 50: 837–843.
Taylor RW, Keil D, Gold EJ, Williams SM, Goulding A . Body mass index, waist girth, and waist-to-hip ratio as indexes of total and regional adiposity in women: evaluation using receiver operating characteristic curves. Am J Clin Nutr 1998; 67: 44–49.
Piers LS, Soares MJ, Frandsen SL, O’Dea K . Indirect estimates of body composition are useful for groups but unreliable in individuals. Int J Obes Relat Metab Disord 2000; 24: 1145–1152.
Sardinha LB, Teixeira PJ . Obesity screening in older women with the body mass index: a receiver operating characteristic (ROC) analysis. Sci Sports 2000; 15: 212–219.
Dudeja V, Misra A, Pandey RM, Devina G, Kumar G, Vikram NK . BMI does not accurately predict overweight in Asian Indians in northern India. Br J Nutr 2001; 86: 105–112.
Frankenfield DC, Rowe WA, Cooney RN, Smith JS, Becker D . Limits of body mass index to detect obesity and predict body composition. Nutrition 2001; 17: 26–30.
Ko GT, Tang J, Chan JC, Sung R, Wu MM, Wai HP et al. Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance. Br J Nutr 2001; 85: 239–242.
Blew RM, Sardinha LB, Milliken LA, Teixeira PJ, Going SB, Ferreira DL et al. Assessing the validity of body mass index standards in early postmenopausal women. Obes Res 2002; 10: 799–808.
Yao M, Roberts SB, Ma G, Pan H, McCrory MA . Field methods for body composition assessment are valid in healthy chinese adults. J Nutr 2002; 132: 310–317.
Yamagishi H, Kitano T, Kuchiki T, Okazaki H, Shibata S . Association between body composition and body mass index in young Japanese women. J Nutr Sci Vitaminol (Tokyo) 2002; 48: 201–206.
De Lorenzo A, Deurenberg P, Pietrantuono M, Di Daniele N, Cervelli V, Andreoli A . How fat is obese? Acta Diabetol 2003; 40 (Suppl 1): S254–S257.
Goh VH, Tain CF, Tong TY, Mok HP, Wong MT . Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population. J Lipid Res 2004; 45: 1892–1898.
Evans EM, Rowe DA, Racette SB, Ross KM, McAuley E . Is the current BMI obesity classification appropriate for black and white postmenopausal women? Int J Obes (Lond) 2006; 30: 837–843.
Jackson A, Ellis K, Mcfarlin B, Sailors M, Turpin I, Bray M . Accuracy of BMI to detect percent fat obesity in men and women, ages 17–39: the TIGER Study. Med Sci Sports Exerc 2006; 38: S311.
Kagawa M, Uenishi K, Kuroiwa C, Mori M, Binns CW . Is the BMI cut-off level for Japanese females for obesity set too high? A consideration from a body composition perspective. Asia Pac J Clin Nutr 2006; 15: 502–507.
Pongchaiyakul C, Nguyen TV, Kosulwat V, Rojroongwasinkul N, Charoenkiatkul S, Pongchaiyakul C et al. Defining obesity by body mass index in the Thai population: an epidemiologic study. Asia Pac J Clin Nutr 2006; 15: 293–299.
Yang F, Lv JH, Lei SF, Chen XD, Liu MY, Jian WX et al. Receiver-operating characteristic analyses of body mass index, waist circumference and waist-to-hip ratio for obesity: screening in young adults in central south of China. Clin Nutr 2006; 25: 1030–1039.
Chen YM, Ho SC, Lam SS, Chan SS . Validity of body mass index and waist circumference in the classification of obesity as compared to percent body fat in Chinese middle-aged women. Int J Obes (Lond) 2006; 30: 918–925.
Ode JJ, Pivarnik JM, Reeves MJ, Knous JL . Body mass index as a predictor of percent fat in college athletes and nonathletes. Med Sci Sports Exerc 2007; 39: 403–409.
De Freitas SN, Caiaffa WT, Cesar CC, Candido APC, Faria VA, Neto RMND et al. A comparative study of methods for diagnosis of obesity in an urban mixed-race population in Minas Gerais, Brazil. Public Health Nutr 2007; 10: 883–890.
Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105–2120.
Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes (Lond) 2008; 32: 959–966.
Prospective Studies Collaboration, Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a metaanalysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370: 1829–1839.
De Lorenzo A, Del Gobbo V, Premrov MG, Bigioni M, Galvano F, Di Renzo L . Normal-weight obese syndrome: early inflammation? Am J Clin Nutr 2007; 85: 40–45.
Dr Somers is supported by NIH grants HL-65176, HL-70302, HL-73211, and M01RR00585. Dr Lopez-Jimenez was the recipient of a Clinical Scientist Development Award from the American Heart Association at the time of performing this study. Dr Somers, Dr Lopez-Jimenez, and Dr Romero-Corral are recipients of an unrestricted grant from Select Research to assess the clinical value of assessing regional body volumes.
The authors declare no conflict of interest.
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Okorodudu, D., Jumean, M., Montori, V. et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis. Int J Obes 34, 791–799 (2010). https://doi.org/10.1038/ijo.2010.5
- body composition
- body mass index
- fat mass
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