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Misclassification of cardiometabolic health when using body mass index categories

International Journal of Obesity volume 40, page 1332 (2016)Cite this article

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We agree with Tomiyama et al.1 that the US Equal Employment Opportunity Commission (EEOC)-proposed rule for employers to impose a financial penalty on employees if they fail to meet health criteria such as a specific (body mass index) BMI is unfair. Such practices may further perpetuate social and economic inequalities for employees with obesity. Employees who are obese, despite comparable job qualifications and demographics, are already exposed to unfair hiring practices, lower wages, biased job performance evaluations and wrongful termination.2 Being a target of weight discrimination also increases the likelihood for depression, low self-esteem, poor body image and contributes to maladaptive eating behaviours.2 Moreover, rising obesity prevalence in high-income countries including the US has largely been driven by increasingly obesogenic environments,3 which skews the range of energy balance-related behaviours within which individuals can choose from, in favour of weight gain rather than weight loss. Therefore, imposing financial penalties on employees with obesity is a misplaced approach.

However, we disagree with the authors’ interpretation of their analysis of cardiometabolic health misclassification and standard BMI categories in the National Health and Nutrition Examination Survey 2005–2012. Similar to other studies,4 Tomiyama et al.1 found overweight and obese individuals who are cardiometabolically healthy and cardiometabolic abnormalities among normal-weight individuals. They concluded that because of this cardiometabolic health ‘misclassification’, the EEOC should not rely on BMI when formulating health policy. Tomiyama et al.,1 however, did not integrate the fact that their findings were from cross-sectional analyses. Emerging evidence from prospective cohort studies indicate that the cardiometabolically healthy obese phenotype is not a stable physiological state, rather it is a transient phase of obesity-associated metabolic deterioration.5, 6, 7 A recent meta-analysis of prospective cohort studies demonstrated that metabolically healthy obese adults have a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults.8

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References

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Authors and Affiliations

  1. MRC Unit for Lifelong Health and Ageing at University College London, London, UK

    R Caleyachetty

  2. Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA

    P Meunnig

  3. Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa

    A P Kengne

  4. The George Institute for Global Health, The University of Sydney, Sydney, Australia

    A P Kengne

  5. Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands

    A P Kengne

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  1. R Caleyachetty
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  2. P Meunnig
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  3. A P Kengne
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Correspondence to R Caleyachetty.

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Caleyachetty, R., Meunnig, P. & Kengne, A. Misclassification of cardiometabolic health when using body mass index categories. Int J Obes 40, 1332 (2016). https://doi.org/10.1038/ijo.2016.65

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