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Body Mass Index (BMI) is a number calculated from a person's weight and
height. BMI is a fairly reliable indicator of body fatness for most people. BMI
does not measure body fat directly, but research has shown that BMI
correlates to direct measures of body fat, such as underwater weighing and
dual energy x-ray absorptiometry (DXA).1, 2 BMI can be considered an
alternative for direct measures of body fat. Additionally, BMI is an inexpensive
and easy-to-perform method of screening for weight categories that may lead
to health problems.
What are some of the other ways to measure obesity? Why doesn't CDC use
those to determine overweight and obesity among the general public?
Other methods to measure body fatness include skinfold thickness
measurements (with calipers), underwater weighing, bioelectrical impedance,
dual-energy x-ray absorptiometry (DXA), and isotope dilution. However, these
methods are not always readily available, and they are either expensive or
need highly trained personnel. Furthermore, many of these methods can be
difficult to standardize across observers or machines, complicating
comparisons across studies and time periods.
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How is BMI calculated and interpreted?
Calculation of BMI
BMI is calculated the same way for both adults and children. The calculation
is based on the following formulas:
Measureme
nt Units
Kilograms
and meters
(or
centimeters)
Pounds and
inches
Weight Status
Below 18.5
Underweight
18.5 24.9
Normal
25.0 29.9
Overweight
Obese
For example, here are the weight ranges, the corresponding BMI ranges, and
the weight status categories for a sample height.
Height
Weight Range
BMI
Weight Status
5' 9"
Below 18.5
Underweight
18.5 to 24.9
Normal
25.0 to 29.9
Overweight
30 or higher
Obese
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What are the health consequences of overweight and obesity for adults?
The BMI ranges are based on the relationship between body weight and
disease and death.5 Overweight and obese individuals are at increased risk
for many diseases and health conditions, including the following: 6
Hypertension
Dyslipidemia (for example, high LDL cholesterol, low HDL cholesterol, or
high levels of triglycerides)
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnea and respiratory problems
Some cancers (endometrial, breast, and colon)
What Are the Health Risks of Overweight and Obesity?
Being overweight or obese isn't a cosmetic problem. It greatly raises the risk
in adults for many diseases and conditions.
Overweight and Obesity-Related Health Problems in Adults
Coronary Heart Disease
Coronary heart disease (CHD) is a condition in which a substance called
plaque (plak) builds up inside the coronary arteries. These arteries supply
oxygen-rich blood to your heart. Plaque is made up of fat, cholesterol,
calcium, and other substances found in the blood.
Plaque can narrow or block the coronary arteries and reduce blood flow to the
heart muscle. This can cause angina (an-JI-nuh or AN-juh-nuh) or a heart
attack. (Angina is chest pain or discomfort.)
As your body mass index (BMI) increases, so does your risk of having CHD
and a heart attack. Obesity also can lead to heart failure. This is a serious
condition in which your heart can't pump enough blood to meet your body's
needs.
for CHD than having extra fat in other parts of the body, such as on the
hips.
A higher than normal triglyceride level (or you're on medicine to treat high
triglycerides).
A lower than normal HDL cholesterol level (or you're on medicine to treat
low HDL cholesterol).
Higher than normal blood pressure (or you're on medicine to treat high
blood pressure).
Higher than normal fasting blood sugar (or you're on medicine to treat
diabetes).
Cancer
Being overweight or obese raises the risk of colon, breast, endometrial, and
gallbladder cancers.
Obesity
What Is Obesity?
2. b
3.
What Causes Obesity?
Obesity occurs when a person consumes more calories than he or she burns.
For many people this boils down to eating too much and exercising too little.
But there are other factors that also play a role in obesity. These may include:
Age. As you get older, your body's ability to metabolize food slows down
and you do not require as many calories to maintain your weight. This is
why people note that they eat the same and do the same activities as
they did when they were 20 years old, but at age 40, gain weight.
Gender. Women tend to be more overweight than men. Men have a
higher resting metabolic rate (meaning they burn more energy at rest)
than women, so men require more calories to maintain their body
weight. Additionally, when women become postmenopausal, their
metabolic rate decreases. That is partly why many women gain weight
after menopause.
Genetics. Obesity (and thinness) tends to run in families. In a study of
adults who were adopted as children, researchers found that
participating adult weights were closer to their biological parents'
weights than their adoptive parents'. The environment provided by the
adoptive family apparently had less influence on the development of
obesity than the person's genetic makeup. In fact, if your biological
mother is heavy as an adult, there is approximately a 75% chance that
you will be heavy. If your biological mother is thin, there is also a 75%
chance that you will be thin. Nevertheless, people who feel that their
genes have doomed them to a lifetime of obesity should take heart.
Many people genetically predisposed to obesity do not become obese
or are able to lose weight and keep it off.
Environmental factors. Although genes are an important factor in many
cases of obesity, a person's environment also plays a significant role.
Environmental factors include lifestyle behaviors such as what a person
eats and how active he or she is.
Physical activity. Active individuals require more calories than less
active ones to maintain their weight. Additionally, physical activity tends
to decrease appetite in obese individuals while increasing the body's
ability to preferentially metabolize fat as an energy source. Much of the
increase in obesity in the last 20 years is thought to have resulted from
the decreased level of daily physical activity.
Psychological factors. Psychological factors also influence eating
habits and obesity. Many people eat in response to negative emotions
such as boredom, sadness, or anger. People who have difficulty with
weight management may be facing more emotional and psychological
issues; about 30% of people who seek treatment for serious weight
problems have difficulties with binge eating. During a binge-eating
episode, people eat large amounts of food while feeling they can't
control how much they are eating.
Illness. Although not as common as many believe, there are some
illnesses that can cause obesity. These include hormone problems such
as hypothyroidism (poorly acting thyroid slows metabolism), depression,
and some rare diseases of the brain that can lead to overeating.
4.
AMD
Obesitys direct effect on eye health was not well recognized until recently. In 2003, Dr.
Seddon found links between increased BMI (a persons total weight in kilograms divided
by the square of height in meters), waist circumference, waist-hip ratio and AMD
progression.
In a study published in Archives of Ophthalmology, 261 middle-age and elderly
patients were found to have a correlation between high levels of body fat and AMD
progression.
Patients with a BMI between 25 to 30 kg/m 2 or greater were more than twice as likely to
experience AMD progression compared to patients with a BMI less than 25 kg/m 2, Dr.
Seddon said.
A larger waist circumference was associated with a two-fold risk of disease progression,
having a more significant risk the greater the waist circumference (P = .02). Patients with a
higher waist-hip ratio also increased their risk of disease progression (P = .02).
To my knowledge this is the first time that anyone has shown a relationship between
abdominal obesity and overall obesity to AMD progression, Dr. Seddon said.
Researchers found that increased physical activity in the cohort studied led to a decrease
in progression to AMD. Considering these factors, Dr. Seddon discussed a possible
association between cardiovascular disease and AMD.
This evidence points to the growing knowledge of the similarities between heart disease
and AMD, Dr. Seddon said. She speculated that cardiovascular factors are somehow
related to the neovascularization process that occurs in AMD. It points to some vascular
etiology, she said.
Cataract
A study in Ophthalmic Epidemiology also found an association between cardiovascular
disease and eye disease.
Christine Younan, MD, of the University of Sydney, and researchers at the Save Sight
Institute in Sydney found a link between cardiovascular disorders and cataract in the Blue
Mountain Eye Study.
In the study, 2,300 patients over age 48 were followed for 5 years. Patients answered
vascular history questionnaires and were measured for height, weight and blood pressure.
Complete ophthalmic examinations were also performed. Photographs of the lens were
taken at initial visits and then again 5 years later to grade for presence of cortical, nuclear,
posterior or subcapsular cataract.
Outcomes showed that obesity was significantly associated with the incidence of cortical
and posterior subcapsular cataract. Patients over age 65 who were treated for
hypertension had a higher incidence of posterior subcapsular cataract at baseline than
patients with normal blood pressure. A higher incidence of cataract surgery was found in
patients with a history of angina and heart-related problems.
These longitudinal data provide some evidence supporting a relationship between
cardiovascular disease, vascular risk factors and incident cataract and cataract surgery,
the authors said in the study abstract.
Retinopathy
Evidence has also been found to link retinopathy to vascular disorders and type 2
diabetes, a disease often triggered by obesity.
In a study in Diabetes Care in 2002, Hendrik A. van Leiden, MD, and researchers at the
University Medical Center in Amsterdam, Netherlands, found the incidence of retinopathy
to be positively associated with increased BMI, among other factors.
Retinopathy is a multi-factorial microvascular complication, which, apart from
hyperglycemia, is associated with blood pressure, lipid concentrations and BMI, the
authors said in the study abstract.
As part of the Hoorn Study, a population-based study of more than 2,484 50- to 70-yearold white subjects, a subset of 626 diabetic and non-diabetic patients was selected for
investigation.
Patients underwent ophthalmic and fundus examinations to assess the incidence of
retinopathy.
Retinopathy was positively associated with elevated blood pressure, BMI, cholesterol and
triglyceride serum levels. Researchers noted that elevated blood pressure, plasma totals
and high cholesterol levels were associated with the presence of retinal hard exudates.
The risk of retinopathy was also linked to an increased waist-hip ratio in another part of the
Hoorn Study carried out by Dr. van Leiden. The study, published in Archives of
Ophthalmology in February 2003, followed 233 patients for 9.5 years to investigate the
effect of sex, age, glycosylated hemoglobin, hypertension, BMI, waist-hip ratio, serum lipid
levels and smoking on the incidence of retinopathy in persons with normal and abnormal
glucose metabolism.
Abdominal obesity (waist-hip ratio), glycemia and hypertension were strong determinants
for retinopathy development. No significant associations between retinopathy and the
remaining risk factors were found in this study.