title: The effect of decision rules on the choice of a body mass index cutoff for obesity: examples from African American and white women.
abstract: BACKGROUND
  Ethnic differences in the relation of body mass index (BMI; in kg/m2) to morbidity and mortality have led investigators to question whether a single cutoff for obesity should be applied to all ethnic groups.
  
  
  OBJECTIVE
  The effects of using 4 different outcomes and 3 different measures of effect as criteria for comparing BMI cutoffs were shown with the use of data from 45- to 64-y-old African American and white women.
  
  
  METHODS
  Data were from the Cancer Prevention Study I (CPS-I) and the Atherosclerosis Risk in Communities (ARIC) Study. The outcomes were mortality (9211 deaths), diabetes (757 cases), hypertension (1518 cases), and hypertriglyceridemia (1264 cases). The measures of effect were incidence rate, rate ratio, and rate difference. The BMI in African American women that was associated with a risk equivalent to that of white women with a BMI of 30 was estimated.
  
  
  RESULTS
  There was no significant association between BMI and mortality in African American women. The BMI in African American women that was associated with a risk of diabetes equivalent to that of white women with a BMI of 30 was 28.0-34.5, depending on the measure of effect. For hypertension, the equivalent risk in African American women occurred at a BMI of <18-38, depending on the measure of effect. There was no BMI at which African American women had an incidence rate or rate ratio for hypertriglyceridemia that was as high as that of white women with a BMI of 30.
  
  
  CONCLUSIONS
  BMI cutoffs associated with equivalent risk across ethnic groups differ widely depending on the outcome and the risk estimate.
authors.affiliation: Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill 27514, USA. june_stevens@unc.edu
authors.forename: June
authors.initials: J
authors.lastname: Stevens
authors.lastname: Juhaeri
authors.forename: Jianwen
authors.initials: J
authors.lastname: Cai
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Jones
mesh_terms: D000428:Alcohol Drinking; D001161:Arteriosclerosis / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D044383:Black People; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D015228:Hypertriglyceridemia / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D015994:Incidence; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D009765:Obesity / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology*; D012015:Reference Standards; D012044:Regression Analysis; D012307:Risk Factors; D044465:White People; D001741:Black or African American