title: Body mass index bias in defining obesity of diverse young adults: the Training Intervention and Genetics of Exercise Response (TIGER) study.
abstract: The BMI cut-score used to define overweight and obesity was derived primarily using data from Caucasian men and women. The present study evaluated the racial/ethnic bias of BMI to estimate the adiposity of young men and women (aged 17-35 years) using dual-energy X-ray absorptiometry (DXA) determination of percentage body fat (DXA-BF%) as the referent standard. The samples were 806 women and 509 men who were tested from one to three times over 9 months providing 1300 observations for women and 820 observations for men. Linear mixed models (LMM) regression showed that with age and BMI controlled, DXA-BF% of African-American (AA) men and women, Asian-Indian men and women, Hispanic women and Asian women significantly differed from non-Hispanic white (NHW) men and women. For the same BMI of NHW women, the DXA-BF% of AA women was 1.76 % lower, but higher for Hispanic (1.65 %), Asian (2.65 %) and Asian-Indian (5.98 %) women. For the same BMI of NHW men, DXA-BF% of AA men was 4.59 % lower and 4.29 % higher for Asian-Indian men. Using the recommended BMI cut-scores to define overweight and obesity systematically overestimated overweight and obesity prevalence for AA men and women, and underestimated prevalence for Asian-Indian men and women, Asian women and Hispanic women. The present study extends the generalisability of research documenting the racial/ethnic bias of the universal overweight and obesity BMI cut-scores.
authors.affiliation: Department of Health and Human Performance, The University of Houston, TX 77204-6015, USA. udde@mac.com
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Jackson
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ellis
authors.forename: Brian K
authors.initials: BK
authors.lastname: McFarlin
authors.forename: Mary H
authors.initials: MH
authors.lastname: Sailors
authors.forename: Molly S
authors.initials: MS
authors.lastname: Bray