Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women.
OBJECTIVE
To compare the National Institutes of Health's (NIH) body mass index (BMI)-based classification to identify obesity in comparison with the World Health Organization (WHO), which uses percent body fat, among white, black, and Hispanic reproductive-aged women.


METHODS
Body weight, height, BMI, and percent body fat (dual-energy X-ray absorptiometry generated) were determined for 555 healthy adult women aged 20-33 years (mean+/-standard deviation 26.5+/-4.0 years). Diagnostic accuracy of the NIH-based obesity definition (BMI of 30 kg/m or higher) was determined using the WHO criterion standard (percent body fat greater than 35%).


RESULTS
Obesity as defined by the NIH (BMI 30 kg/m or higher) and by WHO (percent body fat greater than 35%) classified 205 (36.9%) and 350 (63.1%) of the women as obese, respectively. The NIH-defined obesity cutoff values had 47.8%, 75.0%, and 53.9% sensitivity in white, black and Hispanic, women, respectively. White and Hispanic women had 2.9% greater percent body fat than black women for a given BMI. Receiver operating characteristics curves analyses showed that the respective sensitivities improved to 85.6%, 81.3%, and 83.2%, and that 311 women (56.0%) were classified as obese as a whole when race or ethnic-specific BMI cutoff values driven by our data (BMI at or above 25.5, 28.7, and 26.2 kg/m for white, black, and Hispanic women, respectively) were used to detect percent body fat-defined obesity.


CONCLUSIONS
Current BMI cutoff values recommended by the NIH failed to identify nearly half of reproductive-aged women who met the criteria for obesity by percent body fat. Using race or ethnic-specific BMI cutoff values would more accurately identify obesity in this population than the existing classification system.
Rahman
Mahbubur
M
From the Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, Galveston, Texas.
Berenson
Abbey B
AB
D000328:Adult; D001741:Black or African American; D015992:Body Mass Index; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D009765:Obesity / Q000145:classification* / Q000208:ethnology*; D012680:Sensitivity and Specificity; D044465:White People; D055815:Young Adult
Obes Res. 2002 Aug;10(8):799-808
12181389
Biomed Environ Sci. 2002 Mar;15(1):83-96
12046553
Am J Clin Nutr. 2001 Jan;73(1):123-6
11124761
World Rev Nutr Diet. 2005;94:1-12
16145245
JAMA. 1993 Nov 10;270(18):2207-12
8411605
Int J Obes Relat Metab Disord. 2001 May;25(5):748-52
11360160
Am J Clin Nutr. 2003 Jan;77(1):71-5
12499325
Clin Chem. 1993 Apr;39(4):561-77
8472349
Obes Rev. 2002 Aug;3(3):209-15
12164474
Circulation. 2007 Apr 24;115(16):2111-8
17420343
Int J Obes Relat Metab Disord. 2003 Feb;27(2):253-9
12587007
Radiology. 1982 Apr;143(1):29-36
7063747
Int J Obes (Lond). 2008 Jun;32(6):959-66
18283284
World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
11234459
Int J Obes (Lond). 2006 Jun;30(6):918-25
16432548
Eur Heart J. 2007 Sep;28(17):2087-93
17626030
Nutr Rev. 2003 Mar;61(3):104-7
12723643
Osteoporos Int. 1999;10(2):114-9
10501790
JAMA. 2004 Jun 16;291(23):2847-50
15199035
World Health Organ Tech Rep Ser. 1995;854:1-452
8594834
JAMA. 2005 Jan 19;293(3):293-4
15657315
Lancet. 2005 Oct 1;366(9492):1197-209
16198769
Obstet Gynecol. 2008 Oct;112(4):788-99
18827121
J Bone Miner Res. 1991 Apr;6(4):411-5
1858524
Am J Clin Nutr. 1990 Sep;52(3):405-8
2393001
Br J Nutr. 2001 Feb;85(2):239-42
11242492
Metabolism. 2009 Sep;58(9):1329-37
19501860
Int J Obes (Lond). 2006 May;30(5):837-43
16418761
Obes Res. 1998 Sep;6 Suppl 2:51S-209S
9813653