title: Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women.
abstract: 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.
authors.affiliation: From the Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, Galveston, Texas.
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rahman
authors.forename: Abbey B
authors.initials: AB
authors.lastname: Berenson
mesh_terms: 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
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