Moving Beyond BMI

Researchers suggest taking a whole-person approach to assessing obesity

JAOA review suggests patient’s disease burden, other measures provide clearer picture of one’s health.


It’s not just a patient’s body mass index (BMI) of 30 or greater that can indicate obesity, caution researchers from the Cleveland Clinic’s Bariatric and Metabolic Institute. Instead, the authors recommend using obesity staging models to recognize and manage weight-related health issues that may not be captured by traditional diagnosis criteria, according to a recent clinical review in The Journal of the American Osteopathic Association (JAOA).

“Even with a condition as seemingly straightforward as obesity, physicians need to take a whole-person approach to understand the patient,” said lead author Derrick Cetin, DO. “BMI doesn’t differentiate between lean muscle mass and fat mass, which can skew perceptions of weight in different patients.”

A younger athlete, for example, may have high muscle mass and lower body fat at a BMI of 27, while an older person with a BMI of 25 may have lost muscle due to aging and have higher body fat, he said.

The Edmonton Obesity staged approach to obesity treatment allows for intensive lifestyle modification and weight management at stage zero—when patients are metabolically normal—to prevent disease progression which can lead to increased risk for negative physical and psychological health effects as well as limitation in daily activities.

A 5-10% weight loss through diet and increased physical activities is shown to result in a 30% greater loss of fat around internal organs, which substantially reduces the risk of adverse consequences, researchers noted.

Dr. Cetin also notes physicians should consider the ethnicity of a patient when diagnosing metabolic syndrome. The JAOA review included studies that found Asians had more than the double the risk of type 2 diabetes than Caucasians with the same BMI.

Read the JAOA review to learn more about the researchers’ findings.

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