Anthropometrics in Obesity

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Anthropometrics in Obesity

• Robert Kushner, MD
• Northwestern University
• Feinberg School of Medicine

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Anthropometrics in Obesity

• Height
• Weight
• Body Mass Index (BMI) weight/height2
• Kg/m2
• (lb/in)2 x 703
• Distribution of body fat
• Waist-hip ratio (WHR)
• Waist circumference
• Body composition
• Percent body fat

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Anthropometrics in Obesity

• Height
• Weight
• Body Mass Index (BMI) weight/height2
• Kg/m2
• (lb/in)2 x 703
• Distribution of body fat
• Waist-hip ratio (WHR)
• Waist circumference
• Body composition
• Percent body fat

4
Body Mass Index Chart
Weight (lb)
60
62
64
66
Height (in)
68
70
72
74
76
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BMI-Associated Disease Risk
Classification BMI (kg/m2)
Risk

• Underweight
• Normal 18.524.9 Normal
• Overweight 25.029.9
  Increased
• Obese I 30.034.9 High
• II 35.039.9 Very high
• III ?40 Extremely
  high
• Additional risks
• Large waist circumference (men 40 in women 35
  in)
• 5 kg or more weight gain since age 1820 y
• Poor aerobic fitness
• Specific races and ethnic groups

Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and
Obesity in AdultsThe Evidence Report. Obes Res
19986(suppl 2).
6
Relative Risk of Death From Cardiovascular
Disease, Cancer, and All Other Causes
Men
Women
2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6
3.2 3.0 2.8 2.6 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.
8 0.6
Cardiovascular disease Cancer All other causes
Relative Risk of Death
Relative Risk of Death
40.0
23.5-24.9 25.0-26.4
26.5-27.9 28.0-29.9
30.0-31.9 32.0-34.9
35.0-39.9
20.5-21.9 22.0-23.4
Body-Mass Index
Body-Mass Index

• Multivariate relative risk of death from
  cardiovascular disease, cancer, and all other
  causes among men and women who had never smoked
  and who had no history of disease at enrollment,
  according to body-mass index.
• The reference category was made up of subjects
  with a body-mass index of 23.5 to 24.9.

Calle EE, et al. N Engl J Med. 19993411097-1105.
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Relationship Between BMI and Risk of Type 2
Diabetes Mellitus
100
75
Age-Adjusted Relative Risk
50
25
0
2323.9
2424.9
2526.9
2728.9
3334.9
2930.9
3132.9
35
Body Mass Index (kg/m2)
Chan J et al. Diabetes Care 199417961. Colditz
G et al. Ann Intern Med 1995122481.
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Action BMI Ranges forAsian Populations are Lower
High to very high risk
WHO expert consultation. Lancet 2004363157
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Relationship Between BMI and Percent Body Fat in
Men and Women
70

• Age
• Gender
• Race

Women
60
Men
50
40
Body Fat ()
30
20
10
0
50
60
0
10
20
30
40
Body Mass Index (kg/m2)
Adapted from Gallagher et al. Am J Clin Nutr
200072694.
10
Android
Gynoid
11
Visceral FatThe Critical Adipose Depot
Back
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Waist CircumferenceMeasurement Sites

• Immediately below the lowest rib
• At the narrowest waist1
• Midpoint between the lowest rib and the iliac
  crest2
• Immediately above the iliac crest3,4

• Anthropometric Standardization Reference Manual
• World Health Organization (WHO)
• National Institutes of Health (NIH)
• National Health and Nutrition Examination Survey
  (NHANES)

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How to Measure Waist Circumference

• Place a measuring tape, held parallel to the
  floor, around the patients abdomen at a
  designated level.
• The tape should fit snugly around the waist
  without compressing the skin
• Take the measurement at the end of a normal
  expiration

A waist circumference (at iliac crest) of 40
inches in men or 35 inches in women is
diagnostic of abdominal obesity and suggests the
presence of other cardiometabolic risk factors.
Adapted from Grundy SM, et al. Circulation.
20051122735-2752.
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Classification of overweight and obesity by BMI,
waist circumference and associated disease risks
Disease Risk Relative to Normal Weight and Waist
Circumference
BMI (kg/m2) 29.9 30.0 - 34.9 35.0 - 39.9 40
Obesity Class I II III
Men ( -- -- Increased High Very High Extremely
High
Men (102 cm) 40 in Women (88 cm) 35 in
-- -- High Very High Very High Extremely
High
Underweight Normal Overweight Obesity Extre
me obesity
Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and
Obesity in AdultsThe Evidence Report. Obes Res
19986(suppl 2).
15
Metabolic Syndrome Refined Criteria (IDF)

• Population Group Waist
  Circumference (inches)
• Men Women
• USA (NCEP ATP III) 40 35
• European 37 30.5
• South Asian/ 35.5 30.5
• Chinese
• Japanese 33.5 35.5

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Body Composition (body fat)

• Skinfold Anthropometry
• Bioelectrical impedance analysis (BIA)
• Dual-energy x-ray absorptiometry (DEXA)
• Computed tomography (CT scan)
• Abdominal visceral fat

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Assessing Canine Obesity
Optimal Overweight
Obese BCS5 BCS 6-7
BCS 8-9