Body Mass Index

The body mass index (BMI) is the metric currently in use for defining anthropometric height/weight characteristics in adults and for classifying (categorizing) them into groups. The common interpretation is that it represents an index of an individual's fatness. It also is widely used as a risk factor for the development of or the prevalence of several health issues. In addition, it is widely used in determining public health policies.The BMI has been useful in population-based studies by virtue of its wide acceptance in defining specific categories of body mass as a health issue. However, it is increasingly clear that BMI is a rather poor indicator of percent of body fat. Importantly, the BMI also does not capture information on the mass of fat in different body sites. The latter is related not only to untoward health issues but to social issues as well. Lastly, current evidence indicates there is a wide range of BMIs over which mortality risk is modest, and this is age related. All of these issues are discussed in this brief review.

[1]  A discussion on the measurement of growth and form; secular changes in the heights of British people. , 1950 .

[2]  E. Widdowson Biology of Human Starvation , 1952, Nature.

[3]  J. Vague,et al.  The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. , 1956, The American journal of clinical nutrition.

[4]  B. Škerlj Age changes in fat distribution in the female body. , 1959, Acta anatomica.

[5]  S. Garn Anthropometry in clinical appraisal of nutritional status. , 1962, The American journal of clinical nutrition.

[6]  J. M. Chapman,et al.  THE INTERRELATIONSHIP OF SERUM CHOLESTEROL, HYPERTENSION, BODY WEIGHT, AND RISK OF CORONARY DISEASE. RESULTS OF THE FIRST TEN YEARS' FOLLOW-UP IN THE LOS ANGELES HEART STUDY. , 1964, Journal of chronic diseases.

[7]  H. Blackburn,et al.  ANTECEDENTS OF DISEASE. INSURANCE MORTALITY EXPERIENCE * , 1966 .

[8]  G. Dogliotti [Nutrition today]. , 1969, Minerva medica.

[9]  G. Forbes,et al.  Adult lean body mass declines with age: some longitudinal observations. , 1970, Metabolism: clinical and experimental.

[10]  R. Benn Some mathematical properties of weight-for-height indices used as measures of adiposity. , 1971, British journal of preventive & social medicine.

[11]  E. A. Sims,et al.  Experimental obesity in man: cellular character of the adipose tissue. , 1971, The Journal of clinical investigation.

[12]  H. Blackburn,et al.  Coronary heart disease: overweight and obesity as risk factors. , 1972, Annals of internal medicine.

[13]  Diet and the diabetic patient. , 1972, The Journal of practical nursing.

[14]  A. Harper Dietary goals-a skeptical view. , 1978, The American journal of clinical nutrition.

[15]  D. Jelliffe,et al.  Underappreciated pioneers. Quételet: man and index. , 1979, The American journal of clinical nutrition.

[16]  P. Watson,et al.  Obesity indices. , 1979, The American journal of clinical nutrition.

[17]  R. Andres Effect of obesity on total mortality. , 1980, International journal of obesity.

[18]  E. Drenick,et al.  Excessive mortality and causes of death in morbidly obese men. , 1980, JAMA.

[19]  N. Ruderman,et al.  The "metabolically-obese," normal-weight individual. , 1981, The American journal of clinical nutrition.

[20]  A. Kissebah,et al.  Relation of body fat distribution to metabolic complications of obesity. , 1982, The Journal of clinical endocrinology and metabolism.

[21]  B. Hoffbrand Treat Obesity Seriously. A Clinical Manual , 1982 .

[22]  Lawrence A Leiter,et al.  Survival during fasting may depend on fat as well as protein stores. , 1982, JAMA.

[23]  G. Forbes,et al.  Lean body mass in obesity. , 1983, International journal of obesity.

[24]  Walter J. Greenleaf,et al.  Hormonal changes and sexual function in aging men. , 1983, The Journal of clinical endocrinology and metabolism.

[25]  G. Borkan,et al.  Age changes in body composition revealed by computed tomography. , 1983, Journal of gerontology.

[26]  K. Pennert,et al.  Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. , 1984, British medical journal.

[27]  J. Garrow,et al.  A survey of heights and weights of adults in Great Britain, 1980. , 1985, Annals of human biology.

[28]  C. Bouchard,et al.  Do the new Metropolitan Life Insurance weight-height tables correctly assess body frame and body fat relationships? , 1985, American journal of public health.

[29]  W R Foster,et al.  Health implications of obesity: an NIH Consensus Development Conference. , 1985, Journal of the American Dietetic Association.

[30]  P. Björntorp,et al.  The Influence of Body Fat Distribution on the Incidence of Diabetes Mellitus: 13.5 Years of Follow-up of the Participants in the Study of Men Born in 1913 , 1985, Diabetes.

[31]  J. Garrow,et al.  Quetelet's index (W/H2) as a measure of fatness. , 1985, International journal of obesity.

[32]  G. Borkan,et al.  Comparison of body composition in middle-aged and elderly males using computed tomography. , 1985, American journal of physical anthropology.

[33]  V M Hawthorne,et al.  Three limitations of the body mass index. , 1986, The American journal of clinical nutrition.

[34]  V M Hawthorne,et al.  Maturational timing as a factor in female fatness and obesity. , 1986, The American journal of clinical nutrition.

[35]  J. Manson,et al.  Body weight and longevity. A reassessment. , 1987, JAMA.

[36]  J. Albu,et al.  Body composition, not body weight, is related to cardiovascular disease risk factors and sex hormone levels in men. , 1987, The Journal of clinical investigation.

[37]  M. Najjar,et al.  Anthropometric reference data and prevalence of overweight, United States, 1976-80. , 1987, Vital and health statistics. Series 11, Data from the National Health Survey.

[38]  Michael J. Bernstein The use of therapeutic plasmapheresis for neurological disorders. National Institutes of Health Consensus Development Conference. , 1988, Transfusion medicine reviews.

[39]  Robert W. Fogel,et al.  The Escape from Hunger and Premature Death, 1700-2100: Europe, America, and the Third World , 1989 .

[40]  J. Stamler,et al.  Large fluctuations in body weight during young adulthood and twenty-five-year risk of coronary death in men. , 1989, American journal of epidemiology.

[41]  C. Rice,et al.  Arm and leg composition determined by computed tomography in young and elderly men. , 1989, Clinical physiology.

[42]  C. Bouchard,et al.  Associations between regional body fat distribution, fasting plasma free fatty acid levels and glucose tolerance in premenopausal women. , 1990, International Journal of Obesity.

[43]  A Tremblay,et al.  Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. , 1990, Arteriosclerosis.

[44]  J A Colliver,et al.  Reassessment of body mass indices. , 1990, The American journal of clinical nutrition.

[45]  R. D'Agostino,et al.  Variability of body weight and health outcomes in the Framingham population. , 1991, The New England journal of medicine.

[46]  W. Dietz,et al.  Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. , 1991, The American journal of clinical nutrition.

[47]  E. A. Sims,et al.  Obesity and efforts to lose weight. , 1992, The New England journal of medicine.

[48]  R. Kuczmarski,et al.  Prevalence of overweight and weight gain in the United States. , 1992, The American journal of clinical nutrition.

[49]  G. Strain,et al.  The relationship of weight-height indices of obesity to body fat content. , 1992, Journal of the American College of Nutrition.

[50]  C. Bouchard,et al.  Genetic and nongenetic determinants of regional fat distribution. , 1993, Endocrine reviews.

[51]  K. Brownell,et al.  Body Weight Change, All-Cause Mortality, and Cause-specific Mortality in the Multiple Risk Factor Intervention Trial , 1993, Annals of Internal Medicine.

[52]  N. Norgan Relative sitting height and the interpretation of the body mass index. , 1994, Annals of human biology.

[53]  A Tremblay,et al.  Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. , 1994, The American journal of cardiology.

[54]  S Burastero,et al.  Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. , 1994, The American journal of clinical nutrition.

[55]  K. Flegal,et al.  Increasing Prevalence of Overweight Among US Adults: The National Health and Nutrition Examination Surveys, 1960 to 1991 , 1994 .

[56]  K Kataoka,et al.  [Indices of obesity derived from body weight and height]. , 1995, Nihon rinsho. Japanese journal of clinical medicine.

[57]  C. Bouchard,et al.  Seven-Year Changes in Body Fat and Visceral Adipose Tissue in Women. Association with indexes of plasma glucose-insulin homeostasis , 1996, Diabetes Care.

[58]  C. Bouchard,et al.  A single threshold value of waist girth identifies normal-weight and overweight subjects with excess visceral adipose tissue. , 1996, The American journal of clinical nutrition.

[59]  C. Bouchard,et al.  Anthropometric correlates to changes in visceral adipose tissue over 7 years in women. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[60]  K. Brownell,et al.  Confronting a rising tide of eating disorders and obesity: treatment vs. prevention and policy. , 1996, Addictive behaviors.

[61]  E. Frongillo,et al.  The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[62]  A. R. Frisancho Physical Status: The Use and Interpretation of Anthropometry , 1996, The American Journal of Clinical Nutrition.

[63]  M. Pollock,et al.  Relationships between the Body Mass Index and body composition. , 1996, Obesity research.

[64]  A. Dulloo Human pattern of food intake and fuel-partitioning during weight recovery after starvation: A theory of autoregulation of body composition , 1997, Proceedings of the Nutrition Society.

[65]  A. Ellaway,et al.  Does area of residence affect body size and shape? , 1997, International Journal of Obesity.

[66]  J. Connett,et al.  Early and late weight gain following smoking cessation in the Lung Health Study. , 1998, American journal of epidemiology.

[67]  P. Deurenberg,et al.  Body mass index and percent body fat: a meta analysis among different ethnic groups , 1998, International Journal of Obesity.

[68]  Claude Bouchard,et al.  Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. , 1998, WMJ : official publication of the State Medical Society of Wisconsin.

[69]  J. Peters,et al.  Environmental contributions to the obesity epidemic. , 1998, Science.

[70]  G. Gaesser Thinness and weight loss: beneficial or detrimental to longevity? , 1999, Medicine and science in sports and exercise.

[71]  E. Poehlman,et al.  Effect of menopausal status on body composition and abdominal fat distribution , 2000, International Journal of Obesity.

[72]  M Nestle,et al.  Halting the obesity epidemic: a public health policy approach. , 2000, Public health reports.

[73]  B. Heitmann,et al.  Mortality associated with body fat, fat-free mass and body mass index among 60-year-old Swedish men—a 22-year follow-up. The study of men born in 1913 , 2000, International Journal of Obesity.

[74]  C. Bouchard,et al.  Familial risk of overweight and obesity in the Canadian population using the WHO/NIH criteria. , 2000, Obesity research.

[75]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[76]  C. Bouchard,et al.  Original article underweight, overweight and obesity: relationships with mortality in the 13-year follow-up of the Canada Fitness Survey. , 2001, Journal of clinical epidemiology.

[77]  E. A. Sims,et al.  Are there persons who are obese, but metabolically healthy? , 2001, Metabolism: clinical and experimental.

[78]  D. Giannella‐Neto,et al.  Depot-specific hormonal characteristics of subcutaneous and visceral adipose tissue and their relation to the metabolic syndrome. , 2002, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[79]  C. Bouchard,et al.  Spousal resemblance in the Canadian population: implications for the obesity epidemic , 2002, International Journal of Obesity.

[80]  R. Ross,et al.  Visceral fat and liver fat are independent predictors of metabolic risk factors in men. , 2003, American journal of physiology. Endocrinology and metabolism.

[81]  D. Allison,et al.  Associations of body mass index and anthropometric indicators of fat mass and fat free mass with all-cause mortality among women in the first and second National Health and Nutrition Examination Surveys follow-up studies. , 2003, Annals of epidemiology.

[82]  Markku Peltonen,et al.  Potassium per kilogram fat-free mass and total body potassium: predictions from sex, age, and anthropometry. , 2003, American journal of physiology. Endocrinology and metabolism.

[83]  J. Sallis,et al.  Environmental correlates of walking and cycling: Findings from the transportation, urban design, and planning literatures , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[84]  S. Raudenbush,et al.  Relationship between Urban Sprawl and Physical Activity, Obesity, and Morbidity , 2003, American journal of health promotion : AJHP.

[85]  D. Levitsky,et al.  The more food young adults are served, the more they overeat. , 2004, The Journal of nutrition.

[86]  D. Williamson,et al.  Trying to lose weight, losing weight, and 9-year mortality in overweight U.S. adults with diabetes. , 2004, Diabetes care.

[87]  S. Reis,et al.  Clinical Importance of Obesity Versus the Metabolic Syndrome in Cardiovascular Risk in Women: A Report From the Women’s Ischemia Syndrome Evaluation (WISE) Study , 2004, Circulation.

[88]  A. Fernández-Cruz,et al.  Smoking cessation and weight gain , 2004, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[89]  J. Maddock,et al.  The Relationship between Obesity and the Prevalence of Fast Food Restaurants: State-Level Analysis , 2004, American journal of health promotion : AJHP.

[90]  C. Nishida,et al.  Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies , 2004, The Lancet.

[91]  Katherine M Flegal,et al.  Mean body weight, height, and body mass index, United States 1960-2002. , 2004, Advance data.

[92]  Martin A. Andresen,et al.  Obesity relationships with community design, physical activity, and time spent in cars. , 2004, American journal of preventive medicine.

[93]  Brian Wansink,et al.  Why Visual Cues of Portion Size May Influence Intake , 2004, Obesity research.

[94]  Kaare Christensen,et al.  Total and regional fat distribution is strongly influenced by genetic factors in young and elderly twins. , 2005, Obesity research.

[95]  B. Wansink,et al.  Bad popcorn in big buckets: portion size can influence intake as much as taste. , 2005, Journal of nutrition education and behavior.

[96]  M. Gail,et al.  Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence: A Randomized Controlled Trial , 2005, Gynecologic oncology.

[97]  K. Flegal,et al.  Secular trends in cardiovascular disease risk factors according to body mass index in US adults. , 2005, JAMA.

[98]  A. Rissanen,et al.  Intention to Lose Weight, Weight Changes, and 18-y Mortality in Overweight Individuals without Co-Morbidities , 2005, PLoS medicine.

[99]  G. Dagenais,et al.  Insulin resistance syndrome, body mass index and the risk of ischemic heart disease , 2005, Canadian Medical Association Journal.

[100]  S. Olshansky,et al.  A potential decline in life expectancy in the United States in the 21st century. , 2005, The New England journal of medicine.

[101]  S. Preston,et al.  Deadweight?--The influence of obesity on longevity. , 2005, The New England journal of medicine.

[102]  V. Montori,et al.  Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies , 2006, The Lancet.

[103]  F. Nuttall,et al.  Stability of Body Weight in Type 2 Diabetes , 2006, Diabetes Care.

[104]  B. Popkin,et al.  Commentary: understanding the epidemiology of overweight and obesity--a real global public health concern. , 2006, International journal of epidemiology.

[105]  A. Garg,et al.  Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. , 2006, The Journal of clinical endocrinology and metabolism.

[106]  T. Harris,et al.  Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. , 2006, The New England journal of medicine.

[107]  A. Ward,et al.  Medicare's search for effective obesity treatments: diets are not the answer. , 2007, The American psychologist.

[108]  Devendra Singh,et al.  The Critical Role of Waist-to-Hip Ratio , 2007 .

[109]  Claude Bouchard,et al.  Effects of bariatric surgery on mortality in Swedish obese subjects. , 2007, The New England journal of medicine.

[110]  K. Petersen,et al.  Disordered lipid metabolism and the pathogenesis of insulin resistance. , 2007, Physiological reviews.

[111]  K. Flegal The effects of changes in smoking prevalence on obesity prevalence in the United States. , 2007, American journal of public health.

[112]  T. Jørgensen,et al.  Waist circumference and weight following smoking cessation in a general population: the Inter99 study. , 2007, Preventive medicine.

[113]  K. Reynolds,et al.  The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004) , 2008 .

[114]  M. Schulze,et al.  General and abdominal adiposity and risk of death in Europe. , 2008, The New England journal of medicine.

[115]  K. Reynolds,et al.  The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). , 2008, Archives of internal medicine.

[116]  G. Eknoyan,et al.  Adolphe Quetelet (1796-1874)--the average man and indices of obesity. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[117]  V. Somers,et al.  Accuracy of body mass index in diagnosing obesity in the adult general population , 2008, International Journal of Obesity.

[118]  Robert Plomin,et al.  Evidence for a strong genetic influence on childhood adiposity despite the force of the obesogenic environment. , 2008, The American journal of clinical nutrition.

[119]  Fritz Schick,et al.  Identification and characterization of metabolically benign obesity in humans. , 2008, Archives of internal medicine.

[120]  W. Willett,et al.  The public health and economic benefits of taxing sugar-sweetened beverages. , 2009, The New England journal of medicine.

[121]  A. Fatiregun,et al.  HEALTH RISKS OF OBESITY , 2009, Annals of Ibadan postgraduate medicine.

[122]  R. Collins,et al.  Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies , 2009, The Lancet.

[123]  Tamara B Harris,et al.  Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. , 2009, The American journal of clinical nutrition.

[124]  L. Kuller,et al.  Excessive Loss of Skeletal Muscle Mass in Older Adults With Type 2 Diabetes , 2009, Diabetes Care.

[125]  D. Levy,et al.  Trends in Cardiovascular Disease Risk Factors in Individuals With and Without Diabetes Mellitus in the Framingham Heart Study , 2009, Circulation.

[126]  J. Després,et al.  Does abdominal obesity have a similar impact on cardiovascular disease and diabetes? A study of 91,246 ambulant patients in 27 European countries. , 2009, European heart journal.

[127]  B. Duncan,et al.  Smoking, Smoking Cessation, and Risk for Type 2 Diabetes Mellitus , 2010, Annals of Internal Medicine.

[128]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2008. , 2010, JAMA.

[129]  R. McPherson Chromosome 9p21 and coronary artery disease. , 2010, The New England journal of medicine.

[130]  G. Parati,et al.  Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. , 2010, European heart journal.

[131]  A. Karlamangla,et al.  Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. , 2011, The Journal of clinical endocrinology and metabolism.

[132]  A pitched battle over life span. , 2011, Science.

[133]  A. Keys,et al.  Indices of relative weight and obesity. , 2014, International journal of epidemiology.