Overweight and Obesity in Women: Health Risks and Consequences

Frank B. Hu, M.D., Ph.D.

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In This Article

Assessment Of Obesity

BMI is the most commonly used measure of overall adiposity in the clinical setting. Table 1 shows the classification of overweight and obesity based on assessment of BMI, first proposed by the World Health Organization (WHO)[3] and later adopted by the National Institutes of Health (NIH).[4] Although BMI is a reasonable surrogate measure of overall adiposity in the general population, its validity in measuring adiposity is less well established in children, elderly people, and those who are more muscular.[5] Waist/hip circumference ratio (WHR), a surrogate measure of intraabdominal or central obesity, predicts long-term disease risk in both men[6] and women,[7] independent of BMI. People with a predominance of abdominal (visceral) fat exhibit more insulin resistance and elevated free fatty acid production than those having fat primarily distributed subcutaneously over the lower extremities.[8,9] Studies using computed tomography (CT) suggested the superiority of waist circumference[10] over WHR in measuring intraabdominal fat content. Thus, waist circumference is recommended as the most practical tool to assess abdominal fat or central obesity. The waist circumference is more useful in assessing obesity among individuals who have BMI <30 than among obese subjects. Monitoring changes in waist circumference over time can provide an estimate of changes in abdominal fat even in the absence of changes in weight. Men are at increased disease risk if they have a waist circumference >40 inches (102 cm). The cutoff point for women is 35 inches (88 cm) ( Table 1 ).

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