BMI vs. Abdominal Obesity – A heavy debate

Understanding Abdominal Obesity  &  BMI:

Normal BMI with ‘Abdominal Obesity’ is Deadlier than ‘Obesity’. Body Mass Index or BMI is one of the most commonly used statistical tools to measure body fat. Calculated by taking the ratio of individual’s weight and height, BMI has seen tremendous prevalence, over the years, in usage from both individuals and medical community. Its wide reach can be attributed to the fact that it is extremely simple to calculate, reasonably informative, cheap and non-invasive in nature. It is now commonly accepted as a useful screening tool for weight profiling of individuals as well population groups.

These would include risks for: heart diseases, diabetes (type 2), stroke, and hypertension, some types of cancer and kidney disease. Hence, BMI works as an efficient tool to red flag risks associated with excess body fat and weight. Chart 2 and 3, below, enunciate various insights on population’s BMI status, generated from AllizHealth’s data set.

BMI’s limitations in Indian context

While the benefits of BMI are many, it is imperative to look into its limitations, especially in the context of people belonging to Indian/ South Asian ethnicity. It has been increasingly observed that, among Asians, there is strong correlation between lower BMI and higher body fat. Therefore, there is a high probability that even if an individual has lower BMI, s/he might be having high body fat and therefore at risk of several diseases including diabetes and cardiovascular ailments.

Further, gender based analysis on the issue of waist size shows that 34% of the total female subjects have high abdominal obesity in comparison to 12% male subjects. Out of the total female population only 18% have normal waist size comparison to 38% male. Upon further evaluation it seems that Indian women after the age of 30-35 yrs tend to develop fat around the waist which continues till the latter stage of life. (See Chart 5)

For a given weight, it is therefore, much safer to have the fat distributed all over one’s body or even concentrated around the hip area versus concentrated in the stomach area.

Identifying Abdominal Obesity

Identifying abdominal obesity is simple and does not require any detailed diagnosis or blood tests. In conjunction with BMI, the following two measurements should be considered:
Waist Circumference (WC): You can measure your waist circumference by placing a tape measure around your body at the top of your hipbone and above your belly button. A measure of more than 35 inches for women and more than 40 inches for men-is considered above normal and indicate abdominal obesity.

Waist Hip Ratio (WHR): It is the ratio of the circumference of the waist and hip. According to WHO, hip circumference should be measured around the widest portion of the buttocks, with the tape parallel to the floor. The WHO states that abdominal obesity is defined as a waist-hip ratio above 0.90 for males and above 0.85 for females.

In conclusion

Given the various data points presented here in the paper as well as our understanding of various medical research work in the domain, it is now sufficiently clear that in the context of South Asians including Indians the danger of abdominal obesity and its many potential threats is very real. Also, BMI’s limitation as sole tool to highlight abdominal obesity must be recognized. Necessary additions to existing diagnostic tools (read BMI) must be made by adding the application of WC and WHR. Finally, it is imperative that a holistic approach, consisting of appropriate dietary & lifestyle changes be adapted to reducing and managing abdominal obesity both at an individual and population level.

Important Links –
Childhood Obesity in India – AllizHealth Study
General Diet Plan
Personalized Diet Plan
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References

Website links:

• http://www.cadiresearch.org/topic/obesity/abdominal-obesity/abdominal-obesity-indians
• http://timesofindia.indiatimes.com/how-to-prevent-abdominal-obesity/articleshow/17898464.cms
• http://www.webmd.com/diet/obesity/the-risks-of-belly-fat
• http://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/belly-fat/art-20045685?pg=2
• https://en.wikipedia.org/wiki/Abdominal_obesity

Publications:

• Pitfalls of Using Body Mass Index (BMI) in Assessment of Obesity Risk Trishnee Bhurosy and Rajesh Jeewon Current Research in Nutrition and Food Science (2013)
• Prevalence of generalized & abdominal obesity in urban & rural India- The ICMR-INDIAB Study (Phase-I) [ICMR-INDIAB-3]
• Obesity & abdominal obesity in Asian Indians, Indian J Med Res 123, May 2006

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