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For a Body Fat Tip Off, Look to Your BMI...

Over half the American population is overweight, nearly one quarter of Americans are obese, and it is increasingly evident that this growing girth is taking its toll on the health of the population. Overweight is associated with type 2 diabetes, heart disease, certain forms of cancer and joint problems like osteoarthritis. It is also clear that even modest weight loss can have profound effects on health. But it may take more than a mirror or an arbitrary "goal weight" to get on the road to reducing health risk. A body of research has found that body mass index, or BMI may be a better indicator of health risk than absolute body weight. In addition, where you gain the weight may be equally important in determining your risk for certain diseases. Though it is only one of a number of considerations that health experts use to determine these risks, BMI is more highly correlated with body fat that any other measurement of height and weight.

Below, Anne Wolf, obesity expert and instructor of research at the University of Virginia School of Medicine, offers simple instructions for determining body mass index, and talks about the usefulness of BMI in assessing health risk and as a goal for weight loss.

And what is considered a healthy, and an unhealthy BMI?
A BMI of less than 18.5 would be underweight. A BMI between 18.5 and 24.9 would be considered a healthy body weight, overweight is categorized as 25 to 29.9, and obesity is categorized as a BMI of 30 and above.

Does BMI account for body proportion?
No. And in fact, one of the other measurements that the National Heart, Lung and Blood Institute recommends using with body mass index to assess health risk is waist circumference. We know that a high waist circumference-or high amounts of abdominal body fat-is very dangerous body fat to have, independent of a high body mass index.

So if someone has a body mass index in a healthy range but they have a very high waist circumference, then they still are at risk of developing disease states.

What sorts of health risks does a high BMI pose?
People with high BMI are at very high risk of developing type 2 diabetes and cardiovascular disease. That includes coronary heart disease, hypertension, stroke, and enlarged heart. It's also involved very much with the whole metabolic syndrome. You're at a higher risk for insulin resistance, infertility, and polycystic ovary syndrome. You're at high risk for certain types of cancers, and particularly cancers of the reproductive system-endometrial cancer, breast cancer, etc. Colon cancer for men. We've seen associations with gall bladder cancer, as well, and some other smaller types of cancer.

A high BMI is also associated with structural problems. A lot of people who have a body mass index over 30, which is very high, have many more hip and knee problems, osteoarthritis, and also problems in the hand.

So the health risks are pervasive. They're not just diabetes or heart disease. It also hits the structural system and is highly associated with cancers, and lower quality of life.

Is BMI genetic?
If your family is heavy, you are more likely-for genetic reasons-to be more heavy set than other people. However, genes don't change, and in the last 15, 20 years our body mass indexes have continued to increase dramatically. It's not a shift in our genetic makeup, it's a shift in our environment. We have less physical activity, we are eating more, and we are gaining more weight.

Is BMI a good measurement of health risk for everyone? Or are there certain populations for whom the measurement might not be an accurate assessment of health?
BMI is good for most of the general population. There are, however, people with a lot of muscle-athletes for instance-who have a high BMI but the high weight part of the equation is more a result of muscle, not fat, and they are not at increased risk of health problems.

There's common sense that has to come through. You can look at someone and say, "They're in really good shape. They have high BMI, but it's because they're fit." And you won't see a BMI over 30 if someone is in shape.

So what are the major factors that need to be considered in assessing someone's health risks?
We would measure their weight and their height, calculate their body mass index, and we would measure their waist circumference. A waist circumference lower than 35 inches for women and lower than 40 inches for men is considered good.

We'd also look at family history of disease. If someone has a lot of type 2 diabetes or cardiovascular disease in their family, that tells me they are at higher risk. We also look at their current health. Do they have high blood pressure? Do they have type 2 diabetes or joint pains?

We would also assess their physical activity patterns and dietary history. That's a little bit harder to assess, but ideally you want to get a full picture of that person. If they are overweight but they are active and they feel really good, they're a lot healthier than the person who is sedentary and thinner.

What are realistic goals for lowering a high BMI?
The BMI is only related to health risk, not appearance. Health risks start to increase as BMI gets above 25 and dramatically increase with a BMI of 30 and above. Since you can't change your height, the only way to shift to a lower number in the BMI range is by lowering body weight. They do not have to get to a BMI between 18.5 and 24.9. If someone has a BMI of 40, it is very unlikely that they're going to get to a BMI of 20.

But we know that health risk improves with just a mild weight loss. Even a 5% weight loss can result in profound health improvements. For those people who have a BMI over 30, just losing 5% is very important.