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Letters to the Editor |
1 School of Kinesiology, Simon Fraser University, Vancouver, Canada
aAddress for correspondence: Healthy Heart Program, St. Paul’s Hospital, 180-1081 Burrard St., Vancouver, BC, Canada, V6Z 1Y6. Fax 604-806-8590; e-mail slear{at}providencehealth.bc.ca.
To the Editor:
In his review on the metabolic syndrome (1), Dr. G. Reaven suggests that the body mass index (BMI) measurement is "a simpler and more effective way" to quantify obesity and preferable to the measurement of waist circumference (WC).
BMI determination is not a simple process as it requires the measurement of both height and weight followed by either a calculation or the use of precalculated tables. On the other hand, the WC measure is done once, and the information is readily available. In addition, clinicians and health professionals are to encourage self-management and awareness of health, and it is easier for patients to understand and track WC than BMI. In fact, few patients understand the concept of BMI.
BMI is also flawed because changes in BMI may be attributable to changes in skeletal muscle rather than body fat, whereas WC changes are attributable entirely to changes in abdominal fat. The use of BMI perpetuates the myth that excess weight is the prime concern when the true concern is excess body fat, especially around the abdominal area. Several studies have demonstrated that the WC is superior to BMI as a risk marker (2)(3). Some studies have indicated that peripheral body fat is negatively associated with indicators of insulin resistance, whereas central body fat is positively associated with insulin resistance (4). Exclusive use of BMI would not differentiate between these two body fat distribution profiles.
Dr. Reaven (1) suggests that there are no data available with respect to the reproducibility of WC measurement. We have demonstrated that the intra- and interobserver intraclass correlation coefficients were 0.987 (95% confidence interval, 0.983–0.990) and 0.988 (0.982–0.993), suggesting excellent reproducibility (5).
The current BMI targets have been developed from populations of primarily European or Caucasian origin. Substantial research has indicated that these targets are not appropriate for people of Asian origin, who present with manifestations of insulin resistance at lower BMI values (6)(7)(8). Because Chinese and South Asian populations constitute 30% of the world’s population, identification of appropriate ethnic-specific targets, whether BMI or WC, will have a major impact on prevention of diabetes and cardiovascular disease on a population level.
Lastly, a tape measure costs no more than US $5.00, is portable, and can be more readily included in the clinical tools of health professionals worldwide than can the scale and stadiometer required for BMI measurements.
References
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