Health
BMI is wrong way to measure obesity, researchers say — here’s what they recommend instead
A group of 58 researchers is calling for a new, better way to measure obesity.
The global team’s recommendations were published in The Lancet Diabetes & Endocrinology on Jan. 14.
Body mass index (BMI) has been the international standard for measuring obesity since the 1980s, according to many sources, though some experts have questioned its validity.
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A person’s BMI is calculated by dividing his or her weight by the square of his or her height in feet.
Body mass index (BMI) has been the international standard for measuring obesity since the 1980s, according to many sources, though some experts have questioned its validity. (iStock)
“Obesity is a complex problem and has different significance at the individual level,” the report’s lead author Francesco Rubino, chair of bariatric and metabolic surgery at King’s College London, United Kingdom, told Fox News Digital.
Obesity is a “spectrum,” he said, rather than a “single, distinct clinical entity.”
Rubino went on, “It is impossible to say if obesity is a disease or not, as disease status cannot coincide with body size or mere excess body fat.”
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The Commission on Clinical Obesity has proposed a “reframing” of obesity that distinguishes between people who have a disease here and now, and those who may have a risk for future disease, Rubino said.
Instead of relying solely on BMI, the researchers recommend also measuring adiposity, which is the amount of excess body fat.
A person’s BMI is calculated by dividing his or her weight by the square of his or her height in feet. (iStock)
Adiposity can be determined by measuring a person’s waist circumference or taking body scans to measure fat mass, according to the researchers.
The group of experts recommends using two levels of obesity: preclinical and clinical.
With preclinical obesity, the person has excess body fat that has not affected the function of their tissues and organs.
“People with clinical obesity suffer from a chronic illness and should be treated in the same way as people who suffer from any other chronic disease.”
The person may have, however, an increased risk of developing clinical obesity, type 2 diabetes, heart disease and some types of cancer, the researchers noted.
Clinical obesity is defined as “a chronic, systemic illness characterized by alterations in the function of tissues, organs, the entire individual or a combination thereof, due to excess adiposity.”
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With clinical obesity, the person may experience “severe end-organ damage, causing life-altering and potentially life-threatening complications,” the researchers wrote.
Potential effects of clinical obesity may include heart attack, stroke and kidney failure.
“As these categories of obesity are entirely new, we can’t measure their relative prevalence in the population,” Rubino noted. “Doctors have not yet had the possibility to make such a diagnosis, because many of the organ dysfunctions that characterize clinical obesity have not been routinely assessed so far.”
When excess body fat is confirmed, clinicians should assess individuals to determine whether obesity may have caused any organ dysfunction, the study researcher said. (iStock)
The researchers call for future studies into these diagnoses.
“We recommend that clinicians thoroughly assess people with obesity in the clinic and use other measures of body size — waist circumference or others — to understand if an increased BMI level is due to excess body fat or other reasons, like increased muscle mass,” Rubino told Fox News Digital.
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When excess body fat — meaning obesity — is confirmed, clinicians should assess individuals to determine whether obesity may have caused any organ dysfunction, the researcher said.
“People with clinical obesity suffer from a chronic illness and should be treated in the same way as people who suffer from any other chronic disease,” Rubino said.
People with preclinical obesity should undergo “evidence-based health counseling, monitoring of their health status over time, and, when applicable, appropriate intervention to reduce risk of developing clinical obesity,” they wrote.
Between August 2021 and August 2023, approximately 40% of U.S. adults had obesity, according to the Centers for Disease Control and Prevention (CDC). Around 9.4% of those adults had severe obesity.
‘Outdated measure’
Dr. Brett Osborn, a neurosurgeon, longevity expert and fitness competitor based in Florida, agrees that BMI is an “outdated measure” for diagnosing obesity.
“It is clear that obesity should no longer be defined solely by physical appearance or weight.”
“As medicine evolves, it is clear that obesity should no longer be defined solely by physical appearance or weight — or weight relative to height, as in BMI calculations,” the doctor, who was not involved in this new research, told Fox News Digital.
“Instead, the condition must be understood through the lens of metabolic dysfunction.”
Obesity isn’t just a disease of excess weight, Osborn said, but a “systemic metabolic disorder requiring nuanced and individualized care.”
The condition is better measured by looking at factors like inflammation, insulin resistance and glucose tolerance, according to the doctor.
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In some cases, using BMI can result in “muscular athletes” being labeled as obese, he noted, and people with “normal” BMI can sometimes have “harmful” levels of visceral (abdominal) fat.
Osborn noted that in his own clinic, he and his team do not use BMI, relying instead on visceral fat scores, skeletal muscle mass and body fat percentage.
In some cases, using BMI can result in “muscular athletes” being labeled as obese, one doctor noted. (iStock)
Skeletal muscle mass (the muscles that connect to the bones) is critical to physical strength and metabolic efficiency, Osborn said.
For optimal health, he recommends that males aim for 50% skeletal muscle mass relative to total body weight and females target 45% — although other factors, like age and fitness levels, come into play.
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“Remember, your resilience — your ability to ward off disease — resides in your muscle,” Osborn added.
“By integrating body composition metrics, metabolic markers and personalized assessments, we can more accurately diagnose obesity and tailor interventions to each individual.”
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Those at risk of type 2 diabetes may be able to prevent heart problems later.
A new study published in The Lancet Diabetes & Endocrinology discovered that lowering the blood sugar of those with prediabetes could reduce the risk of heart attack by half.
Diabetes researchers and endocrine experts across Europe, China and the U.S. investigated how bringing blood sugar back to normal levels affected the chances of heart problems later in life, based on a 20-year American study and a 30-year Chinese study, according to a press release.
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In both studies, the prediabetic participants were coached to make appropriate lifestyle changes to lower blood sugar (the amount of glucose in the bloodstream) through diet and exercise, also targeting weight loss.
Participants worked to lower blood sugar through diet and exercise targeted at weight loss. (iStock)
The researchers split the participants into a remission group (where blood sugar returned to normal) and a non-remission group, which included those still in the prediabetes range. They then determined who in these groups had died from heart disease or were hospitalized for heart failure.
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Participants who went into remission had a 58% lower risk of dying from heart disease and being hospitalized for heart failure. This group also had a lower risk of other major heart events and lower overall death rates.
These heart-protective benefits lasted for decades after the program ended, the researchers found.
Those in prediabetes remission had their risk of a heart event reduced by more than half. (iStock)
“Reaching prediabetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalization for heart failure in diverse populations,” the researchers commented in the publication of the study. “Targeting remission might represent a new approach to cardiovascular prevention.”
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In an interview with Fox News Digital, Dr. Andreas Birkenfeld, study co-author and professor of medicine at the University Hospital Tübingen in Germany, reiterated that reaching prediabetes remission is not only relevant for reducing the progression of type 2 diabetes, but may also be associated with a “meaningful reduction in… heart attack risk, cardiac death and heart failure.”
“Importantly, this underscores that prediabetes is a modifiable stage where timely, evidence-based interventions (especially lifestyle measures, and in selected cases, medication) can make a real difference,” he added.
“Reaching prediabetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalization for heart failure in diverse populations,” the researchers commented. (iStock)
The study did have some limitations, including that it is based on analysis of trials not originally designed to measure cardiovascular outcomes, which means the results show association but cannot prove causation.
In addition, unmeasured lifestyle and health factors, population differences and lack of randomization for heart outcomes may have influenced the reduced cardiovascular risk, the researchers acknowledged.
“This underscores that prediabetes is a modifiable stage where timely, evidence-based interventions … can make a real difference.”
Birkenfeld suggested that those with prediabetes should ask their doctors the following questions: “What is my current status? What is my personal cardiovascular risk? What is my target blood glucose level?”
Patients should also inquire about the frequency of testing for blood sugar and key risk factors like blood pressure, cholesterol and other related conditions, such as kidney function or sleep apnea, he advised.
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“If lifestyle changes aren’t enough or my risk is high, would medication be appropriate for me — and what are the benefits and downsides?” the researcher asked as an example.
About 98 million American adults, more than one in three, have prediabetes, according to CDC data. Eight in 10 of these adults are unaware that they have the disease.
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One of the most widely known risks linked to the COVID-19 vaccine is myocarditis, especially in young males — and now a new Stanford study has shed some light on why this rare effect can occur.
Myocarditis, which is inflammation of the heart, occurs in about one in 140,000 people who receive the first dose of the vaccine and one in 32,000 after the second dose, according to a Stanford press release. Among males 30 and younger, that rises to one in 16,750.
Symptoms of the condition include chest pain, shortness of breath, fever and palpitations, which can occur just one to three days after vaccination. Another marker is heightened levels of cardiac troponin, which indicates that the heart muscle has been damaged.
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In most cases, people who experience myocarditis recover quickly and restore full heart function, according to study author Joseph Wu, MD, PhD, the director of the Stanford Cardiovascular Institute and a professor of medicine and radiology.
One of the most widely known risks linked to the COVID-19 vaccine is myocarditis, especially in young males. (iStock)
“It’s not a heart attack in the traditional sense,” Wu told Fox News Digital. “There’s no blockage of blood vessels as found in most common heart attacks. When symptoms are mild and the inflammation hasn’t caused structural damage to the heart, we just observe these patients to make sure they recover.”
In rare cases, however, severe heart inflammation can lead to hospitalizations, critical illness or death, Wu noted.
Finding the cause
The new Stanford study — conducted in collaboration with The Ohio State University — aimed to determine the reasons for the myocarditis. The research team analyzed blood samples from vaccinated people, some with myocarditis and some without.
They found that those with myocarditis had two proteins in their blood, CXCL10 and IFN-gamma, which are released by immune cells. Those proteins then activate more inflammation.
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“We think these two are the major drivers of myocarditis,” said Wu. “Your body needs these cytokines to ward off viruses. It’s essential to immune response, but can become toxic in large amounts.”
In mouse and heart tissue models, high levels of these proteins led to signs of heart irritation, similar to mild myocarditis.
Prevention mechanism
“One of the most striking findings was how much we could reduce heart damage in our models by specifically blocking these two cytokines, without shutting down the entire (desired) immune response to the vaccine,” Wu told Fox News Digital, noting that a targeted, “fine‑tuning” immune approach might be enough to protect the heart.
Myocarditis, which is inflammation of the heart, occurs in about one in 140,000 people who receive the first dose of the vaccine and one in 32,000 after the second dose. (iStock)
“This points to a possible future way to prevent or treat myocarditis in people who are at the highest risk, while keeping the benefits of vaccination,” he added.
The team also found that genistein, an estrogen-like natural compound found in soybeans, reduced inflammation in lab tests, but this has not yet been tested in humans.
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The findings were published in the journal Science Translational Medicine.
“This is a very complex study,” Fox News senior medical analyst Dr. Marc Siegel told Fox News Digital. “Myocarditis is very rare, and the immune mechanism makes sense.”
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“Myocarditis is worse with COVID — much more common, and generally much more severe.”
Wu agreed, adding that COVID infection is about 10 times more likely to cause myocarditis compared to mRNA-based vaccines.
‘Crucial tool’
The researchers emphasized that COVID-19 vaccines have been “heavily scrutinized” for safety and have been shown to have an “excellent safety record.”
In rare cases, however, severe heart inflammation can lead to hospitalizations, critical illness or death. (iStock)
“mRNA vaccines remain a crucial tool against COVID‑19, and this research helps explain a rare side effect and suggests ways to make future vaccines even safer, rather than a reason to avoid vaccination,” Wu said.
“The overall benefits of COVID‑19 vaccination still clearly outweigh the small risk of myocarditis for nearly all groups.”
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The study did have some limitations, primarily the fact that most of the data came from experimental systems (mice and human cells in the lab), which cannot fully capture how myocarditis develops and resolves in real patients, according to Wu.
“This points to a possible future way to prevent or treat myocarditis in people who are at the highest risk.”
“These findings do not change what people should do right now, because our work is still at the preclinical (mouse and human cells) stage,” he said. “Clinical studies will be needed to confirm whether targeted treatments are safe and effective.”
The researcher also added that myocarditis risk could rise with other types of vaccines.
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“Other vaccines can cause myocarditis and inflammatory problems, but the symptoms tend to be more diffuse,” he said in the release. “Plus, mRNA-based COVID-19 vaccines’ risks have received intense public scrutiny and media coverage. If you get chest pains from a COVID vaccine, you go to the hospital to get checked out, and if the serum troponin is positive, then you get diagnosed with myocarditis. If you get achy muscles or joints from a flu vaccine, you just blow it off.”
The study was funded by the National Institutes of Health and the Gootter-Jensen Foundation.
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