Obesity epidemic in America found significantly worse than previously believed.
The scope of the obesity epidemic in the United States has been grossly underestimated, according to a study published in the journal PLoS ONE. Researchers found that the Body Mass Index (BMI) substantially under-diagnoses obesity when compared to the Dual Energy X-ray Absorptiometry (DXA) scan, a direct simultaneous measure of body fat, muscle mass, and bone density.* The disparity is particularly significant for women of advancing age, those with high blood leptin levels, and the normal weight obese (NWO). Researchers also derived a leptin-revised BMI estimate of body fat for clinical use in the absence of DXA.
Co-authors Nirav Shah, MD, MPH, the current New York State Commissioner of Health and Eric Braverman, MD, the Founder and President of PATH Foundation NY, recognize the convenience, safety, and low cost of the BMI, yet agree that it is an outdated mathematical equation which needs to evolve in order to correctly evaluate body fat. The study suggests that adjusting the BMI will have broad population health implications, since obesity contributes to multiple co-morbidities such as coronary heart disease, hypertension, and diabetes.
"These estimates are fundamental to US policy addressing the epidemic of obesity and are central to designing interventions aimed at curbing its growth ... et they [current policies] may be flawed because they are based on the BMI," says Shah and Braverman.
They go on to articulate, "Obesity, body fat, and increased adiposity are more prevalent than the American public and American physicians are aware of."
The principle findings of the study suggest that as many as 39% of Americans who are classified as overweight are actually obese by adiposity measures. Misclassification occurred more frequently in women than in men, and was exacerbated by increasing age. Hyperleptinemia of aging explains why diets fail Americans who are eating less calories as they age but still gaining weight.
According to Shah and Braverman, "Adiposity and hyperleptinemia are more significant than BMI in predicting high risk obesity." Patients with hyperleptinemic states can be corrected by a variety of hormones, nutrients, medication, and lifestyle changes. Dopaminergic transmission also may suppress hyperleptinemia.
"The BMI is an insensitive measure of obesity, prone to under-diagnosis, while direct fat measurements are superior because they show distribution of body fat," Dr. Braverman added.
These findings provide a basis for aging individuals to have their blood tested for leptin and request their body fat percentage be measured when they get their bone density scan. In the near future, a leptin blood test for reversal and treatment of obesity may become as common as testing cholesterol for heart disease and hemoglobin A1c for diabetes.
* Measuring Adiposity in Patients: Utility of Body Mass Index (BMI), Percent Body Fat, and Leptin PLoS ONE April 2nd, 2012 by Nirav R. Shah, MD, MPH and Eric R. Braverman, M.D. www.pathfoundationny.org
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|Title Annotation:||IN THE NEWS|
|Date:||Jun 1, 2012|
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