1. Anthropometrics in Obesity Robert Kushner, MD Northwestern University Feinberg School of Medicine

2. Anthropometrics in Obesity Height Weight Body Mass Index (BMI) [weight/height] 2 —Kg/m 2 —(lb/in) 2 x 703 Distribution of body fat —Waist-hip ratio (WHR) —Waist circumference Body composition —Percent body fat

3. Anthropometrics in Obesity Height Weight Body Mass Index (BMI) [weight/height] 2 —Kg/m 2 —(lb/in) 2 x 703 Distribution of body fat —Waist-hip ratio (WHR) —Waist circumference Body composition —Percent body fat

4. Body Mass Index Chart Weight (lb) 23 22 21 19 18 17 16 15 25 24 22 21 20 19 18 17 16 27 26 24 23 21 20 19 18 17 29 27 26 24 23 22 20 19 18 31 29 28 26 24 23 22 21 20 33 31 29 27 26 24 23 22 21 35 33 31 29 27 26 24 23 22 37 35 33 31 29 27 26 24 23 39 37 34 32 30 29 27 26 24 41 38 36 34 32 30 29 27 26 43 40 38 36 34 32 30 28 27 45 42 40 37 35 33 31 30 28 47 44 41 39 37 35 33 31 29 49 46 43 40 38 36 34 32 30 51 48 45 42 40 37 35 33 32 53 49 46 44 41 39 37 35 33 55 51 48 45 43 40 38 36 34 57 53 50 47 44 42 39 37 35 59 55 52 49 46 43 41 39 37 63 59 55 52 48 46 43 41 40 66 62 58 55 52 49 46 44 41 70 66 62 58 55 52 49 46 44 74 70 65 61 58 55 52 49 46 78 73 69 65 61 57 54 51 49 120 130 140150 160 170 180 190 200 210 220320 340 360 240 250260230270280290 380300400 64 Height (in) 62 60 70 68 66 72 74 76

5. Classification BMI (kg/m 2 ) Risk Underweight <18.5Increased Normal 18.5–24.9 Normal Overweight 25.0–29.9 Increased Obese I 30.0–34.9 High II 35.0–39.9 Very high III  40 Extremely high Additional risks: Large waist circumference (men >40 in; women >35 in) 5 kg or more weight gain since age 18–20 y Poor aerobic fitness Specific races and ethnic groups BMI-Associated Disease Risk Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).

6. Multivariate relative risk of death from cardiovascular disease, cancer, and all other causes among men and women who had never smoked and who had no history of disease at enrollment, according to body-mass index. The reference category was made up of subjects with a body-mass index of 23.5 to 24.9. Multivariate relative risk of death from cardiovascular disease, cancer, and all other causes among men and women who had never smoked and who had no history of disease at enrollment, according to body-mass index. The reference category was made up of subjects with a body-mass index of 23.5 to 24.9. Relative Risk of Death From Cardiovascular Disease, Cancer, and All Other Causes Calle EE, et al. N Engl J Med. 1999;341:1097-1105. 3.2 3.0 2.8 2.6 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 Relative Risk of Death Men Cardiovascular disease Cancer All other causes <18.5 18.5-20.4 20.5-21.9 22.0-23.4 23.5-24.9 25.0-26.4 26.5-27.9 28.0-29.9 30.0-31.9 32.0-34.9 >35.0 Body-Mass Index Women Relative Risk of Death Body-Mass Index <18.5 18.5-20.4 20.5-21.9 22.0-23.4 23.5-24.9 25.0-26.4 26.5-27.9 28.0-29.9 30.0-31.9 32.0-34.9 >40.0 35.0-39.9 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6

7. Relationship Between BMI and Risk of Type 2 Diabetes Mellitus Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481. Age-Adjusted Relative Risk Body Mass Index (kg/m 2 ) <23 24–24.9 25–26.927–28.933–34.9 0 25 50 75 100 1.0 2.9 4.3 5.0 8.1 15.8 27.6 40.3 54.0 93.2 <22 23–23.9 29–30.931–32.9 35+ 1.0 1.5 2.2 4.4 6.7 11.6 21.3 42.1 1.0 Men Women

8. Action BMI Ranges for Asian Populations are Lower WHO expert consultation. Lancet 2004;363:157 High to very high risk

9. Adapted from: Gallagher et al. Am J Clin Nutr 2000;72:694. Body Mass Index (kg/m 2 ) 0 10 20 30 40 50 60 70 010203040 5060 Body Fat (%) Women Men Relationship Between BMI and Percent Body Fat in Men and Women Age Gender Race

10. Android Gynoid

11. Visceral Fat: The Critical Adipose Depot Back

12. Immediately below the lowest rib At the narrowest waist 1 Midpoint between the lowest rib and the iliac crest 2 Immediately above the iliac crest 3,4 Waist Circumference Measurement Sites 1.Anthropometric Standardization Reference Manual 2.World Health Organization (WHO) 3.National Institutes of Health (NIH) 4.National Health and Nutrition Examination Survey (NHANES)

13. How to Measure Waist Circumference ●Place a measuring tape, held parallel to the floor, around the patient’s abdomen at a designated level. ●The tape should fit snugly around the waist without compressing the skin ●Take the measurement at the end of a normal expiration A waist circumference (at iliac crest) of ≥40 inches in men or ≥35 inches in women is diagnostic of abdominal obesity and suggests the presence of other cardiometabolic risk factors. Adapted from Grundy SM, et al. Circulation. 2005;112:2735-2752.

14. Classification of overweight and obesity by BMI, waist circumference and associated disease risks UnderweightNormalOverweightObesity Extreme obesity BMI (kg/m 2 ) <18.5 18.5 - 24.9 25.0 - 29.9 30.0 - 34.9 35.0 - 39.9 >40ObesityClassIIIIII Men (<102 cm) <40 in Women (<88 cm) <35 in ----IncreasedHigh Very High Extremely High Men (>102 cm) >40 in Women (>88 cm) >35 in ----High Very High Extremely High Disease Risk Relative to Normal Weight and Waist Circumference Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).

15. Metabolic Syndrome: Refined Criteria (IDF) Population Group Waist Circumference (inches) MenWomen USA (NCEP ATP III) >40 >35 European >37 >30.5 South Asian/ >35.5 >30.5 Chinese Japanese >33.5 >35.5

16. Body Composition (body fat) Skinfold Anthropometry Bioelectrical impedance analysis (BIA) Dual-energy x-ray absorptiometry (DEXA) Computed tomography (CT scan) —Abdominal visceral fat

17. Assessing Canine Obesity Optimal Overweight Obese BCS=5 BCS= 6-7 BCS = 8-9