Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T08:28:37.118Z Has data issue: false hasContentIssue false
  • English
  • Français

Obesity: criteria and classification*

Published online by Cambridge University Press:  24 January 2013

F. Xavier Pi-Sunyer
F. Xavier Pi-Sunyer*
Affiliation:
Obesity Research Center, St Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA
*
Corresponding author: Dr F. Xavier Pi-Sunyer, fax +1 212 523 4830, email fxp1@columbia.edu
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Obesity is defined as an excess accumulation of body fat. To measure fat in the body accurately is difficult, and no method is easily available for routine clinical use. Traditionally, overweight and obesity have been evaluated by anthropometric measurement of weight-for-height. More recently, BMI has been used. The normal range is 19–24·9 kg/m2, overweight is 25–29·9 kg/m2, and obesity ≥ 30 kg/m2. Not only is the total amount of fat an individual carries important, but also where the fat is distributed in the body. Fat in a central or upper body (android) distribution is most related to health risk. The most accurate way to measure central obesity is by magnetic resonance imaging or computer-assisted tomography scanning, but this approach is too expensive for routine use. Simple anthropometric measurements can be used, such as waist circumference. A waist circumference of greater than 1020 mm in men and 880 mm in women is a risk factor for insulin resistance, diabetes mellitus and cardiovascular disease. There is a clear genetic predisposition for obesity. The genetic contribution to obesity is between 25 and 40 % of the individual differences in BMI. For the overwhelming majority of individuals, the genetic predisposition will not be defined by one gene, but by multiple genes. Eventually, classification of obesity may be done by genetic means, but this approach will require more knowledge.

Keywords

ObesityBody fatGenetic predisposition
Type
Symposium on ‘Body weight regulation and obesity: metabolic and clinical aspects’ - 1st Plenary Session: ‘Obesity’
Information
Proceedings of the Nutrition Society , Volume 59 , Issue 4 , November 2000 , pp. 505 - 509
Copyright
Copyright © The Nutrition Society 2000

Footnotes

*

The other papers presented at this meeting were published in Proceedings of the Nutrition Society (2000) 59 no. 3.

References

Abate, N, Garg, A, Peshock, RM, Adams-Huet, B & Grundy, SM (1996) Relationship of generalized and regional adiposity to insulin sensitivity in men with NIDDM. Diabetes 45, 1684–1693.Google Scholar
Albu, JB, Murphy, L, Frager, DH, Johnson, JA & Pi-Sunyer, FX (1997) Visceral fat and race-dependent health risks in obese nondiabetic premenopausal women. Diabetes 46, 456–462.CrossRefGoogle ScholarPubMed
Allison, DB, Mentore, JM, Heo, M, Chandler, LP, Cappelleri, JC, Infante, MC & Weiden, PJ (1999 a) Meta-analysis of the effects of anti-psychotic medication on weight gain. American Journal of Psychiatry 156, 1686–1696.CrossRefGoogle Scholar
Allison, DB, Zannolli, R, Faith, MS, Heo, M, Pietrobelli, A, VanItallie, TB, Pi-Sunyer, FX & Heymsfield, SB (1999 b) Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. International Journal of Obesity and Related Metabolic Disorders 23, 603–611.CrossRefGoogle ScholarPubMed
Argyropoulos, G, Brown, AM, Willi, SM, Zhu, J, Reitman, M, Gevao, AM, Spruill, I & Garvey, WT (1998) Effects of mutations in the human uncoupling protein 3 gene on the respiratory quotient and fat oxidation in severe obesity and type 2 diabetes. Journal of Clinical Investigation 102, 1345–1351.CrossRefGoogle ScholarPubMed
Bouchard, C (editor) (1994) Genetics of obesity: overview and research direction. In Genetics of Obesity, pp. 223–233. Boca Raton, FL: CRC Press.Google Scholar
Björntorp, P (1993) Visceral obesity: a 'civilization' syndrome. Obesity Research 1, 206–222.CrossRefGoogle ScholarPubMed
Bray, GA (1998) Contemporary Diagnosis and Management of Obesity. Newton, PA: Handbooks in Health Care.Google Scholar
Bray, GA & Gallagher, TF Jr (1975) Manifestations of hypothalamic obesity in man: a comprehensive investigation of eight patients and a review of the literature. Medicine 54, 301–330.CrossRefGoogle Scholar
Clément, K, Vaisse, C, Lahlou, N, Cabrol, S, Pelloux, V, Cassuto, D, Gourmelen, M, Dina, C, Chambaz, J, Lacorte, JM, Basdevant, A, Bougneres, P, Lebouc, Y, Froguel, P & Guy-Grand, B (1998) A mutation in the human leptin receptor gene causes obesity and pituitary dysfunction. Nature 392, 398–401.Google Scholar
Després, JP, Nadeau, A, Tremblay, A, Ferland, M, Moorjani, S, Lupien, PJ, Theriault, G, Pinault, S & Bouchard, C (1989) Role of deep abdominal fat in the association between regional adipose tissue distribution and glucose tolerance in obese women. Diabetes 38, 304–309.Google Scholar
Dilmanian, FA, Weber, DA, Yasumura, S, Kamen, Y, Lidofsky, L, Heymsfield, SB, Pierson, RN Jr, Wang, J, Kehayias, JJ & Ellis, KJ (1990) The performance of the delayed- and promptgamma neutron activation systems at Brookhaven National Laboratory. In In Vivo Body Composition Studies. Recent Advances, pp. 309–316[Yasumura, S, Harrison, JE, NcNeill, KG, Woodhead, AD and Dilmanian, FA, editors\. New York: Plenum Press.Google Scholar
Durnin, JV & Womersley, J (1974) Body fat assessed from total body density and its estimation from skinfold thickness measurements on 481 men and women aged from 16 to 72 years. British Journal of Nutrition 32, 77–97.Google Scholar
Flegal, KM, Troiano, RP, Pamuk, ER, Kuczmarski, RJ & Campbell, SM (1995) The influence of smoking cessation on the prevalence of overweight in the United States. New England Journal of Medicine 333, 1165–1170.CrossRefGoogle ScholarPubMed
Fujimoto, WY, Bergstrom, RW, Boyko, EJ, Leonetti, DL, Newell-Morris, LL & Wahl, PW (1995) Susceptibility to development of central adiposity among populations. Obesity Research 3, 179s–186s.Google Scholar
Gallagher, D, Visser, M, Sepulveda, D, Pierson, RN, Harris, T & Heymsfield, SB (1996) Body mass index as an estimate of fatness across gender, age, sex, and ethnic groups. American Journal of Epidemiology 143, 228–239.CrossRefGoogle Scholar
Garrow, JS & Webster, J (1985) Quetelet's index (W/H2) as a measure of fatness. International Journal of Obesity 9, 147–153.Google Scholar
Goodsitt, MM (1992) Evaluation of a new set of calibration standards for the measurement of fat content via DPA and DXA. Medical Physics 19, 35–44.CrossRefGoogle ScholarPubMed
Gotfrensen, A, Jensen, J, Borg, J & Christiansen, C (1986) Measurement of lean body mass and total body fat using dual photon absorptiometry. Metabolism 35, 88–93.CrossRefGoogle Scholar
Haarbo, J, Marslew, U, Gotfredsen, A & Christiansen, C (1985) Postmenopausal hormone replacement therapy prevents central distribution of body fat after menopause. Metabolism 40, 1323–1326.CrossRefGoogle Scholar
Haffner, SM, Mitchell, BD, Hazuda, HP & Stern, MP (1991) Greater influence of central distribution of adipose tissue on incidence of non-insulin-dependent diabetes in women than men. American Journal of Clinical Nutrition 53, 1312–1317.CrossRefGoogle ScholarPubMed
Lamberti, JS, Bellnier, T & Schwartzkopf, SB (1992) Weight gain among schizophrenic patients treated with clozapine. American Journal of Psychiatry 149, 689–690.Google Scholar
Larsson, BK, Svarsudd, L, Welin, L, Wilhemsen, L, Björntorp, P & Tibblin, G (1984) Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. British Medical Journal 288, 1401–1404.CrossRefGoogle Scholar
Lemieux, S, Prud'homme, D, Bouchard, C, Tremblay, A & Després, J (1996) A single threshold value of waist girth identifies normal-weight and overweight subjects with excess visceral adipose tissue. American Journal of Clinical Nutrition 64, 685–693.Google Scholar
Lindsted, K, Tonstad, S & Kuzma, JW (1991) Body mass index and patterns of mortality among Seventh-Day Adventist men. International Journal of Obesity and Related Metabolic Disorders 15, 397–406.Google Scholar
Lohman, TG (1981) Skinfolds and body density and their relation to body fatness: a review. Human Biology 53, 181–225.Google Scholar
Manson, JE, Willet, WC, Stampfer, MJ, Colditz, GA, Hunter, DJ, Hankinson, SE, Hennekens, CH & Speizer, FE (1995) Body weight and mortality among women. New England Journal of Medicine 333, 677–685.Google Scholar
Marcus, MA, Wang, J, Pi-Sunyer, FX, Thornton, JC, Kofoloulo, I & Pierson, RN Jr (1998) Effects of ethnicity, gender, obesity, and age on central fat distribution: comparison of dual x-ray absorptiometry measurements in white, black, and Puerto Rican adults. American Journal of Human Biology 10, 361–369.Google Scholar
Mazess, RB, Chestnut, CH, McClung, M & Genant, H (1992) Enhanced precision with dual-energy X-ray absorptiometry. Calcific Tissue International 51, 14–17.CrossRefGoogle ScholarPubMed
Metropolitan Life Insurance Company (1983) Metropolitan height and weight tables. Statistical Bulletin of Metropolitan Life Insurance Company 64–69.Google Scholar
Montague, CT, Farooqui, IS, Whitehead, JP, Soos, MA, Rau, H, Wareham, NJ, Sewter, CP, Digby, JE, Mohammed, SN, Hurst, JA, Cheetham, CH, Earley, AR, Barnett, AH, Prins, JB & O'Rahilly, S (1997) Congenital leptin deficiency is associated with severe early-onset obesity in humans. Nature 387, 903–908.CrossRefGoogle ScholarPubMed
Najjar, MF & Rowland, M (1987) Anthropometric Reference Data and Prevalence of Overweight. Vital and Health Statistics Series 11, no. 238. DHEW Publication no. (PHS) 7–1688. Washington, DC: US Government Printing Office.Google Scholar
National Institutes of Health (1998) Clinical guidelines on theidentification, evaluation, and treatment of overweight and obesity in adults – the evidence report. Obesity Research 6, Suppl. 2, 51s–209s.Google Scholar
Nuñez, C, Kovera, AJ, Pietrobelli, A, Heshka, S, Horlick, M, Kehayias, JJ, Wang, Z & Heymsfield, SB (1999) Body composition in children and adults by air displacement plethysmography. European Journal of Clinical Nutrition 53, 382–387.Google Scholar
Ohlson, LO, Larsson, B, Svardsudd, K, Welin, L, Eriksson, H, Wilhelmson, L, Björntorp, P & Tibblin, G (1985) The influence of body fat distribution on the incidence of diabetes mellitus, 13.5 years of follow-up of the participants of the study of men born in 1913. Diabetes 34, 1055–1058.Google Scholar
Pierson, RN Jr, Wang, J, Colt, E & Neumann, P (1982) Bodycomposition measurements in normal men: the potassium, sodium, sulfate, and tritium space in 58 adults. Journal of Chronic Disease 35, 419–428.Google Scholar
Pi-Sunyer, FX (1993) Medical hazards of obesity. Annals of Internal Medicine 119, 655–660.Google Scholar
Quetelet, LAJ (1871) Anthropométrie ou Mesure des Différentes Facultés de l'Homme (Anthropometry or Measurement of Different Characteristics of Man), p. 479. Brussels: Muquerdt.Google Scholar
Ristow, M, Muller-Wieland, D, Pfeiffer, A, Krone, W & Kahn, CR (1998) Obesity associated with a mutation in a genetic regulator of adipocyte differentiation. New England Journal of Medicine 339, 953–959.Google Scholar
Schoeller, DA (1996) Hydrometry. In Human Body Composition, pp. 25–44 [Roche, AF, Heymsfield, SB and Lohman, TG, editors]. Champaign, IL: Human Kinetics.Google ScholarPubMed
Segal, KR, Gutin, B, Albu, J, Nyman, A & Pi-Sunyer, FX (1987) Body composition not body weight is related to cardiovascular disease risk factors and sex hormone levels in men. Journal of Clinical Investigation 80, 1050–1055.CrossRefGoogle Scholar
Segal, KR, Gutin, B, Presta, E, Wang, J & VanItallie, TB (1985) Estimation of human body composition by electrical impedance methods: a comparative study. Journal of Applied Physiology 58, 1565–1571.Google Scholar
Seidell, JC, Deurenberg, P & Hautvast, JGAJ (1987) Obesity and fat distribution in relation to health-current insights andrecommendations. World Review of Nutrition and Dietetics 50, 57–91.Google Scholar
Stanton, JM (1995) Weight gain associated with neurolepticmedication: a review. Schizophrenia Bulletin 21, 463–472.CrossRefGoogle ScholarPubMed
Troiano, RP, Frongillo, EA Jr, Sobal, J & Levitsky, DA (1996) The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies. International Journal of Obesity and Related Metabolic Disorders 20, 63–75.Google Scholar
UK Prospective Diabetes Study Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352, 837–853.Google Scholar
Walston, J, Silver, K, Bogardus, C, Knowler, WC, Celi, FS, Austin, S, Manning, B, Strosberg, AD, Stern, MP & Raben, N (1995) Time of onset of non-insulin-dependent diabetes mellitus and genetic variation in the beta3-adrenergic-receptor gene. New England Journal of Medicine 333, 343–347.Google Scholar
World Health Organization (1997). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva: WHO.Google Scholar
Zumoff, B, Strain, GW, Miller, LK, Rosner, W, Senie, R, Seres, DS & Rosenfeld, RS (1990) Plasma free and non-sex-hormone-binding-globulin-bound testosterone are decreased in obese men in proportion to their degree of obesity. Journal of ClinicalEndocrinology and Metabolism 71, 929–931.CrossRefGoogle ScholarPubMed