Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012
International journal of obesity (2005) | 5 Feb 2016
AJ Tomiyama, JM Hunger, J Nguyen-Cuu and C Wells
The United States (US) Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30% of health insurance costs if they fail to meet ‘health’ criteria such as reaching a specified Body Mass Index (BMI). Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40 420) were individuals aged 18+ in the nationally representative 2005-2012 National Health and Nutrition Examination Survey (NHANES). Using blood pressure, triglyceride, cholesterol, glucose, insulin resistance, and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI. Nearly half of overweight individuals, 29% of obese individuals, and even 16% of obesity type II/III individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy. There was no significant race x BMI interaction, but there was a significant gender x BMI interaction, F(4,64)=3.812, P=0.008. Using BMI categories as the main indicator of health, an estimated 74 936 678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health.International Journal of Obesity accepted article preview online, 04 February 2016. doi:10.1038/ijo.2016.17.
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