Comparison of the classification of obesity by BMI vs. dual-energy X-ray absorptiometry in the Newfoundland population

Abstract

Although BMI is the most widely used measure of obesity, debate still exists on how accurately BMI defines obesity. In this study, adiposity status defined by BMI and dual-energy X-ray absorptiometry (DXA) was compared in a large population to evaluate the accuracy of BMI. A total of 1,691 adult volunteers from Newfoundland and Labrador participated in the study. BMI and body fat percentage (%BF) were measured for all subjects following a 12-h fasting period. Subjects were categorized as underweight (UW), normal weight (NW), overweight (OW), or obese (OB) based on BMI and %BF criteria. Differences between the two methods were compared within gender and by age-groups. According to BMI criteria, 1.2% of women were classified as UW, 44.2% as NW, 34.2% as OW, and 20.3% as OB. When women were classified according to %BF criteria, 2.2% were UW, 29.6% were NW, 30.9% were OW, and 37.1% were OB. The overall discrepancy between the two methods for women was substantial at 34.7% (14.6% for NW and 16.8% for OB, P < 0.001). In men, the overall discrepancy was 35.2% between BMI and DXA (17.6% for OW and 13.5% for OB, P < 0.001). Misclassification by BMI was dependent on age, gender, and adiposity status. In conclusion, BMI misclassified adiposity status in approximately one-third of women and men compared with DXA. Caution should be taken when BMI is used in clinical and scientific research as well as clinical practice.