The performance of anthropometric tools to determine obesity: a systematic review and meta-analysis

Abstract

The aim of this systematic review was to assess the performance of anthropometric tools to determine obesity in the general population (CRD42018086888). Our review included 32 studies. To detect obesity with body mass index (BMI), the meta-analyses rendered a sensitivity of 51.4% (95% CI 38.5-64.2%) and a specificity of 95.4% (95% CI 90.7-97.8%) in women, and 49.6% (95% CI 34.8-64.5%) and 97.3% (95% CI 92.1-99.1%), respectively, in men. For waist circumference (WC), the summary estimates for the sensitivity were 62.4% (95% CI 49.2-73.9%) and 88.1% for the specificity (95% CI 77.0-94.2%) in men, and 57.0% (95% CI 32.2-79.0%) and 94.8% (95% CI 85.8-98.2%), respectively, in women. The data were insufficient to pool the results for waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) but were similar to BMI and WC. In conclusion, BMI and WC have serious limitations for use as obesity screening tools in clinical practice despite their widespread use. No evidence supports that WHR and WHtR are more suitable than BMI or WC to assess body fat. However, due to the lack of more accurate and feasible alternatives, BMI and WC might still have a role as initial tools for assessing individuals for excess adiposity until new evidence emerges.

Figure 1

Flow chart of study selection process.

Figure 2

Summary ROC curve including summary point for Body Mass Index (BMI) in (A) Women (sensitivity: 51.4% [95%CI 38.5–64.2%]; specificity: 95.4% [95%CI 90.7–97.8%]) (B) Men (sensitivity: 49.6% [95% CI 34.8–64.5%]; specificity: 97.3% [95% CI 92.1–99.1%]) and for Waist Circumference (WC) in (C) Women (sensitivity: 62.4% [95% CI 49.2–73.9%] and for specificity 88.1% [95% CI 77.0–94.2%]) (D) men (sensitivity: 57.0% [95% CI 32.2–79.0] and for specificity 94.8% [95% CI 85.8–98.2%]).

Figure 3

Paired forest-plots of sensitivity and specificity for body mass index (BMI), waist circumference (WC), waist-to hip ratio (WHR), waist to height ratio (WHtR) in women; data not weighted; TP, true positives; FP, false positives, FN, false negatives; TN, true negatives.

Figure 4

Paired forest-plots of sensitivity and specificity for body mass index (BMI), waist circumference (WC), waist-to hip ratio (WHR), waist to height ratio (WHtR) in men; data not weighted; TP, true positives; FP, false positives, FN, false negatives; TN, true negatives.