Diseasespecific recommendations

Body mass index (BMI)

BMI can be used to estimate, albeit crudely, the prevalence of overweight and obesity within a population and the risks associated with it. It does not, however, account for the wide variations in obesity between different individuals and populations. The classification of overweight and obesity, according to BMI, is shown in Table 8.

Table 8

Classification of overweight in adults according to BMIa

Table 8

Classification of overweight in adults according to BMIa

Classification

BMI (kg/m2)

Risk of comorbidities

Underweight

<18.5

Low (but risk of other clinical problems

increased)

Normal range

18.5-24.9

Average

Overweight

525.0

Pre-obese

25.0-29.9

Increased

Obese class I

30.0-34.9

Moderate

Obese class II

35.0-39.9

Severe

Obese class III

540.0

Very severe

a These BMI values are age-Independent and the same for both sexes. However, BMI may not correspond to the same degree of fatness In different populations due, In part, to differences In body proportions. The table shows a simplistic relationship between BMI and the risk of comorbidity, which can be affected by a range of factors, including the nature and the risk of comorbidity, which can be affected by a range of factors, including the nature of the diet, ethnic group and activity level. The risks associated with increasing BMI are continuous and graded and begin at a BMI below 25. The interpretation of BMI gradings in relation to risk may differ for different populations. Both BMI and a measure of fat distribution (waist circumference or waist : hip ratio (WHR)) are important in calculating the risk of obesity comorbidities. Source: reference 26.

a These BMI values are age-Independent and the same for both sexes. However, BMI may not correspond to the same degree of fatness In different populations due, In part, to differences In body proportions. The table shows a simplistic relationship between BMI and the risk of comorbidity, which can be affected by a range of factors, including the nature and the risk of comorbidity, which can be affected by a range of factors, including the nature of the diet, ethnic group and activity level. The risks associated with increasing BMI are continuous and graded and begin at a BMI below 25. The interpretation of BMI gradings in relation to risk may differ for different populations. Both BMI and a measure of fat distribution (waist circumference or waist : hip ratio (WHR)) are important in calculating the risk of obesity comorbidities. Source: reference 26.

In recent years, different ranges of BMI cut-off points for overweight and obesity have been proposed, in particular for the Asia-Pacific region (27). At present available data on which to base definitive recommendations are sparse.1 Nevertheless, the consultation considered that, to achieve optimum health, the median BMI for the adult population should be in the range 21-23 kg/m2, while the goal for individuals should be to maintain BMI in the range 18.5-24.9 kg/m2.

Waist circumference

Waist circumference is a convenient and simple measure which is unrelated to height, correlates closely with BMI and the ratio of waist-to-hip circumference, and is an approximate index of intra-abdominal fat mass and total body fat. Furthermore, changes in waist circumference reflect changes in risk factors for cardiovascular disease and other forms of chronic diseases, even though the risks seem to vary in different populations. There is an increased risk of metabolic complications for men with a waist circumference 5102 cm, and women with a waist circumference 588 cm.

1 AWHO Expert Consultation on Appropriate BMI for Asian Populations and its Implications for Policy and Intervention Strategies was held in Singapore from 8 to 11 July 2002 in order to: (i) review the scientific evidence on the relationship between BMI, body composition and risk factors in Asian populations; (ii) examine if population specific BMI cut-off points for overweight and obesity are necessary for Asian populations; (iii) examine the purpose and basis of ethnic-specific definitions; and iv) examine further research needs in this area. As one of its recommendations, the Consultation formed a Working Group to examine available data on the relationship between waist circumference and morbidity, and the interaction between BMI, waist circumference and health risk in order to define future research needs and develop recommendations for the use of additional waist measurements to further define risks.

Physical activity

A total of one hour per day of moderate-intensity activity, such as walking on most days of the week, is probably needed to maintain a healthy body weight, particularly for people with sedentary occupations.2

Total energy intake

The fat and water content of foods are the main determinants of the energy density of the diet. A lower consumption of energy-dense (i.e. high-fat, high-sugars and high-starch) foods and energy-dense (i.e. high free sugars) drinks contributes to a reduction in total energy intake. Conversely, a higher intake of energy-dilute foods (i.e. vegetables and fruits) and foods high in NSP (i.e. wholegrain cereals) contributes to a reduction in total energy intake and an improvement in micronutrient intake. It should be noted, however, that very active groups who have diets high in vegetables, legumes, fruits and wholegrain cereals, may sustain a total fat intake of up to 35% without the risk of unhealthy weight gain.

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