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Chronic Condition Prevention: Where BMI Alone Falls Short

Obesity is a leading risk factor for many chronic conditions and the epidemic has grown in recent years. According to the 2015 Dietary Guidelines Advisory Committee, approximately two-thirds of American adults are overweight or obese. To curb this trend, organizations charged with managing population health must focus on identifying and reducing key indicators of weight risk. Today, as part of the Healthy People 2020 initiative, providers are encouraged to use body mass index (BMI) to initiate weight management interventions, but this metric has its limitations. BMI is a measure of weight to height ratio—it is not a direct measurement of fat and does not take into consideration the body composition of fat versus muscle.

How appropriate are the current BMI cut point values?

  • There is a positive association of elevated disease risk with BMI higher than 25.0 kg/m2
  • Overweight individuals (BMI 25.0 to 29.9 kg/m2) are not associated with elevated risk of all-cause mortality
  • Obese individuals (BMI >/= 30 kg/m2) do show an elevated risk of all-cause mortality
  • People of Asian descent show risk at lower cut points than other populations

What You See is What You Get: Central Adiposity

Because of the limitations of BMI calculations, understanding body size is an important clinical measure and it may provide a clearer picture of health risk. Understanding body size requires assessing body type (e.g. apple shape versus pear shape) by measuring hip to waist ratio and abdominal obesity by measuring waist circumference.

Excess visceral fats are predictive of metabolic abnormalities such as atherogenic dyslipidemia and insulin resistance, and increase the risk of developing cardiovascular disease and type 2 diabetes. Although waist circumference and hip to waist ratios may not show all incidences of visceral adiposity, there is a clear measurable correlation between visceral fat (seen on CT scan surrounding the internal organs in the abdominal cavity) and subcutaneous fat (measured via waist circumference).

Weight Risk Identification and Management Starts with You

Key Steps for Physicians:

To assess a more complete view of a patient’s weight and chronic disease risk, physicians should align their care processes with the goals and objectives outlined by the Health People 2020 program:

  • Measure BMI and waist circumference to identify dangerous abdominal fat
  • Detect poorly fit individuals who are at marked risk of cardiovascular disease based on:
    • Nutrition quality
    • Sedentary behaviors
  • The Scientific Report of the 2015 Dietary Guidelines Advisory Committee also suggests the importance of identifying individuals with dangerous levels of visceral fat.

Beyond identification of weight risk, patient engagement focused on improving lifestyle behaviors is a critical step toward preventing chronic disease. Although weight management has historically been an afterthought to medication management, new chronic disease guidelines now recommend lifestyle  changes as the primary treatment before initiating pharmacological interventions. These changes include increasing physical activity, improving nutrition, and obtaining ideal body weight. 

For more insight on weight risk support and intervention, read our recent blog post: Five Ways to Engage and Motivate Patients for Weight Loss.

Key Steps for Employers:

Providing easy and complimentary access to weight management information is an essential step to ensuring successful disease management. Ultimately, the upfront investment in prevention services will reap greater rewards in cost savings down the line:

  • Organize health fairs and offer screenings that combine both BMI and waist circumference measurements
  • Encourage the use of tools and resources that help employees better understand their risks; these include the American Heart Association’s Heart Attack Risk Calculator, which uses both BMI and waist circumference metrics
  • Educate on lifestyle change modifications and provide access to total population health programs that focus on obesity and chronic condition prevention and management. In addition to learning their particular health measurements (where they fall in the BMI screen for overweight or obesity levels) your employees need to be educated about their individual clinical needs (how body shape, apple vs. pear, effects their health and how abdominal fat contributes to higher risks regardless of BMI calculation), and offered support for behavior change management.

Employee engagement will also play a pivotal role in reducing weight risks across your workforce. Beyond educating patients and helping them to monitor their health stats, your health management programs should also motivate them with team health challenges, games or tools that encourage movement at work (such as a work out room, onsite yoga classes, or walking competitions), rewards and other incentives that may also help promote better nutrition and physical exercise.

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