Fat Assessment in Adults

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^W eight assessment is a dynamic process by which the weight status of an individual or a group is evaluated. The process is considered dynamic because weight in terms of pounds may not be enough to predict health risks. However, this process enables a clinician or individual to identify risks and determine appropriate intervention. There are many measures used in weight assessment, all aiming to provide similar information.

Body Mass Index (BMI) is a number calculated from a person's weight and height, indicating presence of obesity and highly correlated with body fat and health risk. As BMI increases so does the risk of morbidity and mortality. BMI can be used to determine a "healthy weight" range for an individual or health risk, which is increased in persons with conditions such as diabetes, hypertension, or cardiovascular disease. BMI is a mathematical value calculated by weight in kilograms divided by height in meters squared (kg/m2). The BMI value corresponds to a certain obesity class, applicable to both men and women:

BMI

Obesity Class

18.5

Underweight

18.5-24.9

Normal weight

25.0-29.9

Overweight

30-34.9

Obesity (Grade I)

3 5-39.9

Obesity (Grade II)

40

Severe Obesity (Grade III)

Even though BMI is considered a good estimate of body fat, it does misclassify elite athletes and bodybuilders as obese. Therefore, other measures have been created to better estimate body fat. Waist circumference (WC) is another measure that indicates an individual's relative risk for obesity related diseases. The indicator for obesity for males is a WC greater than 101.5 cm and for females a WC greater than 88.9 cm, and individuals with excess abdominal fat are at an increased risk for Type-2 diabetes, dyslipidemia, hypertension, and cardiovascular disease. WC is a specific measure of abdominal obesity, which is a stronger risk factor for many chronic diseases than other types of obesity. To determine WC, measure the circumference around the upper hipbone. The tape measure should be snug, but should not cause compressions on the skin. Measuring waist circumference is an inexpensive, convenient, and noninvasive method for estimating abdominal fat before and during weight-loss treatment.

Anthropometrics is a method used to establish whether BMI indicates muscle or fat. Common methods include measurements of wrist circumference and elbow breadth, which serve as criteria to determine body frame size. Frame size, useful in determining appropriate ranges of desirable body weight, is then calculated by dividing height by wrist circumference. Some people may find that they may have to lose more or less weight than they were originally led to believe since each person's bone structure and frame varies in size and density. Wrist circumference is measured at the bones of the wrist.

Men Women

Large (cm)

When using elbow breadth measurement, the height corresponds with elbow breadth. The ranges fall in small frame (< range), medium frame (within range) and, large frame (> range):

Men Height

5'3"-5'6" 5V-5'10" 5'ii"-6'2" 6'4"

Women Height

Elbow Breadth (cm) 6.35-7.30

Elbow Breadth (cm) 5.73-7.30 5.73-7.30 6.03-6.67 6.03-6.67 6.35-6.98

In addition to the weight and length measures used to determine a person's weight, there are also ways to calculate body fat. Five common ways to calculate body fat are the bio-electric impedance, underwater weighing, bod pod, magnetic resonance imaging (MRI), and skin folds measures. Each of these measures has strengths and weaknesses in determining body fat. For example, MRI is considered the gold standard in terms of measuring abdominal obesity but costs thousands of times more than skin folds measures. And although either underwater weighing or the bod pod are considered the most accurate in terms of measuring total body fat, both are very invasive to the individual being tested. They involve taking off all one's clothes apart from a bathing suit or undergarments and then either submersing oneself in water (after exhaling all the air in the lungs) or lying in a confined space for anywhere from three to five minutes. Even though MRI, underwater weighing, and the "bod pod" are considered the gold standards for fat assessment, they are rarely used to measure fat because of cost and logistics. Therefore, even though skin folds and BMI (Body-Mass Index) are not nearly as accurate as the gold standards, they are far more commonly used.

Ever since Louis Dublin showed that weight is a strong risk factor for death, people have been trying to figure out if all weight is bad. In the later part of the twentieth century, it was believed that it was not weight alone that contributed to the increased risk but rather percentage of body fat. It is now believed that it is not just percentage of body fat but rather type and quantity of "bad" or abdominal fat that matters. As new ways of quantifying and qualifying fat become available, the definition will likely continue to evolve.

SLG/Rakhi Patel

See also Brillat-Savarin; Dublin

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