Assessing Adiposity

Abstract

T he prevalence of obesity in the United States and the world has risen to epidemic/pandemic proportions. This increase has occurred despite great efforts by healthcare providers and consumers alike to improve the health-related behaviors of the population and a tremendous push from the scientific community to better understand the pathophysiology of obesity. This epidemic is all the more concerning given the clear association between excess adiposity and adverse health consequences such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The risks associated with overweight/obesity are primarily related to the deposition of adipose tissue, which leads to excess adiposity or body fatness. Furthermore, weight loss, specifically loss of body fat, is associated with improvement in obesity-related comorbidities. Before weight loss interventions can be recommended, however, patients must be assessed for their adiposity-related risk. Unfortunately, healthcare providers and systems have not done a good job of assessing for excess adiposity even in its simplest form, such as measuring body mass index (BMI). It is for these reasons that we must emphasize the importance of assessing adiposity in clinical practices. Although it can be argued that the entire population should be targeted as an important public health issue with a goal of prevention of weight gain and obesity, there are currently so many "at risk" individuals that simple strategies to identify and treat those individuals are necessary. We must identify those individuals at highest risk of comorbidities in order to identify those who might benefit the most from aggressive weight management.This scientific statement will first briefly review the epidemiology of obesity and its related comorbidities, supporting the need for improved assessment of adiposity in daily clinical practice. This will be followed by a discussion of some of the challenges and issues associated with assessing adiposity and then by a review of the methods available for assessing adiposity in adults. Finally, practical recommendations for the clinician in practice will be given with a goal of identifying more at-risk overweight/obese individuals.

Patterns of weight change and progression to overweight and obesity differ in men and women: implications for research and interventions

“…A striking result from the study was the emergence of abdominal obesity, which increases risk of many chronic diseases independently of total adiposity (11)(12)(13) , particularly among women during follow-up. While weight gain might be expected, presence of abdominal obesity is among the first indications of detrimental metabolic changes.…”

“…Evidence mainly from Caucasian populations and cross-sectional studies indicates that abdominal obesity (waist circumference (WC): men $102 cm; women $88 cm), which affects approximately two-fifths (men: 29 %; women: 48 %) of adults worldwide (9) and 53 % of US adults (10) , may be of greater importance in increasing morbidity and mortality risk than total obesity (11)(12)(13) . Additionally, abdominal obesity is a key component of the metabolic syndrome, a clustering of cardiometabolic risk factors which includes abdominal obesity, hypertension, low HDL-cholesterol, hypertriacylglycerolaemia and hyperglycaemia (14) .…”

Proposed cut‐off values of the waist circumference for metabolic syndrome based on visceral fat volume in a Japanese population

“…Although the VFA at the umbilicus has been widely used to identify visceral obesity13, 14, 15, 16, 17, 18, 19, we previously showed that the maximal VFA was not at the umbilicus, but was widely distributed from L1 to L520, 21.…”

“…In contrast, the Japan Society for the Study of Obesity (JASSO) has recommended that the appropriate cut‐off values of WC for detecting visceral obesity are 85 cm in Japanese men and 90 cm in Japanese women from the general population12, and these values are widely used for diagnosis of MetS in Japan. As the JASSO cut‐off value of WC is higher for women than men, unlike the criteria used in other Asian countries, reassessment of the cut‐off values for Japanese persons has been carried out previously, and different values have been proposed13, 14, 15, 16, 17, 18, 19. However, these previous Japanese studies were based on WC and/or the visceral fat area (VFA) at the umbilicus determined by CT scanning.…”

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012–2013 Medical Expenditures Panel Survey

“…In 2011, the estimated annual direct cost for CVD and stroke in the United States was about $196 billion 1. Incidence, associated morbidity, disability, mortality, and healthcare costs have been shown to depend largely on modifiable risk factors (MRFs) for CVD 3, 4, 5, 6…”