Body mass index and waist-to-hip ratio misclassification of overweight and obesity in Chinese military personnel

Abstract

Background: The rising prevalence of obesity in military personnel has raised great concerns. Previous studies suggest that body mass index (BMI)-and waist-to-hip ratio (WHR)-based obesity classifications in US military personnel and firefighters have high false negative and subsequently cause obesity misclassification. Objective: To determine whether BMI and WHR could reflect the fat mass of Chinese military personnel. Methods: Three hundred fifty-three male Chinese military personnel and 380 age-matched male adults were recruited. Obesity classification was defined by BMI, WHR, and body fat percentage (BFP). Results: Chinese military personnel had extremely low obesity rate determined by either BFP (0.3%) or BMI (0.6%). By combining overweight and obese individuals, BMI-and WHR-determined prevalence of overweight/obesity was 22.4% and 17.0% compared to BFP-based standard (4.0%) (P < 0.05). In reference to BFP, BMI and WHR have high false-positive rate compared to the control group. Further analysis showed that Chinese military personnel consisted of high percentage of BFP low BMI high and/or BFP low WHR high subpopulations. Eighty-one percent of BMI high and 78.3% of WHR high of them were BFP low. Conclusions: Chinese military personnel has extremely low obesity rate. BMI and WHR have high false-positive rates in reference to BFP, which cannot accurately reflect the mass of adipose tissue and leads to obesity misclassification.

Assessment of Risk Factors for Development of Overweight and Obesity among Soldiers of Polish Armed Forces Participating in the National Health Programme 2016–2020

“…The selection of personnel was based on availability rather than on any particular characteristic associated with obesity. BMI alone may overdiagnose obesity because it does not take into account the real muscle mass, which is larger in soldiers than in the general population [ 29 , 31 ]. However, we used BMI to divide participants into groups to be consistent with the literature and to allow comparisons.…”

“…However, we used BMI to divide participants into groups to be consistent with the literature and to allow comparisons. It should be noted that soldiers in the obese range, but not in the overweight range, have an increased amount of body fat (e.g., [ 31 ]). Therefore, in the majority of our analyses, we compared soldiers at normal weight with soldiers with BMI exceeding 30 to minimize this bias.…”

“…Due to the fact that the effect of increased BMI may be related to expanded muscle mass (so-called muscular overweight), which is relatively common among soldiers [ 29 , 30 , 31 ], only groups with BMI corresponding to normal body weight and obesity were used to determine the odds ratio (OR) of BMI ≥ 30 for the risk factors in question. Overweight participants were not included in the analyses, as this group might have included participants with normal body fat and increased muscle mass.…”

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“…Moreover, a nationwide study of 6,833,744 Koreans with a median follow-up time of 7.30 years has indicated that abdominal obesity (defined as waist circumference ≥90 cm for men and 85 cm for women) is significantly associated with glioma risk, and the relationship was more pronounced in abdominal obesity with BMI >25 kg/m 2 ( 8 ). Compared with BMI, WHR is a more accurate surrogate marker for obesity because it measures the anatomic distribution of body fat and distinguishes between lean muscle mass and fat mass ( 22 ). Therefore, identification of the relationship between glioma risk and general and abdominal obesity is warranted in future studies.…”

The associations between body composition and vital capacity index of medical students in Shenyang of China: a cross-sectional survey

“…BMI was calculated as body weight (in kilograms) divided by the square of height (in metres), as shown in the following formula: BMI = weight (kg) / height (m) 2 . Based on Chinese National Standard of BMI Classification [ 27 ], a BMI lower or equal to 18.5 kg/m 2 is defined as underweight, between 18.5 kg/m 2 and 23.9 kg/m 2 is considered as normal weight for individuals. Overweight is defined as BMI between 24.0 and 27.9 kg/m 2 , and obesity is defined as BMI above 28.0 kg/m 2 .…”