Normal Weight Obesity – a myth or a reality?

Introduction

There is a widely prevalent myth amongst the populace that normal body weight always equals healthy weight and they do not need to worry about practising healthy lifestyle behaviours. However, nothing could be further from the truth. Normal weight obesity is well recognised entity. In my post “What is obesity – is it merely about BMI?” What is obesity? obesity had been defined as “excessive body fat accumulation (not weighing too much), which is associated with clear risks to health.” Surprisingly, even though obesity has been defined as the presence of ‘excess’ fat, there is no consensus on how to define obesity based on body fat content or body fat percentage.

WHO has established Body Mass Index (BMI) as the parameter for identifying overweight and obesity. Because of its simplicity, it has become a popular tool for assessing the prevalence of obesity and overweight at the population level. However, BMI has some serious limitations which will be discussed in detail in a subsequent post. The main limitation of BMI is that it cannot differentiate body fat from lean (fat-free) mass and central (intra-abdominal fat or visceral fat; colloquially known as belly fat) from peripheral fat. As a result, current BMI criteria miss more than half of the individuals with increased body fat percentage, who would otherwise be categorised as ‘obese’ using the WHO criteria of excess body fat, especially in older adults.

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What is obesity – is it merely about BMI?

Introduction

In my earlier post “Is obesity a disease or a risk factor for other conditions”? I had highlighted that now obesity is recognised universally as ‘a chronic, relapsing, progressive disease process.’ However, misconceptions still abound about ‘what is obesity’, not only in the public at large but even among the health professionals. Traditionally, when talking about what is obesity, we tend to erroneously confuse how we measure obesity with the definition of obesity. One such popular and well-known measure of obesity, which will be discussed subsequently, is Body Mass Index (BMI). BMI However, obesity is not about BMI; at its most basic, the term obesity describes the presence of ‘excess’ fat in the body. 

Definition of obesity

In the year 1998, WHO defined obesity as under:

“A condition of abnormal or excessive body fat accumulation, to the extent that health may be impaired.”

In the year 2010, Scottish Intercollegiate Guidelines Network, part of the NHS Quality Improvement Scotland, described obesity as under:

“Obesity is defined as a disease process characterised by excessive body fat accumulation with multiple organ-specific consequences.”

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