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Clinical Studies and Practice

Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004

International Journal of Obesity volume 40, pages 761–767 (2016)Cite this article

Subjects

Abstract

Background:

Body composition changes with aging lead to increased adiposity and decreased muscle mass, making the diagnosis of obesity challenging. Conventional anthropometry, including body mass index (BMI), while easy to use clinically may misrepresent adiposity. We determined the diagnostic accuracy of BMI using dual-energy X-ray absorptiometry (DEXA) in assessing the degree of obesity in older adults.

Methods:

The National Health and Nutrition Examination Surveys 1999–2004 were used to identify adults aged ⩾60 years with DEXA measures. They were categorized (yes/no) as having elevated body fat by gender (men: ⩾25%; women ⩾35%) and by BMI ⩾25 and ⩾30 kg m−2. The diagnostic performance of BMI was assessed. Metabolic characteristics were compared in discordant cases of BMI/body fat. Weighting and analyses were performed per NHANES (National Health and Nutrition Examination Survey) guidelines.

Results:

We identified 4984 subjects (men: 2453; women: 2531). Mean BMI and % body fat was 28.0 kg m−2 and 30.8% in men, and 28.5 kg m−2 and 42.1% in women. A BMI ⩾30 kg m−2 had a low sensitivity and moderately high specificity (men: 32.9 and 80.8%, concordance index 0.66; women: 38.5 and 78.5%, concordance 0.69) correctly classifying 41.0 and 45.1% of obese subjects. A BMI ⩾25 kg m−2 had a moderately high sensitivity and specificity (men: 80.7 and 99.6%, concordance 0.81; women: 76.9 and 98.8%, concordance 0.84) correctly classifying 80.8 and 78.5% of obese subjects. In subjects with BMI <30 kg m−2, body fat was considered elevated in 67.1% and 61.5% of men and women, respectively. For a BMI ⩾30 kg m−2, sensitivity drops from 40.3% to 14.5% and 44.5% to 23.4%, whereas specificity remains elevated (>98%), in men and women, respectively, in those 60–69.9 years to subjects aged ⩾80 years. Correct classification of obesity using a cutoff of 30 kg m−2 drops from 48.1 to 23.9% and 49.0 to 19.6%, in men and women in these two age groups.

Conclusions:

Traditional measures poorly identify obesity in the elderly. In older adults, BMI may be a suboptimal marker for adiposity.

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Acknowledgements

This work was supported in part by the Dartmouth Health Promotion and Disease Prevention Research Center, which was supported by Cooperative Agreement Number U48DP005018 from the Centers for Disease Control and Prevention. The findings and conclusions in this journal article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Dr Batsis receives funding from Health Resources Services Administration (UB4HP19206-01-00) for medical geriatric teaching, the Junior Faculty Career Development Award, the Department of Medicine, Dartmouth-Hitchcock Medical Center and the Dartmouth Centers for Health and Aging. Dr Bartels receives funding from the National Institute of Mental Health (K12 HS0217695 (AHRQ), NIMH: T32 MH073553, R01 MH078052, R01 MH089811; R24 MH102794 CDC U48DP005018. Dr Somers receives funding from NHLBI: R01 HL114676-02; R01 HL114024-03; R01 HL065176-12. Dr Lopez-Jimenez: N/A. Dr Mackenzie/Sahakyan: N/A.

Author contributions

Dr Batsis—conception, design, acquisition, analysis, interpretation of data, drafted manuscript, statistical analysis, and material support and obtaining funding; Dr Mackenzie—conception, design, acquisition, analysis, interpretation of data, critical revision of the manuscript for important intellectual content, statistical analysis and supervision; Dr Bartels—conception, design, interpretation of data, critical revision of the manuscript for important intellectual content, administrative, technical or material support and supervision; Dr Sahakyan—interpretation of data, critical revision of the manuscript for important intellectual content, administrative, technical or material support; Dr Somers—interpretation of data, critical revision of the manuscript for important intellectual content, administrative, technical or material support and supervision; Dr Lopez-Jimenez—conception, design, analysis, interpretation of data, critical revision of the manuscript for important intellectual content, administrative, technical or material support and supervision. Drs Batsis and Mackenzie had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    J A Batsis

  2. Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA

    J A Batsis, T A Mackenzie & S J Bartels

  3. Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA

    J A Batsis & S J Bartels

  4. Health Promotion Research Center at Dartmouth, Lebanon, NH, USA

    J A Batsis & S J Bartels

  5. Dartmouth Weight and Wellness Center, Lebanon, NH, USA

    J A Batsis

  6. Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    K R Sahakyan, V K Somers & F Lopez-Jimenez

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  1. J A Batsis
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Correspondence to J A Batsis.

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Additional information

Work presented at the 2015 Gerontological Society of America Conference, Orlando, FL, USA.

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Batsis, J., Mackenzie, T., Bartels, S. et al. Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004. Int J Obes 40, 761–767 (2016). https://doi.org/10.1038/ijo.2015.243

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