Obesity Epidemic in America Found Significantly Worse Than Previously Believed
Apr 2, 2012 - 5:37:54 PM
Body Mass Index (BMI) Formula Inaccurate, Revolutionary Leptin-Based Blood Test Can Measure Obesity
(HealthNewsDigest.com) -NEW YORK, April 2, 2012 – The scope of the obesity epidemic in the United States has been grossly underestimated, according to a study by Eric R. Braverman, M.D. and Nirav Shah, M.D., M.P.H. published in the journal PLoS ONE today. Researchers found that the Body Mass Index (BMI) formula substantially under-diagnosed obesity when compared to the Dual-energy X-ray Absorptiometry (DXA) scan, a direct simultaneous measure of body fat, muscle mass and bone density. The researchers also derived a leptin-revised BMI estimate of body fat for clinical use in the absence of DXA.
As co-authors of the study, Dr. Shah and Dr. Braverman recognize the convenience, safety and low cost of the BMI formula, yet agree that it is an outdated mathematical equation which needs to evolve in order to correctly evaluate body fat. The study suggests that adjusting the BMI will have broad population health implications, since obesity contributes to multiple co-morbidities such as coronary heart disease, hypertension and diabetes.
“These estimates are fundamental to U.S. policy addressing the epidemic of obesity and are central to designing interventions aimed at curbing its growth, yet current policies may be flawed because they are based on the BMI,” say authors Dr. Shah and Dr. Braverman. “Obesity, body fat and increased adiposity are more prevalent than the American public and physicians are aware of.”
The principle findings of the study suggest that as many as 39 percent of Americans who are classified as overweight are actually obese by adiposity measures. Misclassification occurred more frequently in women than in men and was exacerbated by increasing age. The disparity is particularly significant for women of advancing age, those with high blood leptin levels, and the normal weight obese (NWO). Hyperleptinemia (over-active leptin) of aging explains why diets fail Americans who are eating fewer calories as they age but are still gaining weight.
Leptin is the first blood test useful in the diagnosis and treatment of obesity. Changing and lowering leptin will lead to permanent weight loss. Furthermore, as leptin levels rise significantly, obesity may become irreversible, calling for the public health need for early leptin measurement. The public health crisis of obesity, like diabetes, requires earlier and earlier detection. America's obese children and young adults need a leptin measurement. Dr. Braverman has created a leptin-adjusted BMI table that can be utilized throughout the country.
“Adiposity and hyperleptinemia are more significant than BMI in predicting high risk obesity,” say authors Dr. Shah and Dr. Braverman.
Patients with hyperleptinemic states can be corrected by a variety of hormones, nutrients, medication, and lifestyle changes. Dopaminergic transmission also may suppress hyperleptinemia.
“The BMI formula is an insensitive measure of obesity prone to under-diagnosis, while direct fat measurements are superior because they show distribution of body fat,” Dr. Braverman added. Prior publications, such as JAMA, declared that, “BMI was not a good measure of fatness or of the risks obesity posed to an individual patient.” This work provides a BMI leptin-adjusted solution and a revised definition of obesity of BMI > 24 for females and BMI > 28 for males, rather than BMI > 30 as in use today.
“The Healthy People 2010 goal was to reduce rates of obesity (defined using BMI > 30) from 23% in 1988-1994 to the target of 15%. Not only was this goal unmet, but in light of this data we may be much further behind than we thought,” say Dr. Shah and Dr. Braverman. “The American Society of Bariatric Physicians is using both BMI and DXA as criteria for interventions, and this may be a reasonable transition in public health policy.”
Weill/Cornell Medical College Department of Neurosurgery will host Dr. Eric R. Braverman, M.D., Dr. Nirav Shah, M.D. (as permitted) and Nora Volkow, M.D., Director of the National Institute on Drug Abuse, on April 4th, 2012 to discuss the findings further at:
Rockefeller Research Laboratory.
430 East 67th Sreet (between 1st/York Avenue)
10:00am – 12:30pm
Nirav Shah, M.D., M.P.H is the current New York State Commissioner of Health. At the time the research was completed he was Assistant Professor in the Department of Medicine at New York University School of Medicine.
Eric Braverman, M.D. is the Founder and President of PATH Foundation NY and PATH Medical, a non-profit devoted to establishing how the brain functions and developing practical diagnostic and treatment methods that improve well-being and increase longevity.
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