Measuring Adiposity in Patients: The Utility of Body Mass
Index (BMI), Percent Body Fat, and Leptin
Nirav R. Shah1.¤, Eric R. Braverman2,3*.
1Department of Medicine, New York University School of Medicine, New York, New York, United States of America, 2PATH Foundation NY, New York, New York, United
States of America, 3Department of Neurosurgery, Weill-Cornell Medical College, New York, New York, United States of America
Background: Obesity is a serious disease that is associated with an increased risk of diabetes, hypertension, heart disease,
stroke, and cancer, among other diseases. The United States Centers for Disease Control and Prevention (CDC) estimates a
20% obesity rate in the 50 states, with 12 states having rates of over 30%. Currently, the body mass index (BMI) is most
commonly used to determine adiposity. However, BMI presents as an inaccurate obesity classification method that
underestimates the epidemic and contributes to failed treatment. In this study, we examine the effectiveness of precise
biomarkers and duel-energy x-ray absorptiometry (DXA) to help diagnose and treat obesity.
Methodology/Principal Findings: A cross-sectional study of adults with BMI, DXA, fasting leptin and insulin results were
measured from 1998–2009. Of the participants, 63% were females, 37% were males, 75% white, with a mean age=51.4
(SD=14.2). Mean BMI was 27.3 (SD=5.9) and mean percent body fat was 31.3% (SD=9.3). BMI characterized 26% of the
subjects as obese, while DXA indicated that 64% of them were obese. 39% of the subjects were classified as non-obese by
BMI, but were found to be obese by DXA. BMI misclassified 25% men and 48% women. Meanwhile, a strong relationship
was demonstrated between increased leptin and increased body fat.
Conclusions/Significance: Our results demonstrate the prevalence of false-negative BMIs, increased misclassifications in
women of advancing age, and the reliability of gender-specific revised BMI cutoffs. BMI underestimates obesity prevalence,
especially in women with high leptin levels (.30 ng/mL). Clinicians can use leptin-revised levels to enhance the accuracy of
BMI estimates of percentage body fat when DXA is unavailable.
Citation: Shah NR, Braverman ER (2012) Measuring Adiposity in Patients: The Utility of Body Mass Index (BMI), Percent Body Fat, and Leptin. PLoS ONE 7(4):
Editor: Qamaruddin Nizami, Aga Khan University, Pakistan
Received November 30, 2011; Accepted February 6, 2012; Published April 2, 2012
Copyright: ? 2012 Shah, Braverman. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors are grateful to the Life Extension Foundation for their generous financial support to PATH Foundation NY. The funders had no role in study
design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have read the journal’s policy and have the following conflicts: This work was supported by a research grant from the PATH
Foundation. All research and financial support for this article preceded NRS’s joining the New York State Department of Health. Similarly, except for minor
editorial changes, the article was completed before that time. The views expressed in this article are solely those of the authors as individuals and do not
represent the views or policies of the State of New York or the New York State Department of Health. During the period when the work was completed, NRS was
also supported by grant 1 R01 HS01 8589-01. All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on
request from the corresponding author and declare that (1) NRS has received grants from the PATH Foundation for the submitted work; ERB has received no
personal compensation for the submitted work; (2) NRS has relationships with AstraZeneca, Pfizer, Merck, Ortho-McNeil, Roche, Shering-Plough, GlaxoSmithKline,
Novartis, Partners Healthcare, Bellevue Hospital Association, NIH, AHRQ, CDC, Robert Wood Johnson Foundation, Cerner LifeSciences, Vemco MedEd, FAIR Health,
Venebio Group, LLC, American Academy of Neurology, Pinnacle Health Geisinger Health System, MetaResearch, LLC, Johnson & Johnson, Takeda, Xcenda, Engage
Healthcare, Medical Learning Institute, American Health & Drug Benefits, Center of Excellence Media LLC, Nassau University Medical Center, National Institute for
Quality Improvement and Education and St. John’s Episcopal Hospital. ERB has relationships with PATH Medical, Total Health Nutrients, Inc. and LLC, Life
Extension Foundation, Weill-Cornell Medical College, the Stanley and Fiona Druckenmiller Fund, the American Academy of Anti-aging Medicine Fellowship in
Anti-Aging, Regenerative, and Functional Medicine: Master’s Degree in Metabolic & Nutritional Medicine in conjunction with the University of South Florida
Medical School; the American Academy of Anti-aging Medicine Tarsus Medical Conference; and Douglas Labs, Life Extension Magazine; and has authored a book
on weight loss; (3) Their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) NRS and ERB have no
non-financial interests that may be relevant to the submitted work. This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and
* E-mail: firstname.lastname@example.org
. These authors contributed equally to this work.
¤ Current address: New York State Department of Health, Albany, New York, United States of America
Global trends of increasing obesity threaten public health and
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individuals has commensurately reached critical importance.
With the increasing importance of obesity detection, it is useful
to reevaluate how body fat is determined. For adults, the body
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Flawed Measurement of Adiposity in Patients
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