PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
J Am Coll Cardiol. Author manuscript; available in PMC 2010 August 2.
Published in final edited form as:
J Am Coll Cardiol. 2009 February 10; 53(6): 527.
doi:  10.1016/j.jacc.2008.10.034
PMCID: PMC2913491
NIHMSID: NIHMS93940

Reply to letter to the editor: “MEASURES OF OBESITY AND CARDIOVASCULAR RISK AMONG MEN AND WOMEN”

Rebecca P. Gelber, MD, DrPH, J. Michael Gaziano, MD, MPH, E. John Orav, PhD, JoAnn E. Manson, MD, DrPH, Julie E. Buring, ScD, and Tobias Kurth, MD, ScD

The assessment of clinical usefulness for any measure, and perhaps particularly for measures of adiposity, relies largely on preference when the measures are statistically similar in their associations with relevant outcomes. While it is true that our study’s results (1) are based on analyses of large cohorts, we do not agree that they are limited in their application to individuals, as suggested by Dr. Green. In our study, we found that measures of obesity other than BMI do not substantially improve statistical prediction of cardiovascular outcomes. At the same time, we acknowledged the limitations of BMI, both in misclassifying the muscular lean and in its deficiency in describing the distribution of body fat.

The question then shifts to which measure should be employed clinically. Conveying the risks of obesity to patients in daily clinical practice requires, in part, a measure substantiated in standard definitions of overweight and obese. While, for a given individual, changes in BMI over time will rely on changes in body weight, the meaning of these changes in weight is often interpreted as progress toward a healthier goal based on BMI. We do not yet understand fully how best to target modifications of the waist circumference or waist-height-ratio, since body fat distribution appears less malleable to change than overall weight. Further study on approaches to and benefits of altering body composition and waist circumference may clarify these issues.

In our study, we do not advocate a single measure be strictly employed in clinical practice. Certainly, for some patients, following changes in various anthropometric measures may prove clinically useful in encouraging healthy weight goals. Many patients, however, will strive for better health through weight reduction. For these individuals, success is defined by a lower BMI, and not by other measures.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

1. Gelber RP, Gaziano JM, Orav EJ, Manson JE, Buring JE, Kurth T. Measures of obesity and cardiovascular risk among men and women. JACC. 2008;52(8):605–615. [PMC free article] [PubMed]