CORRESPONDENCE: LETTER TO THE EDITOR
Reply
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
* Harvard Medical School, Harvard Vanguard Medical Associates, 147 Milk Street, Boston, Massachusetts 02109 (Email: rpgelber{at}gmail.com).
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 body mass index (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.
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References
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1. Gelber RP, Gaziano JM, Orav EJ, Manson JE, Buring JE, Kurth T. Measures of obesity and cardiovascular risk among men and women J Am Coll Cardiol 2008;52:605-615.[Abstract/Free Full Text]
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Is Body Mass Index Really the Best Measure of Obesity in Individuals?
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J. Am. Coll. Cardiol. 2009 53: 526.
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