Makindo Medical Notes

📖 Introduction

Body Mass Index (BMI) is a quick and widely used screening tool that relates an individual’s weight to their height, providing a numerical estimate of body fat. Although originally designed for population-level epidemiology by Adolphe Quetelet in the 19th century, it remains a key measure in modern clinical practice and public health. It is especially useful for flagging those at risk of undernutrition, overweight, or obesity, all of which carry significant health implications.

🧮 Calculation and Classification

BMI is calculated using the standard formula:

BMI = Weight (kg) / [Height (m)]²

For adults, BMI is classified into categories (WHO/NICE):

• ⚠️ Underweight: <18.5
• ✅ Normal weight: 18.5 – 24.9
• ⚠️ Overweight: 25 – 29.9
• ⬆️ Obesity Class I: 30 – 34.9
• ⬆️ Obesity Class II: 35 – 39.9
• 🚨 Obesity Class III (Morbid obesity): ≥40

🏥 Clinical Significance

• 📊 Screening tool: Provides a rapid overview of nutritional status in both undernutrition and obesity.
• ❤️ Risk stratification: Higher BMI is associated with increased risk of type 2 diabetes, hypertension, cardiovascular disease, stroke, and some cancers.
• 🧩 Monitoring: Useful for following weight changes over time, particularly in patients on weight management programmes or nutritional support.
• 👶 Paediatrics: In children, BMI must be plotted against age- and sex-specific centile charts (UK-WHO growth charts) rather than adult cut-offs.

⚖️ Limitations of BMI

• 💪 Muscle vs fat: BMI does not distinguish lean mass from fat mass, so muscular individuals may appear “overweight.”
• 🧍 Fat distribution: Central obesity (visceral fat) carries more cardiometabolic risk than peripheral fat, but BMI alone cannot capture this.
• 🧓 Age & sex: Elderly patients may have sarcopenia (muscle loss) despite a “normal” BMI. Women generally have higher body fat at the same BMI than men.
• 🌍 Ethnic variation: In South Asian and Chinese populations, health risks occur at lower BMI thresholds → NICE advises using 23 kg/m² as the overweight threshold for these groups.

📌 Alternative / Complementary Measures

• Waist Circumference (WC): Better predictor of central obesity and metabolic syndrome risk.   → Risk increased if WC >94 cm (men) or >80 cm (women).
• Waist-to-Height Ratio: >0.5 suggests increased cardiometabolic risk.
• Body Fat %: Measured by bioelectrical impedance or DEXA scanning, gives more accurate assessment of adiposity.
• Clinical context: Combine BMI with blood pressure, lipids, HbA1c, and lifestyle assessment.

🧭 Conclusion

BMI remains a simple, cost-effective, first-line screening tool for assessing nutritional status. However, it should never be used in isolation. Interpreting BMI alongside waist circumference, comorbidities, and demographic factors provides a more accurate picture of health risk. In UK practice, NICE and Public Health England recommend combining BMI with waist measures to guide interventions in obesity and metabolic risk.

📚 References

• NICE CG189: Obesity Identification, Assessment and Management
• WHO – Obesity and Overweight
• Public Health England. Adult Obesity: Applying All Our Health.