Heart Risk – BMI Not Useful

Or as Reuters put it: “[T]he best predictors of future heart risk are measures of blood pressure, cholesterol and history of diabetes.”

According to a paper in The Lancet:

BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.

Researchers looked at height, weight, hip, waist, blood pressure, cholesterol and other data from more than 220,000 adults — who had no previous history of heart disease – and tracked them over time to see who had heart attacks. Once they controlled for age, sex, smoking, baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, they found that BMI or waist-to-hip ratio didn’t add much information.

The headlines and articles focus on how this refutes the notion that “pear-shaped” fat people are at less risk of heart disease than “apple-shaped”. I wonder if this implies that thin people who have high cholesterol, high blood pressure or diabetes (all of which can be affected by family history) might have their risk factors ignored because they’re thin.

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Posted

March 11, 2011

FatnessInGeneral, health, News

Living 400lbs

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13 responses to “Heart Risk – BMI Not Useful”

RNegade

March 11, 2011

Off topic so please forgive:

Not sure why, today, but I feel compelled to stop by here and say thank you for writing this blog and for sharing your views, and those of others, with so much compassion and empathy.

Words are inadequate to express how much it means to me–to know that your blog exists, and that your voice is heard.

Reply
1. Living 400lbs
  
  March 11, 2011
  
  You’re welcome. Thank you for saying so.
  
  Reply
shaunta

March 11, 2011

OMG, yes. I needed to hear this today. I’m so tired of defending my health. And I shouldn’t have to. Because even if I wasn’t healthy, it isn’t as though skinny people don’t get sick. I had a conversation with a very thin friend once, where I was talking about how difficult it is for a fat person to get decent medical care. She told me that she had cancer–and it went undiagnosed for a long time because she appears to be healthy.

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1. Living 400lbs
  
  March 12, 2011
  
  I had a conversation with a very thin friend once, where I was talking about how difficult it is for a fat person to get decent medical care. She told me that she had cancer–and it went undiagnosed for a long time because she appears to be healthy.
  
  Argh. People keep wanting “healthy” to be obvious, and it isn’t.
  
  Reply
Heart Risk – BMI Not Useful (via Living ~400lbs) « Tracy Brown, RD, LD/N

March 11, 2011

[…] Or as Reuters put it: "[T]he best predictors of future heart risk are measures of blood pressure, cholesterol and history of diabetes." According to a paper in The Lancet: BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabe … Read More […]

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Dee

March 14, 2011

Just FYI, gave this post a call-out on Big Fat Blog:
http://www.bigfatblog.com/pattie-thomas-psychology-today

I’d like to read the study and write more on the topic, but it’s so important to get the core issue out there, as you’ve done here.

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1. Living 400lbs
  
  March 14, 2011
  
  Thanks for the link!
  
  Reply
Squeegeelicious

March 14, 2011

For your question about thin people being at risk with high cholesterol, high blood pressure or diabetes, I actually subscribes to the Lancet and looked at the full paper to get a look at the hard data, and this is what I found: They included only people with a BMI of 20 kg/m2 or higher. This means that they were examining the risk associated with higher BMI’s in comparison to people with ‘normal’ BMI’s. They explicitly left out BMI’s less than 20, because of “non-linear associations” (read: increased risk for those in the ‘under-weight’ category). Looking closer at their tables for risk, they measure the increase in risk by every 4.56 points BMI, 12.6 cm waist circumference increase, and every 0.083 higher hip-to-waist ratio. […]

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1. Living 400lbs
  
  March 15, 2011
  
  You may also want to check out a response to these numbers at http://www.bigfatblog.com/pattie-thomas-psychology-today#comment-45049
  
  Reply
  1. Squeegeelicious
    
    March 15, 2011
    
    Ahh, yeah. I did not look closely enough at the study the first time and missed an important graph. I’ve explained how I came to my error and have verified what DeeLeigh’s findings. Thanks for the heads up! http://www.bigfatblog.com/pattie-thomas-psychology-today#comment-45050
    
    Reply
    1. Squeegeelicious
      
      March 16, 2011
      
      I need to say this here for everyone’s sake, do not take what I wrote as fact. It is false. I need to own up for my error here and on other blogs. I am not an expert, I am a college student with just enough knowledge about science to take something like this on, but not enough to actually understand it. Please read Deeliegh’s review of the topic listed in the link above. It has been much better addressed there.
      
      Reply
Squeegeelicious

March 14, 2011

Just to clarify my answer to your question: Yes, if the physician is using adipose measurements to determine cardiovascular risk, they will likely misdiagnose someone who is fat as well as overlook someone who is thin and showing other symptoms. If the physician uses a combination of adipose measurements and intermediate risk factors such as high blood pressure, blood lipids, and diabetes, they might exaggerate the risk for someone who is fat and down play the risk for someone who is thin. If they judge by intermediate risk factors alone, they will have the best results.

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1. Living 400lbs
  
  March 14, 2011
  
  Thanks for the additional info!
  
  Reply