Exploring the Science
on Measures of Body
Composition, Body Fat
Distribution, and Obesity
_____
Amanda Berhaupt, Rapporteur
Roundtable on Obesity Solutions
Food and Nutrition Board
Health and Medicine Division
Proceedings of a Workshop Series
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American Cancer Society; American Council on Exercise; American Society for Nutrition; Blue Shield of California Foundation; Bipartisan Policy Center; Eli Lilly and Company; Found Health Inc.; General Mills, Inc.; The JPB Foundation; Kresge Foundation; Mars, Inc.; Nemours Children’s Health System; Novo Nordisk; Obesity Action Coalition; Partnership for a Healthier America; Reinvestment Fund; Rudd Center for Food Policy and Health; Robert Wood Johnson Foundation; SHAPE America; Society of Behavioral Medicine; The Obesity Society; Trust for America’s Health; Wake Forest Baptist Medical Center; and Walmart. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Exploring the science on measures of body composition, body fat distribution, and obesity: Proceedings of a workshop series. Washington, DC: The National Academies Press. https://doi.org/10.17226/27461.
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PLANNING COMMITTEE ON EXPLORING THE SCIENCE ON MEASURES OF BODY COMPOSITION, BODY FAT DISTRIBUTION, AND OBESITY: A WORKSHOP SERIES1
IHUOMA ENELI (Cochair), professor of pediatrics, The Ohio State University; director, Nationwide Children’s Hospital Center for Healthy Weight and Nutrition
NICOLAAS (NICO) P. PRONK (Cochair), president, HealthPartners Institute; chief science officer, HealthPartners, Inc.
S. BRYN AUSTIN, professor of social and behavioral sciences, Harvard T.H. Chan School of Public Health; professor of pediatrics, Harvard Medical School
W. SCOTT BUSCH, director of obesity medicine, Bariatric and Metabolic Institute, the Cleveland Clinic
CRAIG M. HALES, clinical reviewer, Division of Diabetes, Lipid Disorders, and Obesity, U.S. Food and Drug Administration
NATHANIEL KENDALL-TAYLOR, chief executive officer, FrameWorks Institute
MICHAEL G. KNIGHT, associate chief quality and population health officer; head of healthcare delivery transformation; and assistant professor of medicine, The George Washington University Medical Faculty Associates
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON OBESITY SOLUTIONS1
NICOLAAS (NICO) P. PRONK (Chair), HealthPartners Institute and HealthPartners, Inc., Bloomington, Minnesota
CHRISTINA ECONOMOS (Vice Chair), Tufts University, Boston, Massachusetts
IHUOMA ENELI (Vice Chair), Nationwide Children’s Hospital, Columbus, Ohio
JAMY D. ARD, Wake Forest University, Winston-Salem, North Carolina
HEIDI MICHELS BLANCK, Centers for Disease Control and Prevention, Atlanta, Georgia
JEANNE BLANKENSHIP, Academy of Nutrition and Dietetics, Washington, DC
JAMIE BUSSEL, Robert Wood Johnson Foundation, Princeton, New Jersey
DEBBIE I. CHANG, Blue Shield of California Foundation, San Francisco, California
LAURIE FRIEDMAN DONZE, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
JENNIFER FASSBENDER, Reinvestment Fund, Philadelphia, Pennsylvania
AMENDA FISHER, Walmart, Bentonville, Arkansas
ALLISON GERTEL-ROSENBERG, Nemours Children’s Health System, Washington, DC
JAMIE GLONEK, Novo Nordisk, Plainsboro, New Jersey
J. NADINE GRACIA, Trust for America’s Health, Washington, DC
KAYLA JACKSON, The School Superintendents Association, Alexandria, Virginia
JOHN JAKICIC, University of Kansas Medical Center, Kansas City, Kansas
GABRIELLE N. JOHNSTON, American Council on Exercise, San Diego, California
PETER T. KATZMARZYK, Pennington Biomedical Research Center, Baton Rouge, Louisiana
REKHA KUMAR, Found Health Inc., New York, New York
THEODORE KYLE, The Obesity Society, Pittsburgh, Pennsylvania
BRUCE Y. LEE, City University of New York, New York, New York
MONICA V. LUPI, Kresge Foundation, Troy, Michigan
KYLE MACDONALD, Alliance for a Healthier Generation, Portland, Oregon
MYETA M. MOON, United Way Worldwide, Alexandria, Virginia
STEPHANIE A. MORRIS, SHAPE America, Reston, Virginia
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
JOSEPH NADGLOWSKI, JR., Obesity Action Coalition, Tampa, Florida
MELISSA NAPOLITANO, The George Washington University, Washington, DC
PATRICIA NECE, Obesity Action Coalition
MEGAN NECHANICKY, General Mills, Inc., Minneapolis, Minnesota
ANAND PAREKH, Bipartisan Policy Center, Washington, DC
SARAH A. WELLER PEGNA, National League of Cities, Washington, DC
BARBARA PICOWER, The JPB Foundation, New York, New York
MARGARET READ, Partnership for a Healthier America, Prince Frederick, Maryland
VICTORIA ROGERS, American Academy of Pediatrics, Portland, Maine
CHRISTY N. ROSS, National Association for the Advancement of Colored People, Washington, DC
SYLVIA ROWE, SR Strategy, LLC, Washington, DC
MARLENE SCHWARTZ, The Rudd Center for Food Policy and Health, Hartford, Connecticut
STEPHANIE A. NAVARRO SILVERA, Montclair State University, Montclair, New Jersey
TRACY SIMS, Eli Lilly and Company, Indianapolis, Indiana
JESSICA SMITH, Mars Wrigley, Hackettstown, New Jersey
KRISTEN R. SULLIVAN, American Cancer Society, Decatur, Georgia
SUSAN Z. YANOVSKI, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
Staff
HEATHER DEL VALLE COOK, Roundtable Director
CYPRESS LYNX, Associate Program Officer
AMANDA NGUYEN, Program Officer
MEREDITH PARR, Research Assistant
ANN L. YAKTINE, Director, Food and Nutrition Board
Consultant
WILLIAM (BILL) H. DIETZ, the George Washington University, Washington, DC
Food and Nutrition Board Liaison
SHIRIKI KUMANYIKA, Drexel University, Philadelphia, Pennsylvania
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
BROOK BELAY, Centers for Disease Control and Prevention
SUSAN Z. YANOVSKI, The National Institutes of Health
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BARBARA HANSEN, University of South Florida. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
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Acknowledgments
Staff thanks William (Bill) H. Dietz, the George Washington University, for providing his technical expertise in the preparation of this publication.
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Contents
Organization of This Proceedings
2 OBESITY: DEFINTIONS AND PERSPECTIVES
Cultural Approaches to Obesity, BMI, and Nutrition
BMI Categories, Drug Companies, and the Drive for Reimbursement
Clinical Context: How Can We Measure a Disease to Track Its Improvement?
3 TENSIONS AND PERSPECTIVES AROUND BMI
Tensions and Perspectives Around BMI: A Clinician Perspective
4 APPLICATIONS AND USES OF BMI, BODY COMPOSITION, AND BODY FAT DISTRIBUTION
Adipose Tissue, BMI, and Fat Distribution
Occupational Health and Safety Lens on BMI
BMI Outside the Clinic: The Patient Perspective
An Equity Framework Approach to Chart Needed Action
Obesity Treatment: How to Measure Success for Public Health
Looking Ahead: Clinical Assessment of Obesity
6 COMMUNICATING HOW OBESITY IS DEFINED AND DIAGNOSED
The Lancet Commission on the Definition and Diagnosis of Clinical Obesity
EOSS for Adults and Pediatrics
7 INNOVATIONS IN COMMUNICATING ABOUT BODY WEIGHT IN THE CLINIC AND BEYOND
Educating Future Clinicians About Weight Bias and Stigma
Navigating Discussions Gracefully in a Body Positivity Versus Obesity Treatment World
8 ETHICS AND TRUST IN COMMUNICATING ABOUT THE INTERSECTION OF BODY WEIGHT AND HEALTH
Weight-Related Stigma and Health Disparities
Poverty, Health Policy, and Obesity
9 IMPROVING COMMUNICATION ABOUT BODY WEIGHT
Improving Communication About Body Weight from a Policy and Public Health Perspective: TFAH
A New Narrative on Childhood Obesity
10 PROMOTING CHANGE IN CULTURE AND PERCEPTION ABOUT BODY WEIGHT
A Socioecological Approach to Addressing Structural Racism and Weight Discrimination
A Lived-Experience Perspective on the Culture and Perception About Body Weight
B Biographical Sketches of Workshop Speakers and Planning Committee Members
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Box and Figures
BOX
1-1 Workshop Series Statement of Task
FIGURES
2-2 Role of epicardial adipose tissue in cardiovascular risk
2-3 Growing understanding of how excess abnormal fat drives disease
3-1 Trends in women show increases in obesity and severe obesity in all racial/ethnic groups
5-1 Framework for increasing equity impact in obesity prevention
5-2 U.S. jurisdictions that protect against weight discrimination
6-4 Case #1: 12-year-old boy with severe obesity (BMI z-score: 3.4)
6-5 Case #2: 12-year-old boy with severe obesity (BMI z-score: 3.4)
7-1 Examples of people-first language
7-2 Sample script for Scenario 1
7-3 Sample script for Scenario 2
7-4 Sample script for Scenario 3
8-1 Weight-inclusive approach as opposed to the traditional weight-normative approach by clinicians
Acronyms and Abbreviations
AACE | American Association of Clinical Endocrinology |
AAP | American Academy of Pediatrics |
ABCD | adiposity-based chronic disease |
ACC | American College of Cardiology |
AHA | American Heart Association |
AMA | American Medical Association |
ASCVD | atherosclerotic cardiovascular disease |
BMI | body mass index |
BRFSS | Behavioral Risk Factor Surveillance System |
CDC | Centers for Disease Control and Prevention |
CEO | chief executive officer |
CMS | Centers for Medicare & Medicaid Services |
COVID-19 | coronavirus disease 2019 |
DASH | Dietary Approaches to Stop Hypertension |
DEXA | dual X-ray absorptiometry |
EHR | electronic health records |
EOSS | Edmonton Obesity Staging System |
EOSS-P | Edmonton Obesity Staging System for Pediatrics |
FRAC | Food Research and Action Center |
ICD-10 | International Classification of Diseases-10 |
IOTF | International Obesity Task Force |
LGBTQI+ | lesbian, gay, bisexual, transgender, queer, and intersex1 |
NCQA | National Committee for Quality Assurance |
NHANES | National Health and Nutrition Examination Survey |
NHLBI | National Heart, Lung, and Blood Institute |
NIH | National Institutes of Health |
OCEANS | Outreach, Community, Engagement, Advocacy, Nondiscriminatory Support |
RWJF | Robert Wood Johnson Foundation |
SDOH | social determinants of health |
SEM | Socioecological Model |
SNAP | Supplemental Nutrition Assistance Program |
STRIPED | Strategic Training Initiative for the Prevention of Eating Disorders |
SWOT | strengths, weaknesses, opportunities, threats analysis |
TFAH | Trust for America’s Health |
TOS | The Obesity Society |
WHO | World Health Organization |
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1 https://www.samhsa.gov/behavioral-health-equity/lgbtqi (accessed November 7, 2023).