1.3 Anthropometric Evaluation
Key Points
  • Evaluation of patients for obesity should include a complete history and physical examination
  • Body mass index (BMI) cutpoints vary with race and ethnicity
  • Waist circumference
    • Adds information on cardiometabolic risk
    • Cutpoints vary with gender and race and ethnicity
  • Excess adiposity must be present for BMI to indicate obesity
    • Athletes and others with high muscle mass may have high BMI values but are not obese

AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity Recommendations1
  • R3. All adults should be screened annually using a BMI measurement; in most populations a cutoff point of ≥25 kg/m2 should be used to initiate further evaluation of overweight or obesity.
  • R4. BMI should be used to confirm an excessive degree of adiposity and to classify individuals as having overweight (BMI 25 to 29.9 kg/m2) or obesity (BMI ≥ 30 kg/m2), after taking into account age, gender, ethnicity, fluid status, and muscularity; therefore, clinical evaluation and judgment must be used when BMI is employed as the anthropometric indicator of excess adiposity, particularly in athletes and those with sarcopenia.
  • R5. Other measurements of adiposity (e.g., bioelectric impedance, air/water displacement plethysmography, or dual-energy X-ray absorptiometry [DEXA]) may be considered at the clinician’s discretion if BMI and physical examination results are equivocal or require further evaluation. However, the clinical utility of these measures is limited by availability, cost, and lack of outcomes data for validated cutoff points.
  • R6. When evaluating patients for adiposity-related disease risk, waist circumference should be measured in all patients with BMI < 35 kg/m2. In many populations, a waist circumference cutoff point of ≥ 94 cm in men and ≥ 80 cm in women should be considered at risk and consistent with abdominal obesity; in the U.S. and Canada, cutoff points that can be used to indicate increased risk are ≥ 102 cm for men and ≥ 88 cm for women.
  • R7. A BMI cutoff point value of ≥ 23 kg/m2 should be used in the screening and confirmation of excess adiposity in South Asian, Southeast Asian, and East Asian adults.
  • R8. Region- and ethnic-specific cutoff point values for waist circumference should be used as measures of abdominal adiposity and disease risk; in South Asian, Southeast Asian, and East Asian adults, men with values ≥85 cm and women ≥74 to 80 cm should be considered at risk and consistent with abdominal obesity.
Download slides (PDF)