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Call for waist in QOF as BMI doubts grow

Obesity experts are pushing for waist circumference to be added to the quality framework as a diagnostic tool, in the wake of another study casting doubt on the validity of BMI.

The National Obesity Forum has told the QOF review panel that waist circumference should be used alongside BMI in drawing up obesity registers for quality points.

At the same time a study published early online by the European Heart Journal showed that BMI was a 'poor index to diagnose obesity' in patients with coronary artery disease.

While trying to work out why CAD patients with a slightly elevated BMI survived better and had fewer cardiovascular events, US researchers found BMI did not discriminate between muscle and fat, and that below a BMI of 30 the measure was a poor way to diagnose obesity. Researchers also found that because of the low sensitivity of BMI values over 30, more than half of patients with too much body fat might be misclassified as non-obese.

Lead author Dr Francisco Lopez-Jimenez, assistant professor of medicine at the Mayo Clinic, Minnesota, US, said: 'Is BMI a good measure of obesity in patients with CAD? The results of our study suggest the answer is no, especially for patients with a BMI of less than 30. Only when BMI is high is it able to differentiate between body fat percentage and lean mass.'

Dr David Haslam, the forum's clinical director and a GP in Watton-at-Stone, Hertfordshire, agreed BMI was a flawed measurement for obesity. He said: 'For example, rugby players can be deemed obese when it is muscle. And someone with stick arms and stick legs and a massive belly can slip through the net.'

Dr Haslam said the forum had submitted evidence to the QOF review panel in June that practice obesity registers should take into account both BMI and waist circumference. He added: 'BMI won't drop off the scene because all the historical records are for BMI. And waist circumference isn't perfect because it doesn't take height into account and is no use at all for super-obese people. The forum has also called for a register for childhood obesity to be included in the quality framework.

Study findings

• BMI had a good correlation with body fat percentage and also with lean mass, but failedto discriminate between the

• BMI =25 has good sensitivity but poor specificity to detect body fat percentage obesity

• Findings could explain controversial link of mild elevations of BMI to better survival and fewer cardiovascular events in patients with CAD

Study findings Study findings

• BMI had a good correlation with body fat percentage and also with lean mass, but failed to discriminate between the
• BMI =25 has good sensitivity but poor specificity to detect body fat percentage obesity
• Findings could explain controversial link of mild elevations of BMI to better survival and fewer cardiovascular events in patients with CAD

Experts want waist measurement to join BMI on practice obesity registers Experts want waist measurement to join BMI on practice obesity registers

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