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 Table of Contents  
HISTORICAL VIGNETTE
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 55-57

Emergence of body mass index as a measure of obesity: A brief recapitulation


Vaidya Scientist, Division of Endocrine & Metabolic Disorders, Medical Research Centre - Kasturba Health Society, Vile Parle (W), Mumbai, India & Physician -Integrative Health, AIM Swasthya Clinics, India

Date of Submission18-Oct-2013
Date of Decision24-Oct-2013
Date of Acceptance01-Nov-2013
Date of Web Publication30-Dec-2013

Correspondence Address:
Namyata Pathak
Medical Research Centre, Kasturba Health Society, 17 K Desai Road, Vile Parle (W), Mumbai - 400 056, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.123934

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How to cite this article:
Pathak N. Emergence of body mass index as a measure of obesity: A brief recapitulation. J Obes Metab Res 2014;1:55-7

How to cite this URL:
Pathak N. Emergence of body mass index as a measure of obesity: A brief recapitulation. J Obes Metab Res [serial online] 2014 [cited 2019 Jul 16];1:55-7. Available from: http://www.jomrjournal.org/text.asp?2014/1/1/55/123934

'If a man increased equally in all dimensions, his weight at different ages would vary as the cube of his height.'

Adolphe [1] (1796-1874)

Adolphe Quetelet [Figure 1], Professor of Mathematics, University of Ghent, made the aforesaid observation when he charted weights and heights of a sample population across age groups. He sought to find an equation that can describe the relationship between these two variables. While studying the variables of height and weight, he observed their individual distribution to be a normal, bell shaped, Gaussian curve. [2] However, the manner in which the values of weight varied with those of height was not of Gaussian nature. Expansion in size would have naturally contributed to the weight. So Quetelet wondered if this could be resolved with an extension of the above conversation. Of course, people don't grow that rapidly in the horizontal direction. Eventually, he came to the conclusion that in adults, the weight in kilograms varies as the square of the height in meters, which now followed the elusive bell curve. This was called the Quetelet index, whose validity was not to be tested until the next century.
Figure 1. Adolphe quetelet, who proposed the quetelet index.
Adapted from wikipedia


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  A Quest for Body Norms Top


Obesity was not considered to be a problem when Quetelet proposed this index. He was on a pursuit of defining normal proportions of human body, just as Charaka, Sushruta and Leonardo da Vinci did in their own way. Charaka and Sushruta had defined the relative measures of normal human body vis-ΰ-vis the width of that individual's index finger. 'Anguli pramana', was a discipline of Ayurveda with diagnostic and prognostic relevance. [3],[4] In Europe, many pre renaissance paintings had abnormal human configurations - longer torsos, legs or necks, shorter arms, legs and shoulders. In the fifteenth century, Leonardo da Vinci created his figure of Vitruvian man [Figure 2] based on the normal proportions of man described by Roman architect, Vitruvius. [5] It may have influenced renaissance and post renaissance paintings which show more proportionate representation of the human body. These changes could have been helpful to Quetelet, who was also a painter and sculptor. When he entered this field of studying human body norms, Quetelet had training with the likes of Joseph Fourier, Simon Poisson and Pierre Laplace. He was well grounded in methods for organised data collection and probability theory. He had wished to apply 'social physics' to the study of man's physical and psychological traits. [6]
Figure 2. 'Vitruvian man' – the proportionate human created by Leonardo da Vinci. Adapted from Wikipedia

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  A Need to Study Obesity Top


After World War II, it was observed that those persons with higher body weight had greater mortality. It was counter-intuitive then, because in popular parlance, 'fatness was a socially welcome and a sign of 'health'. [7] Intrigued by the findings, the insurance companies got engaged with the problems and initiated attempts to understand the basic relationship between height and weight. In 1970, when the Framingham study's population data was studied using various indices of height-weight proposed, the Quetelet index was validated. [8] Meanwhile Ancel Keys [Figure 3] further studied the index with respect to obesity in a landmark study involving 7400 persons in five countries. Once again, the Quetelet index was validated and renamed as body mass index (BMI) by Keys et al.[9] Soon, as weight and height were simple to measure to a fairly accurate degree and available in recorded data, BMI was retrospectively determined in a wide range of studies. [10],[11]
Figure 3. Ancel Keys, who late renamed Quetelet index as body mass index on cover of TIME, January, 1961

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  BMI: On-going Debates and Relevance to Health Top


Interestingly, keys warned against the use of that measure for individual diagnosis of obesity as it would be influenced by age, gender and ethnicity. Yet, in 1985, BMI was used by the National Institutes of Health to define obesity for individuals. At 85 th percentile, men were 'obese' above 27.8 and women above 28.3 at that time. [12] Obesity was associated with increased mortality, through a higher death rate from heart disease, hypertension, diabetes mellitus and cancer. [13]

Acharya Charak mentioned: [14]



Meaning that 'It is better to be lean than to be overweight, as the lean are not distressed with diseases and their inflictions are easier to manage. Those who have a balanced musculature and strength, those with responsive senses and function, are the ones who do not fall sick frequently.'

It was interesting that good musculature was delineated as a positive factor for health. BMI has the limitation of being unable to distinguish between fat mass, its distribution and muscle tissue contributing to the weight. For example, in 2003, Yudkin and Yajnik collaborators at Oxford University, described the Y-Y paradox of BMI. At the same BMI of 22.3, Yajnik had more adiposity (21.2%) than Yudkin (9%) [Figure 4] as seen in the cover of Lancet. [15]
Figure 4. Reprinted from The Lancet; 363(9403), Yajnik CS & Yudkin JS, Pg 163, Copyright (2004), with permission from Elsevier (RightsLink). Both men at body mass index 22.3 kg/m2, Yajnik (left) has more body fat than Yudkin(right).

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In 2004, the World Health Organization proposed international cut-offs for obesity based on BMI, which was not age, gender, ethnicity specific. Emergent literature suggested that at the same BMI, South Asian Indians were at a greater cardiometabolic risk than other ethnic populations. [16] Hence, by 2009, the BMI cut-offs were revised for Indians, based on their ability to sensitively and specifically pick up existent additional cardiometabolic risks in certain Indian populations. [17] An Indian would be obese at 25 kg/m 2 , unlike the rest of the world, which would be Grade I obese at 30 kg/m 2 .

For identification of cardiometabolic risk, it seemed that the distribution of weight was of more relevance, with central obesity suggestive of visceral fat. The role of visceral fat and ectopic fat are well explained in this issue by Prof Ghosh. [18] In the 16 th century, Madhav nidan, a text of Ayurveda diagnosis wrote which meant that mostly, it is the one with increased abdominal girth who is obese. [19] Hence, for the definition of metabolic syndrome which indicates overall cardio-metabolic risk, the criteria prudently include waist circumference and not BMI.

It is of interest here to mention that loose abdominal fat ( in Ayurveda) as against a taut large abdomen used to be described as 'visceroptosis' in the last century. Apart from gross estimates of visceral fat, its inflammatory potential, ability to cause metabolic derangement, influence on and by the autonomic nervous system may be even more important to be addressed. Like other obesity related variables which have arisen from the past, been defined and gained acceptance as quantitative measures, can there be non-invasive, inexpensive tools to assess the more damaging phenotype of inflammatory visceral fat as well?


  Conclusion Top


BMI is and will remain an important tool to provide a snapshot of obesity and provide a reason to probe further and correct existent conditions. Further classifications and gradations based on relevant markers and available treatment modalities will improve both our understanding and management of the burgeoning problem of obesity. Often future advances have occurred by experience from relatively distant past, which may be appropriately considered, time and again.

 
  References Top

1.Adolphe Q. Of the development of weight and of its relation to the development of the height of the body. In: Treatise on man book. 2 nd ed. Reprint 1968. New York: Burt Franklin; 1842.  Back to cited text no. 1
    
2.Eknoyan G. Adolphe Quetelet (1796-1874) - The average man and indices of obesity. Nephrol Dial Transplant 2008;23:47-51.  Back to cited text no. 2
[PUBMED]    
3.Agnivesha. Charaka samhita, Section vimana, Ch. 6, Verse 117. (Original ~1500 BC). Chaukhamba Publication,Varanasi, India.Reprinted 2001.  Back to cited text no. 3
    
4.Shirodkar J. Associations of anguli praman with diabetes mellitus. PhD thesis. 2010.  Back to cited text no. 4
    
5."The Vitruvian man". Available from: http://www.Leonardodavinci.stanford.edu. [Retrieved on 2013 Oct 23].  Back to cited text no. 5
    
6.Hawkins FH. Adolphe Quetelet as statistician. New York: Columbia University Press; 1968.  Back to cited text no. 6
    
7.Eknoyan G. A history of obesity, or how what was good became ugly and then bad. Adv Chronic Kidney Dis 2006;13:421-7.  Back to cited text no. 7
[PUBMED]    
8.Florey CV. The use and interpretation of ponderal index and other weight-height ratios in epidemiological studies. J Chronic Dis 1970;23:93-103.  Back to cited text no. 8
    
9.Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and adiposity. J Chronic Dis 1972;25:329-43.  Back to cited text no. 9
[PUBMED]    
10.Dahlström S, Viikari J, Akerblom HK, Solakivi-Jaakkola T, Uhari M, Dahl M, et al. Atherosclerosis precursors in Finnish children and adolescents. II. Height, weight, body mass index and skinfolds, and their correlation to metabolic variables. Acta Paediatr Scand Suppl 1985;318:65-78.  Back to cited text no. 10
    
11.Rosenbaum S, Skinner RK, Knight IB, et al. A survey of heights and weights of adults in Great Britain, 1980. Ann Hum Biol 1985;12:115-27.  Back to cited text no. 11
[PUBMED]    
12.Health implications of obesity. National Institutes of Health Consensus Development Conference Statement. Ann Intern Med 1985;103 (6 (Pt 2)):1073-7.  Back to cited text no. 12
    
13.Bray GA. Overweight is risking fate. Definition, classification, prevalence, and risks. Ann N Y Acad Sci 1987;499:14-28.  Back to cited text no. 13
[PUBMED]    
14.Agnivesha. Charaka samhita, Section vimana, Ch. 21, Verse 17-8. (Original ~1500 BC). Chaukhamba Publication, Varanasi, India.Reprinted 2001.  Back to cited text no. 14
    
15.Yudkin JS. The Y-Y paradox. Lancet 2004;363:163.  Back to cited text no. 15
[PUBMED]    
16.Vikram NK, Pandey RM, Misra A, Sharma R, Devi JR, Khanna N, et al. Non-obese (body mass index<25 kg/m 2 ) Asian Indians with normal waist circumference have high cardiovascular risk. Nutrition 2003;19:503-9.  Back to cited text no. 16
    
17.Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163-70.  Back to cited text no. 17
[PUBMED]    
18.Ghosh S. Ectopic fat. J Obes Metab Res 2013;1:30-8.  Back to cited text no. 18
    
19.Madhavkar. Madhav nidan. Ch. 34. Verse 4. (Original ~1600 AD).Motilal Banarasidas, Delhi, India. Reprinted 2002.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


This article has been cited by
1 Reimagining Obesity
Jaime Schultz
Quest. 2016; : 1
[Pubmed] | [DOI]



 

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