Diagnostic Performance of BMI and Waist Circumference in Detecting Excess Adiposity
Authors' conclusion
Waist-based definitions were more sensitive than BMI, whereas BMI provided greater specificity. LC criteria performed comparably to existing definitions. Incorporating WC into screening may improve the detection of excess adiposity.
Study context
- Population
- US adults aged 20–59 years, NHANES 2011–2018; excess adiposity defined by DXA
- Participants
- 10,747 adults
- Comparison
- BMI thresholds vs waist-based measures vs Lancet Commission (LC) criteria for DXA-defined excess adiposity
- Outcome
- Diagnostic performance (sensitivity, specificity, PPV, NPV, AUC) for DXA-defined excess adiposity
Methodological detailscross-sectional, NHANES 2011-2018
- Cross-sectional
- NHANES 2011-2018
Performance
As reported in the abstract
Diagnostic performance for DXA-defined excess adiposity
| Strategy | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| CDC BMI thresholds | 74.6% | 82.2% | 67.0% | 87.0% |
| NHLBI waist circumference (WC) thresholds | 88.5% | 66.7% | — not stated in the abstract | — not stated in the abstract |
| LC: BMI plus ≥ 1 waist measure | 74.6% | 82.2% | — not stated in the abstract | — not stated in the abstract |
| LC: ≥ 2 waist measures | 88.5% | 66.8% | — not stated in the abstract | — not stated in the abstract |
Sensitivity
CDC BMI thresholds74.6%
NHLBI waist circumference (WC) thresholds88.5%
LC: BMI plus ≥ 1 waist measure74.6%
LC: ≥ 2 waist measures88.5%
Specificity
CDC BMI thresholds82.2%
NHLBI waist circumference (WC) thresholds66.7%
LC: BMI plus ≥ 1 waist measure82.2%
LC: ≥ 2 waist measures66.8%
PPV
CDC BMI thresholds67.0%
NHLBI waist circumference (WC) thresholds— not stated in the abstract
LC: BMI plus ≥ 1 waist measure— not stated in the abstract
LC: ≥ 2 waist measures— not stated in the abstract
NPV
CDC BMI thresholds87.0%
NHLBI waist circumference (WC) thresholds— not stated in the abstract
LC: BMI plus ≥ 1 waist measure— not stated in the abstract
LC: ≥ 2 waist measures— not stated in the abstract
— not stated in the abstract
- AUC, BMI
- 0.876
- AUC, WC
- 0.882
- AUC, waist to height ratio
- 0.887
- AUC, waist to hip ratio
- 0.715
Further findings
Weighted prevalence of DXA-defined excess adiposity
- Weighted prevalence
- 36.4%
Original publication
Diagnostic Performance of BMI and Waist Circumference in Detecting Excess Adiposity. Obesity (Silver Spring). Published 22 February 2026. doi:10.
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