Beyond BMI: How is Obesity Defined?

We break down what obesity means in clinical terms and how to measure risk with more clarity. We compare BMI, waist circumference, body fat percentage, and the Edmonton Obesity Staging System to show how each tool informs smarter care.

• BMI strengths for population screening 
• BMI limits for individuals and for women 
• Waist circumference thresholds and why visceral fat matters 
• Clothing fit as a practical proxy for central adiposity 
• Body fat percentage cutoffs and testing methods 
• Edmonton Obesity Staging System from stage 0 to 4 
• How staging guides prevention, treatment, and goals 
• Early action to reduce medications and avoid complications

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Episode Transcript

Speaker (00:00):
Welcome to the Modern Metabolic Health Podcast with
your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.

(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medical treatment.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.
We hear this term all the time,but we rarely talk about the

(00:54):
definition.
So there are a couple ofdifferent ways that we can
measure if somebody has obesityor not.
The most common way that weclassify somebody as having
obesity is with the BMI.
And there are benefits andnegatives to the BMI.

(01:15):
What is BMI?
It is body mass index.
And this is taking somebody'sheight and their weight and
using an equation to create arelative number that we can
compare to other people ofdifferent heights.
And it's important to know thatthis calculation was created

(01:41):
using only men.
And so it left out our women,and so that is a huge limitation
in what this means for ourfemale patients.
But if you want to calculateyour BMI, a link will be
included below, and so you cantype in your height and your

(02:01):
weight, and you can find yourBMI and find out which category
you fit into.
And the benefits of BMI arethat it is inexpensive to
calculate, it's very easy tocalculate, and we can easily
watch it over time.
And it's really helpful forgeneral populations and getting

(02:23):
information on a large group ofpeople.
It is less helpful for the oneperson in front of you.
It does not tell you what ismaking up your weight.
Do you have dense bones?
Do you have a lot of muscle?
Do you have excess fat?
We don't know what the weightis with the BMI.

(02:44):
So a very muscular, likefootball player or professional
basketball player, they couldhave a BMI technically in the
obese category, but we know thatthese are very healthy
individuals.
Compared to maybe somebody whodoes not typically exercise,
they actually may have a quoteunquote thin body, but may be

(03:07):
carrying more fat mass thanmuscle mass, and may have a
normal BMI, but may not be asmetabolically healthy as that
athlete that I mentionedearlier.
Normal BMI is considered 18.5to 24.9.
Overweight is 25 to 29.9, andobese is 30 or above.

(03:38):
Other ways that we cancategorize or quantify obesity
is using the waistcircumference.
And waist circumference is alsovery inexpensive to calculate
and easy to replicate.
And this is something that anindividual or a provider can

(04:01):
monitor over time.
Fat that is in those areas isless likely to cause disease in

(04:33):
somebody.
Another way that you can kindof do this is watching how your
clothes fit over time.
So are your pants tight?
Um, are they loose?
Are you needing to change yourpant size?
This is a proxy for your waistcircumference.
So for men, a waistcircumference of 40 or greater

(04:57):
is considered obese.
And for women, a waistcircumference of 35 or higher is
considered obese.
And we are talking about incheshere.
The most precise way to measureobesity is body fat percentage.
And the reason that this may bethe most precise is that for

(05:23):
obesity, it's less the fact thatsomebody weighs more than what
is considered a healthy weightfor them.
What's really a cause forconcern or caution when it comes
to somebody's health is howmuch excess adipose tissue or

(05:44):
fat tissue that they have.
Again, predominantly we areconcerned about that excess of
fat tissue in the abdomen oraround our organs.
And so if we know whatpercentage body fat somebody
has, it doesn't necessarilymatter if their BMI falls in the

(06:04):
obese range if they have lowbody fat.
For men, a body fat percentageof 25 or greater is considered
obese, and for women, a cutoffis 32% or greater.
There are many ways tocalculate your body fat, and

(06:24):
there are varying degrees of howaccurate these tests are.
There are calipers, there areelectrical impedance devices,
there's DEXA scans, and thereare even higher tech, more
precise ways of measuring bodyfat that are really mostly used

(06:46):
for research purposes.
I also want to talk aboutsomething that you probably
haven't heard before.
It's the Edmonton ObesityStaging System.
Attributes a stage 0 through 4to kind of stage how excess
weight or obesity is impactingtheir health.
This is really helpfulinformation to have because not

(07:09):
everybody that has excess weightor has obesity has medical
conditions.
They might not be impacted byit, and that's okay.
They can be healthy at thatsize.
But if you do have obesity andyou have complications, it's
good to know how severe theyare, and that's where the
Edmonton staging system comesin.

(07:31):
And so, stage zero, you don'thave any complications from your
excess weight.
Stage one, you're starting tohave some symptoms, but they're
not really impacting you on aregular basis.
So you may have a little bit ofknee pain here and there, your
blood sugar might be a littlebit elevated, your cholesterol
might be a little bit elevated,you have borderline high blood

(07:54):
pressure, but you're not needingmedications.
It's just something that we'restarting to take notice of.
Stage two is when you have adiagnosis of a weight-related
condition.
So you have that diagnosis ofdiabetes, you have high blood
pressure, you have highcholesterol, you are starting to

(08:14):
need medication for man.
Stage three is when the medicalconditions are becoming more
significant.
You're needing multiplemedications to manage your
weight-related conditions.
You're impacted on yourday-to-day life, you're having
limitations in the things thatyou can do.
Your knee pain is sosignificant that you're not able
to go on your walks like youlike to.

(08:36):
You may have had to have ahospitalization because of your
diabetes or your heart disease.
It's getting more significantat this point.
And then stage four isend-stage disease.
This is when your medicalconditions that are related to
your weight have gotten to thepoint where they are not managed

(08:58):
and they are not reversible.
So we're trying to catch peopleat the earliest stages so that
we can manage and treat andreverse their conditions by
treating their weight as theprimary underlying or one of the
most significant attributingfactors.

(09:18):
And so again, the Edmontonstaging system for obesity goes
from stage zero where you don'thave any conditions or symptoms
yet.
Stage one, starting to havesome evidence of a condition
developing, but you're notreally having any symptoms on

(09:39):
your day-to-day.
Stage two, you have a diagnosisof a condition, you have
diabetes, hypertension, you'restarting to need medication.
Stage three is becoming moresignificant, impacting your
day-to-day.
You're having multiplemedications, possibly a
hospitalization.
And stage four, irreversibleconditions, really significant

(10:01):
impact, limiting what you can doon a more significant scale.
So I hope this was helpful andI look forward to talking more
about obesity and how it impactshealth and what we can do to
treat it and manage it andprevent it.

(10:22):
If you don't already follow meon Instagram, I post there
multiple times per week and Iwould love to have you follow
me.
So check out that link below aswell.
And I will see you all nextMonday.
Have a great week.
Thank you for listening andlearning how you can improve

(10:42):
your metabolic health in thismodern world.
If you found this informationhelpful, please share with a
friend, family member, orcolleague.
We need to do all we can tocombat the dangerous
misinformation that is outthere.
Please subscribe and write areview.
This will help others find thepodcast so they may also improve
their metabolic health.
I look forward to ourconversation next week.