[Limitations in the Clinical Assessment of Obesity: comments on the American Heart Association's 2006 Statement].

The American Heart Association (AHA) update on obesity has recently been published.1 The purpose of this letter is to comment briefly on the limitations of the clinical assessment of obesity. The link between obesity and cardiovascular risk (CVR) has traditionally been controversial. Although the Framingham study already observed in 1967 that higher body weight raised an individual’s probability of cardiovascular disease (CVD),2 it was only in 1998 that the AHA (American Heart Association class) first recognized obesity as a major independent cardiovascular risk factor.3 The explanation to this problem lies precisely in the limitations of obesity assessment, which should be expressed as a percentage of body fat,4,5 but is difficult to quantify clinically.5 Numerous anthropometric variables have been used for this purpose, but body mass index (BMI) is the most highly extended to assess body weight and, along with abdominal circumference, is the method recommended by the AHA.1 The key limitations in the clinical assessment of obesity include the following: