Comparison of methods for setting weight loss goals in males.

To the Editor: In the American Heart Association’s (AHA) guidelines for the metabolic syndrome,1 the diagnosis of obesity is based on an abdominal circumference (AC) of 40 inches or more in males and 35 inches or more in females. For weight management, the AHA guidelines recommend reduction of weight to a body mass index (BMI) of less than 25 kg/m2. In this study, we compare that recommendation to two other methods for setting weight loss goals. The subjects in this study were a convenience sample of volunteers at health screenings conducted at a hospice, a family medicine residency, and a community center. Six of the male subjects had an AC of 44 inches or more (moderate and severe obesity), and 11 of the male subjects had an AC of 40 inches to 42 inches (mild obesity). Figure 1 shows a comparison of weight loss goals in six subjects with moderate or severe obesity. The weight loss goals were BMI 24 kg/m2 (not overweight), BMI 29 kg/ m2 (not obese), and 24% body fat (not obese) measured by bioelectric impedance analysis (BIA). As shown in Figure 1, the BMI of 24 kg/m2 method produced weight loss recommendations that exceeded those of BIA by a range of 112% to 310% in five of the six subjects. In contrast, the BMI of 29 kg/m2 method produced weight loss recommendations that were comparable to BIA ratings in four of the six subjects. Recommendations with the degree of error found when using a BMI of 24 kg/m2 are a health hazard because the patient either drops out of treatment or follows a weight loss goal that will result in a significant loss of lean weight and increased morbidity. Figure 2 shows a comparison of weight loss goals in 11 male subjects with mild obesity. As in 0 10 20 30 40 50 60 70