Obesity is the same for both sexes

Obesity occurs as a result enlargement of white adipose tissue, caused by adipocyte hyperplasia, hypertrophy or both 32 Obesity can be classified to either generalized or localized (abdominal) obesity. Majority of subjects with generalized obesity also suffer abdominal obesity, in the contrary; subject with abdominal obesity may be free of generalized obesity. 33

Obesity is commonly diagnosed by five anthropometric indices: BMI, body fat percentage (% body fat), waist circumference (WC), waist-hip ratio (WHR) and waist-to-stature ratio (WSR). dual energy x-ray absorptiometry (DEXA), Magnetic resonance imaging (MRI), and computerized tomography (CT) are objective procedures for evaluation of abdominal adiposity, but for practical purposes, using a tape measure is simple, easy to administer in epidemiological settings. 34

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The WHO recommends the body mass index (BMI) as a measure of obesity. BMI is a simple index of weight-for height and is defined as the weight in kilograms divided by the square of height in meters (kg/m2). BMI provides the most useful and widely accepted measure of overweight and obesity at the clinical and population level, as it is the same for both sexes and for all ages, and has been widely used in most studies world-wide. 2

The BMI is the simplest and most widely accepted measure of obesity. A BMI of 30 kg/m2 is widely accepted as a cut-off point for obesity. 35 Obesity is classified according to BMI to mild obesity (class I)) as 30-34.9 kg/m2, moderate obesity (class II) as 35-39.9 kg/m2, and morbid obesity ((class III) as >40 kg/m2), 36, 37, 38

Other indices as waist and hip circumferences are relatively simple measures 39 that measure different aspects of body composition and fat distribution. 40 Although both increased BMI and waist circumference (WC) are associated with increased health risks, but WC has the strongest correlation with health and cardiovascular diseases risks. 41 In term of adiposity distribution; the waist circumference (WC) and the waist to hip ratio (WHR) are utilized as a measure of obesity, 42 since both of them can accurately and specifically detect the presence of excess intra-abdominal fat accumulation. 43 BMI measures the “total” adiposity of the body and may miss many cases of “central/abdominal” obesity, in which the body fat accumulates mainly around the waist, so the waist circumference (WC); the simple clinical measure of central obesity is the tool of choice in this situation. 36 Central obesity; a disorder characterized by excess visceral fat accumulation; mainly on the abdominal region, resulting in increased WC. Central obesity cut point are estimated to be WC >102 cm and WC >88 cm in men and women respectively, where it is defined according to waist-hip ratio (W-H ratio) cut points of (W-H ratio) >0.9 for men and >0.85 for women. 44, 45, 46

Waist circumference (WC), a measure utilized to evaluate abdominal obesity, is often used as an alternative or in combination with BMI, WC can be considered a surrogate marker of abdominal fat mass, because WC correlates with subcutaneous and intra-abdominal fat mass and is more closely correlated with general health and cardiometabolic disease risk. 47 Obese Asian individuals have WC cut off points ? 90 cm (36 inches) and ? 80 cm (32 inches) for male and female respectively, while obese white Caucasians have WC cut off points ? 102 cm (40 inches) and ? 88 cm (35 inches) respectively.  The WC cut off point ? 102 cm is tightly correlated with BMI ?30. 29, 48

In addition to WC, the waist -to-hip circumference ratio (WHR) is another measure of central obesity. A WHR>1.0 in men and WHR>0.85 in women are used as cut-offs for identifying individuals with central obesity. However, WC is the preferred and more commonly used measure of abdominal obesity compared with WHR. 39

Waist to hips ratio (WHR) or abdominal-to-gluteal circumference ratio is another measure of obesity and is calculated by dividing WC by hip girth. WHR cut off pint at which there is an increased relative atherogenic risk Men > 0.9 and Women > 0.8. 49 Body fat percentage (BFP) is total body fat expressed as a percentage of total body weight. Men with more than 25% BFP and women with more than 33% BFP are considered obese. 50

Weight excess is linked with increased incidence of chronic disorders. Although BMI is still the primary index for monitoring of body weight due to its simplicity and ease of application; 51 But WC is better than BMI or waist- hip ratio “WHR” in obesity evaluation because WC is a better predictor of visceral fat than BMI or WHR, 52 since WC is highly correlated with visceral adiposity 53 and thus is usually used in combination with BMI for better evaluation of the level of cardiovascular risk associated with obesity. 54 WC is reflecting the status of abdominal and visceral fat. 51, 55

Monitoring changes in WC over time can provide an estimate of abdominal fat status even in the absence of a change in BMI. Interestingly; WC can be obviously changed without BMI change; providing an estimation of abdominal fat status. 56 Waist circumference (WC) is probably a better indicator of abdominal fatness than either body mass index (BMI) or waist to hip ratio (WHR).