A new study challenges the conventional understanding of heart health risks by focusing on abdominal fat rather than overall body weight. It reveals that middle-aged and older adults carrying excess fat around their midsection face a heightened risk of heart disease, even if their weight appears healthy when assessed by the traditional Body Mass Index (BMI).
From BMI to BRI: A Shift in Measuring Obesity
BMI, a widely used tool for assessing obesity, calculates weight relative to height. While useful, it fails to account for critical variables such as fat distribution and muscle mass. This limitation has led researchers to explore alternative methods like the Body Roundness Index (BRI), which considers both waist circumference and height.
“Not all excess body fat poses health risks; in particular, abdominal or (visceral fat) has the greatest health risks, while fat in the thigh area poses the lowest risk,” explains Steven B. Heymsfield, MD, a professor at the Pennington Biomedical Research Center at Louisiana State University in Baton Rouge.
He adds, “BRI picks up these shape differences in a single measure better than BMI.”
Unlike BMI, which paints a broad picture of weight status, BRI zooms in on abdominal obesity, a significant predictor of cardiovascular issues.
Study Findings: Even Moderate Belly Fat Raises Cardiovascular Risks
The study examined five years of BRI data for approximately 10,000 Chinese adults, averaging 59 years of age, with no prior history of cardiovascular disease such as heart attack or stroke.
Over the study’s final four years, researchers recorded 3,052 cardiovascular disease events and 894 deaths.
The results were striking:
- Participants with high BRI levels throughout the study period faced a 55% increased risk of developing heart disease, a 46% higher likelihood of stroke, and a 35% greater chance of experiencing cardiac events like a heart attack.
- Even moderate BRI levels were associated with elevated risks: a 22% higher likelihood of heart disease, a 29% increased risk of stroke, and a 14% greater chance of cardiac events.
These findings remained consistent even after accounting for various factors that influence heart health, such as age, medical history, medication use, and levels of blood pressure, blood sugar, and cholesterol.
Why Fat Distribution Matters More Than Weight Alone
Fat isn’t created equal. Abdominal fat, or visceral fat, accumulates around internal organs and has been linked to inflammation, insulin resistance, and other factors contributing to heart disease. Conversely, fat in areas like the thighs is less metabolically active and poses minimal health risks.
Dr. Heymsfield underscores this distinction: “The body builder will have less body fat and more body mass in the upper extremities. That variation in body shape will be captured with BRI, but not BMI.”
This observation highlights why BRI offers a more nuanced assessment of health risks. It considers how fat is distributed, which BMI overlooks.
BRI’s Role and Its Limitations
While BRI provides valuable insights, experts caution against relying solely on this measure.
Maya Feller, RD, CDN, founder and lead nutritionist at Maya Feller Nutrition in Brooklyn, New York, advises using BRI as part of a broader health assessment.
“If a person has a high BRI, I recommend not using that as the stand-alone determinant and instead using the data from their most recent physical examination,” she says.
Tests for blood pressure, blood sugar, and cholesterol levels offer a more comprehensive understanding of cardiovascular disease risks. Combining these indicators with BRI can paint a clearer picture of an individual’s heart health.
The Study’s Limitations and Scope
While the findings are compelling, the study has its limitations. The follow-up period of five years may be too short to observe long-term cardiovascular trends. Additionally, the focus on Chinese participants raises questions about the applicability of the results to other racial or ethnic groups.
Nevertheless, the research provides a strong argument for looking beyond BMI as the sole indicator of health risks. Many individuals with the same BMI can have vastly different levels of fat distribution and muscle mass, underscoring the need for more precise tools like BRI.
Steps to Mitigate Cardiovascular Risks
For those identified as high-risk, there are practical steps to improve cardiovascular health. Nutritionist Maya Feller emphasizes the importance of a balanced, plant-based diet:
“Following a pattern of eating that is abundant in vegetables, fruits, ancient grains, beans, nuts, and seeds — and culturally relevant and accessible — generally reduces chronic disease risk,” she says.
Fiber-rich foods, including grains, beans, nuts, and vegetables, play a key role in reducing inflammation and supporting heart health. Regular physical activity and routine health check-ups further enhance these efforts, offering proactive ways to manage risk factors.
A Paradigm Shift in Obesity and Heart Health Assessment
This study underscores the importance of revising traditional approaches to obesity and cardiovascular risk. While BMI has long been the standard metric, its limitations make a compelling case for adopting BRI as a complementary tool.
As researchers continue to refine our understanding of fat distribution and its implications, a more comprehensive approach to health assessments is emerging. By integrating tools like BRI with traditional health metrics, individuals and healthcare providers can work together to identify risks early and implement effective strategies for a healthier future.
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