# Better than BMI! What's your ABSI? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [August 31, 2013, 7:02pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682 "2013-08-31T19:02:12Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 31, 2013, 7:02pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/1 "2013-08-31T19:02:12Z")
I posted this in a Pit thread but people who read here may be more interested. We have had multiple past discussions about the limitations of BMI other than as a screening tool and as tool for studying populations. Waist circumference (WC) alone is also far from ideal for placing an individual on a health risk strata. I’ve recently learned of a newer tool though that seems pretty dang useful and powerful called simply “A Body Shape Index” ([ABSI](http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039504?imageURI=info:doi/10.1371/journal.pone.0039504.g002)). It uses WC and adjusts for height and weight. Turns out > [@](#): > > ABSI had little correlation with height, weight, or BMI. Death rates increased approximately exponentially with above average baseline ABSI … The association of death rate with ABSI held even when adjusted for other known risk factors including smoking, diabetes, blood pressure, and serum cholesterol. ABSI correlation with mortality hazard held across the range of age, sex, and BMI, and for both white and black ethnicities (but not for Mexican ethnicity), and was not weakened by excluding deaths from the first 3 yr of follow-up. [On-line tool available!](http://absi-calc.appspot.com/) Plug in your height weight age and waist circumference (not pants size, see [here](http://dev.musc.edu/cme/resources/obesity_resources/WCMG-Self-Measurement.pdf) for how to measure, just above hip bones at end of a normal exhalation). My ABSIz score is -1.3. From that calculator site I can click to a figure in the article (that “compare your score” link) and see that such means I am on the flat portion of the lowered mortality curve. Yea me! 🙂 Where are you? Have fun! Oh. Better ask for some opinons else this be considered a MPSIMS … would you like to see this as a value you follow at your health care provider’s more than your weight or BMI? Is this ready for prime time? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 31, 2013, 7:10pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/2 "2013-08-31T19:10:11Z")
Hahahahaha. -1.3 That puts me in the healthy range. This is fun. I’ve never been considered healthy before based on these kinds of readings. Both my BMI and waist size are too high when those are measured alone. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [August 31, 2013, 7:17pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/3 "2013-08-31T19:17:08Z")
-2.8. I have no idea what that means. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [August 31, 2013, 8:19pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/4 "2013-08-31T20:19:29Z")
-2.7 puts me outside the chart, as well. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [August 31, 2013, 8:26pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/5 "2013-08-31T20:26:43Z")
Reading the article, it appears to be equivalent to waist/hip ratio, something doctors have used in combination with BMI for some time. Like w/h, it’s supposed to be used along with BMI. FTR, I get scolded and told to lose weight when only BMI is considered, but told “you’re fine so long as you don’t sit on your butt all day” when w/h is taken into account. ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [August 31, 2013, 8:49pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/6 "2013-08-31T20:49:00Z")
+3, but I already knew I need to lose 2 stone. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 31, 2013, 9:08pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/7 "2013-08-31T21:08:10Z")
Basically any zero and below (zero would be 50%ile) is a good number and the higher above zero the greater the risk. 1.0 (1 SD high, roughly in the top 15%) is about 50% greater mortality risk and 2.0 (2 SD, roughly top 2 to 3%) is roughly twice the mortality risk. Your -2.7 and -2.8 z-scores, if based on accurate measurements, would mean your scores are in the lowest 0.35 and 0.25% respectively. From a risk status it is not much different though than someone who is -0.5 (31%ile roughly) and only a bit better than those who are smack dab average. That said, are you following the directions for WC from the link? Again, not your pants size. Use a cloth tape measure and follow directions carefully. The data is very sensitive to accurate data in. You two both could be among the almost 3 sigma outliers but measurement error is more probable. > [@](#): > > Note that since ABSI varies over a small range (population standard deviation is of order 5%, Figure 1b), it is sensitive to the accuracy of the biometric measurements on which it is based. In particular, WC should be measured according to the NHANES protocol [22] in order to meaningfully compare ABSI with the population normals given here **Nava** I don’t get that from the article. The comment about waist hip ratio is in comparison to BMI alone and WC alone and that it might also be improved by adjustment for BMI and ht. > [@](#): > > In addition to WC, inverse hip circumference, or waist to hip ratio, have been suggested as alternative measures of body shape that predict mortality better than BMI [18], [47]. It is theorized that gluteofemoral fat may benefit health by removing free fatty acids from the bloodstream [48]. Different studies have reached a range of conclusions about whether WC [14], [16] or waist to hip ratio [13], [17] is a better predictor of mortality; a meta-analysis of British studies found them to be equally good predictors [49]. … waist to hip ratio, despite its nondimensional form, was significantly correlated to BMI (), and we may hypothesize that adjusting hip circumferences or waist to hip ratios for height and weight, as done here for WC, would make them more useful as predictors of mortality hazard. The significance of hip circumference or waist to hip ratio cannot be evaluated with NHANES 1999–2004 data because hip circumference was not measured … It would be of interest to compare the waist to hip ratio’s performance with that of ABSI in suitable data sets, and it may well be that ABSI can be improved as an indicator of hazardous body shape by including hip circumference in addition to height, weight and WC (which is why ABSI for now bears the indefinite article). … This metric appeals to me intuitively. Two people with the same weight and height, but different WC implies a lot about where the weight is. Likewise two people with same WC but one with a higher BMI implies that the higher BMI person has more muscle mass or minimally less visceral fat and more subcutaneous fat on his/her arms and legs - and is at lower health risk. ---
**Author:** ![Renee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/renee/32/287_2.png) [@Renee](https://boards.straightdope.com/u/Renee)\ **Post date:** [August 31, 2013, 9:54pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/8 "2013-08-31T21:54:46Z")
-3.4. What do I win? I have to say I didn’t find the compare your score site all that easy to understand upon a brief perusal. ---
**Author:** ![Helena330](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/helena330/32/531_2.png) [@Helena330](https://boards.straightdope.com/u/Helena330)\ **Post date:** [August 31, 2013, 10:13pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/9 "2013-08-31T22:13:10Z")
-1.0!! 🙂 I don’t understand exactly how it works, but it certainly seems like it would be a better measurement. I read a figure that using BMI, roughly half the NFL is obese. It seems like this method would be MUCH more accurate when you take that into consideration. (Granted, some NFL players are rather beefy, but not half of them). ---
**Author:** ![one\_red\_shoe](https://avatars.discourse-cdn.com/v4/letter/o/54ee81/32.png) [@one\_red\_shoe](https://boards.straightdope.com/u/one_red_shoe)\ **Post date:** [August 31, 2013, 10:26pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/10 "2013-08-31T22:26:12Z")
0.079 ABSI. BMI 25. Someone please tell me what this means. ---
**Author:** ![Surreal](https://avatars.discourse-cdn.com/v4/letter/s/eada6e/32.png) [@Surreal](https://boards.straightdope.com/u/Surreal)\ **Post date:** [August 31, 2013, 11:15pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/11 "2013-08-31T23:15:01Z")
BMI: 22 ABSI: 0.073 ABSIz: -1.8 ---
**Author:** ![DataX](https://avatars.discourse-cdn.com/v4/letter/d/e99b99/32.png) [@DataX](https://boards.straightdope.com/u/DataX)\ **Post date:** [August 31, 2013, 11:41pm UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/12 "2013-08-31T23:41:24Z")
Just a few comments… 1. I don’t think this is necessarily “better” than BMI - BMI is simple and easy to see on a chart - this you need - website. The complain you hear all the time are that there are healthy people out there with high BMI’s. anyone out there with a high BMI and is healthy - is working their ass off. They don’t need a BMI to know they are healthy. The BMI is good for couch potatoes who don’t realize how fat they are. 2. The measurement is highly dependent on how you measure waist size. How many people posting their scores actually followed the instructions vs just using their pants size? I’m still trying to find my new tape measure - as I broke the last one :). But I know from other measurements of done of this type - 3-4 inch differences aren’t uncommon. And that makes a big diff on that “z” measure. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 1, 2013, 12:04am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/13 "2013-09-01T00:04:58Z")
**one red shoe** , you can take your\* z-score\* and then can look on [this graph](http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039504?imageURI=info:doi/10.1371/journal.pone.0039504.g002). The z-score also varies with age but you have about the same raw score I do, so odds are that your z-score and RR are about the same as mine too. I found another version of an online calculator [here](http://absi.nl.eu.org/) which reads the relative mortality risk (RR) for us. Makes it much easier. Using that one it tells me right off that my RR is 0.75 by ABSI and using both ABSI and BMI is 0.59. Which mean that have by ABSI 25% less mortality risk and 41% less by using both ABSI and BMI together. **Renee** what you win is a new tape measure! 🙂 I do think the _accurate_ measurement of WC is the tricky bit for this. It has be the right spot in the right way. Not pants size! My pants size is 29 to 30 depending on the brand; my WC measured as directed is 34.5 to 35 depending on the exhalation. There are also other protocols for WC out there and within their studies they are fine; but for this tool this \*particular \*techinique of measuring WC must be followed. A good thing about following this metric is what happens when someone has been following a nutrition/exercise plan for a while and is getting frustrated because they are not losing any more weight, maybe even (because of a slight increase in muscle mass) gained some. This will show them the improvement. A slight decrease in WC with a slight increase in BMI significantly decreases ABSI, capturing the fact that (s)he has significantly improved body composition even as the scale disappoints. This metric better captures abdominal obesity relative to BMI and height and it really is abdominal obesity, especially _in relation to muscle mass_, that seems to matters most. **DataX** BMI is simple to see on a chart because it has been calculated by the EMR or by someone using some set of tables or a BMI wheel. No reason the EMR cannot calculate this just as easily once WC is entered in as well. And yes, as above, the number of sigma outliers we are seeing here do speak to the difficulty of getting WC right at home. Also agreed to some degree that BMI is a screening tool only and that someone with a “high” BMI (and here we are talking over 25 to under 35, not 35 and over) who is exercising regularly and eating healthy should not be told they need to lose weight. Yes a high BMI can identify a person who is a couch potato who does not realize how fat they are. BUT. Of those with “normal” BMIs (18 to 25) 8% are metabolically unhealthy. They have relatively low muscle mass and a _relatively_ high amount of abdominal (visceral) fat. They are low fitness and at high risk of diabetes and heart disease of a worse prognosis than the diabetes and heart disease that shows up in the obese (that “obesity paradox”). BMI as a screen will miss them; ABSI won’t. ---
**Author:** ![Tapiotar](https://avatars.discourse-cdn.com/v4/letter/t/3be4f8/32.png) [@Tapiotar](https://boards.straightdope.com/u/Tapiotar)\ **Post date:** [September 1, 2013, 1:29am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/14 "2013-09-01T01:29:35Z")
Wow, I like this. According to it, I’m in great shape, even though according to scale and BMI, I am not. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [September 1, 2013, 1:36am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/15 "2013-09-01T01:36:20Z")
I had a real issue with my waist size - I think I started measuring too low (at my hips). There is a noticable difference between my hips and my waist, but I was getting a two - and with a BMI of 23 and a small waist, there was no way I was a two. I think I’m closer to a .6 ---
**Author:** ![rhubarbarin](https://avatars.discourse-cdn.com/v4/letter/r/eb9ed0/32.png) [@rhubarbarin](https://boards.straightdope.com/u/rhubarbarin)\ **Post date:** [September 1, 2013, 2:39am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/16 "2013-09-01T02:39:48Z")
Interesting, hadn’t heard of this. -2. Because I am average height but underweight by BMI and have an unusually small waist. These measurements don’t reflect that I’m lean, fit, have visible muscle, eat a healthy high-calorie diet, enjoy good general health, and have perfect blood pressure/blood lipids etc. Anything based on the statistics of the average healthy person doesn’t seem to apply well to me. But this score is more in my favor than BMI. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [September 1, 2013, 2:46am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/17 "2013-09-01T02:46:35Z")
> [@DSeid](#): > > Basically any zero and below (zero would be 50%ile) is a good number and the higher above zero the greater the risk. 1.0 (1 SD high, roughly in the top 15%) is about 50% greater mortality risk and 2.0 (2 SD, roughly top 2 to 3%) is roughly twice the mortality risk. Your -2.7 and -2.8 z-scores, if based on accurate measurements, would mean your scores are in the lowest 0.35 and 0.25% respectively. From a risk status it is not much different though than someone who is -0.5 (31%ile roughly) and only a bit better than those who are smack dab average. That said, are you following the directions for WC from the link? Again, not your pants size. Use a cloth tape measure and follow directions carefully. The data is very sensitive to accurate data in. You two both could be among the almost 3 sigma outliers but measurement error is more probable. Women wouldn’t use their pants size, **DSeid** : they’re not measured in inches in the US. I measure my waist with a cloth measuring tape and take care not to suck in my gut because that’s cheating 😃 ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [September 1, 2013, 3:08am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/18 "2013-09-01T03:08:00Z")
> [@elfkin477](#): > > Women wouldn’t use their pants size, **DSeid** : they’re not measured in inches in the US. Sort of: apparently my US pants size is my _hip_ circumference in inches. ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [September 1, 2013, 3:46am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/19 "2013-09-01T03:46:01Z")
> [@Nava](#): > > Sort of: apparently my US pants size is my _hip_ circumference in inches. 😕 I’m no great shakes at math but circumference is the outer measurement of a circle, right? I doubt you have hips between 4" and 26", which are the most typical US sizes. Not to mention an 4 fits ~36" hips and a 26W fits ~56" hips. ---
**Author:** ![rhubarbarin](https://avatars.discourse-cdn.com/v4/letter/r/eb9ed0/32.png) [@rhubarbarin](https://boards.straightdope.com/u/rhubarbarin)\ **Post date:** [September 1, 2013, 3:47am UTC](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682/20 "2013-09-01T03:47:52Z")
^considering typical US women’s sizes go from 00 to 32 (but the upper range can be very hard to find) I doubt that. ETA: or what elfkin said. [Next page](https://boards.straightdope.com/t/better-than-bmi-whats-your-absi/667682.md?page=2)