Study Finds This Measurement Is Better Than BMI at Predicting Disease
Body roundness index (BRI), may be a better predictor of disease than body mass index (BMI), new research shows.
Researchers determined that higher BRI trajectories were significantly associated with the risk of cardiovascular disease.
Experts explain what you need to know about the measurement.
Whether “too high,” “too low,” or “just right,” your body mass index (a.k.a. BMI) has historically been used as an evaluation of health. However, it’s been a controversial measurement for years (Prevention no longer uses BMI as an indicator). Now, research shows that a new measurement, body roundness index (BRI), may be a better assessment of your health and at predicting disease than BMI.
Meet the Experts: Meghan Garcia-Webb, M.D., triple board-certified in internal medicine, lifestyle medicine, and obesity medicine physician and internist at Beth Israel Lahey Health; Joseph Mercola, D.O., board-certified family medicine osteopathic physician; Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board.
A study published in JAHA: Journal of the American Heart Association analyzed BRI measurements (calculated using a standard formula factoring in waist circumference and height) for more than 9,935 adults 45 years old and up in China from 2011 to 2016. During this time, none reported a diagnosis of cardiovascular disease. Rather than relying on a single measurement of the body roundness index, researchers also looked at BRI changes over time and took blood samples and blood pressure readings from the participants throughout the study.
Researchers then analyzed the trajectories of the BRI measurements over time, and put the participants into three groups: low, moderate, and high BRI. With increasing and persistently higher BRI measurements, they saw a higher risk of developing cardiovascular disease, stroke, or cardiac events. More specifically, they found that the risk of heart disease in the moderate BRI group was 61% higher than in the low BRI group; and the difference in risk between high and low was 163%.
What is BRI?
BRI is a new way to measure body fat and the fat around your organs that is based on waist circumference and height, and is used to describe a person’s body shape, says Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board.
Waist circumference is a measurement of abdominal obesity, and it is essentially a proxy measurement for visceral body fat, adds Meghan Garcia-Webb, M.D., triple board-certified in internal medicine, lifestyle medicine, and obesity medicine physician and internist at Beth Israel Lahey Health. “Visceral body fat is the fatty tissue deposited around our abdominal organs, and greatly increases the risk of heart disease, fatty liver disease, and diabetes,” she explains.
BRI vs. BMI
“Both BRI and BMI include height in their calculations—they differ in that BMI uses weight whereas BRI uses waist circumference,” says Prest.
BMI has been criticized because it is a fairly limited measurement that only takes into account a person’s height and weight, says Dr. Garcia-Webb. It does not account for body composition—how much body fat someone has compared to their lean body mass, or where the fat is distributed, she adds. “This is where BRI has an advantage—instead of using weight as a measurement, it looks at how waist circumference relates to height,” Dr. Garcia-Webb points out.
So, the idea is that looking at one’s BRI gives a much better sense of overall health, says Dr. Garcia-Webb. “For example, a bodybuilder might have a BMI that placed them in the ‘obese’ category because their weight is high due to muscle mass. But their BRI would tell a very different story about their health, as waist circumference would be quite low compared to height.”
Why does BRI matter?
BRI is essentially a measurement of visceral fat deposition, says Dr. Garcia-Webb. “Visceral fat is the fat deposited behind the abdominal wall, deep within the abdominal cavity of the body, right next to our pancreas, liver, and intestines, and just below the heart and lungs,” she says. Fatty tissue in excess can have an inflammatory effect, and having excess visceral fat, right next to our vital organs, can increase the risk of heart disease, diabetes, and fatty liver disease, she explains.
Through this study, we’ve learned that where you carry your weight is just as important as how much you weigh, says Joseph Mercola, D.O., board-certified family medicine osteopathic physician. “In fact, this study from China found that BRI might be a superior indicator when it comes to predicting cardiovascular disease risk,” he says.
It’s not just about the numbers on the scale—it’s about how your body shape changes over time, and what’s particularly interesting is how BRI tracked these changes over time, Dr. Mercola continues. “The study showed that maintaining a high BRI or seeing it increase was linked to higher cardiovascular risk,” he says. This suggests that BRI might be capturing important changes in our body composition that other measures miss, he explains.
The bottom line
BRI’s focus on abdominal obesity gives us a more nuanced view of health risks than BMI, potentially allowing for earlier and more targeted interventions, says Dr. Mercola. “It’s a promising step forward in our understanding of body composition and chronic disease risk,” he says.
While many people understand that excess body weight may raise the risk of chronic diseases and heart issues, this study shows that abdominal fat (measured by waist circumference) is just as important—if not more—when it comes to disease risk, notes Prest. However, “one thing to keep in mind is that this study was conducted in China with a group of people who are representative of their community, so results may vary when applying the results to other groups of people,” she points out.
Dr. Garcia-Webb predicts that BRI will likely become a more routine measurement for everyone at their annual physical and could be very useful as a screening tool, in the same way that we use BMI now. “Of course, anyone with a history of obesity and weight-related comorbidities can benefit from knowing their BRI,” Dr. Garcia-Webb advises. But it will also be useful to capture those patients who don’t have a high BMI but may still be at elevated risk for weight-related medical issues due to their body composition, she notes.
Remember, though, that BRI is just one tool in our health toolkit, says Dr. Mercola. “It’s not about achieving a ‘perfect’ number, but rather understanding our bodies better and making informed choices for our overall well-being.”
Instead, Dr. Mercola recommends looking at the big picture of your health, including diet, exercise, stress management, and sleep.
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