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Introduction

A planning committee of the National Academies of Sciences, Engineering, and Medicine (the National Academies) convened a workshop series¹ to explore the current science on measures of body composition and body fat distribution, with a focus on the strengths and limitations of body mass index (BMI) as a measure of adiposity and an indicator of health. Other topics examined were the anthropological and clinical perspectives of BMI, communicating to different audiences about BMI, and the policy implications of BMI on health care. The series consisted of two workshops held in 2023 (April 4 and June 26).

The April workshop explored the science of body composition and body fat distribution measures, with a focus on the strengths and limitations of BMI as a measure of adiposity and health. The presentations explored how different sectors and people from different ethnic groups, cultures, and life stages perceive and use BMI. Workshop presentations also examined BMI and alternative measures to assess obesity morbidity and mortality and how their accuracy affects obesity prevention, treatment, and policy.

The June workshop explored communication strategies and solutions to improve messaging around obesity and adiposity. Presentations

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¹ The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

demonstrated the connection between misinformation and bias and stigma about obesity; introduced evidence-based strategies to improve communication about body composition, BMI, adiposity, and health; and identified gaps in evidence and potential next steps to advance the field.

INTRODUCTORY REMARKS

Nicolaas (Nico) P. Pronk, president of HealthPartners Institute and chief science officer at HealthPartners, Inc., welcomed participants to the first workshop; Ihuoma Eneli, board-certified general pediatrician and professor at The Ohio State University and director of Nationwide Children’s Hospital Center for Healthy Weight and Nutrition, began the second workshop. As planning committee co-chairs, they provided a brief overview of the Roundtable on Obesity Solutions at the start of each workshop, explaining that it engages leaders and voices from diverse sectors and industries (e.g., academia, government, public health and health care, business, finance, media, education, child care, nonprofit) to help solve the nation’s obesity crisis. Through meetings, public workshops, reports, innovation collaboratives, and other workgroups, the roundtable provides a venue for ongoing dialogue on critical and emerging issues in obesity prevention and treatment and weight maintenance. It applies a policy, systems, and environmental change lens; focuses on sustainable, equitable strategies for addressing obesity-related disparities; and explores and advances effective solutions.

Pronk began with welcoming remarks, briefly describing the agenda and aims. He shared that the primary objective of the first workshop was to examine the state of the science on BMI as a measure of adiposity, obesity, and health. Because obesity is not universally accepted as a disease, the workshop focused on a variety of definitions and measures for adiposity and obesity, the utility of BMI in preventing and treating obesity, and the implications in the context of the clinic, public health, and health care policy.

Eneli welcomed participants to the second workshop, explaining that it built on the first to focus on communication strategies and solutions to improve messaging about obesity and adiposity across diverse groups and sectors and also linked the presence of misinformation with weight-related bias and stigma, cultural perceptions of body weight and adiposity, and evidence-based strategies for providers to shift their treatments to focus on health, and not weight.

ORGANIZATION OF THIS PROCEEDINGS

The proceedings follow the order of the workshop agendas (Appendix A) with each session recorded as an individual chapter. Chapter 2 summarizes Session 1 from the April 2023 workshop, which described the background and basis for the series by focusing on the different perspectives and definitions of obesity. Chapters 3–5 report on the remainder of that workshop, which included sessions on the tensions and perspectives around BMI (Chapter 3); applications and uses of BMI, body composition, and body fat distribution (Chapter 4); and a summary with steps for the future (Chapter 5). Chapters 6–10 are dedicated to the June 2023 workshop, which included sessions on communicating about obesity as it is defined and diagnosed (Chapter 6); innovations for communicating about body weight in the clinical setting (Chapter 7); ethics and trust in communicating about the intersection of body weight and health (Chapter 8); evidence-based approaches to improve communication about body weight (Chapter 9); and strategies and solutions to promote changes in perception and culture about body weight (Chapter 10). Appendix B contains biographical sketches of the planning committee members and speakers.

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