What is BMI?
Body Mass Index (BMI) is a measure calculated by dividing body weight by the square of body height. A value between 18.5 and 24.9 is considered normal.
The Limitations of BMI
BMI alone does not fully reflect your health status. Despite a normal BMI, you may:
- have a high body fat percentage (hidden obesity)
- have developed insulin resistance
- show signs of metabolic syndrome
- have cardiovascular risk factors
Hidden Obesity (Skinny Fat)
Normal-weight individuals with a high body fat percentage have insufficient muscle mass. This condition is called “skinny fat” or “hidden obesity.” In these individuals, the risk for diabetes, heart disease, and high blood pressure is increased.
Measuring Health Correctly
Instead of BMI or together with BMI, the following measurements provide more accurate information:
- Waist Circumference: Women over 88 cm, men over 102 cm = risk
- Waist-to-Hip Ratio: Over 0.85 (women) and 0.90 (men) = risk
- Body Fat Percentage: DEXA, bioelectrical impedance analysis, or skinfold measurement
- Blood Tests: Fasting blood glucose, insulin, cholesterol panel
Conclusion
Even with a normal BMI, it is important to have regular health check-ups, exercise, and eat a balanced diet. If you have concerns, contact your doctor.
Normal BMI, But Metabolic Syndrome?
Many people with normal BMI still show signs of metabolic syndrome. Dr. Türker Karabuğa regularly observes patients in his obesity clinic in Izmir who appear normal weight but have severe metabolic problems. Metabolic syndrome is the simultaneous occurrence of high blood pressure, elevated blood sugar, elevated triglycerides, and low HDL cholesterol.
Visceral fat is a dangerous type of fat that accumulates around internal organs. Someone can be normal weight but still have a very high proportion of visceral fat. Without blood tests, fasting blood glucose, insulin levels, and hormone status, this problem is often not detected. Waist circumference is a better indicator of metabolic risk than BMI. If waist circumference is over 94 cm for men and over 80 cm for women, metabolic problems are likely despite normal weight.
The TOFI Concept (Thin Outside, Fat Inside)
The TOFI concept describes individuals who appear slim on the outside but have a high fat percentage on the inside. In his practice, Dr. Türker Karabuğa observes that some patients who consider themselves slim show signs of metabolic obesity in test results.
TOFI individuals have insufficient muscle mass. The fat tissue has accumulated in internal organs instead of muscles. The risk for heart disease, diabetes, and high blood pressure can be as high as in individuals classified as obese by BMI. This condition develops through a sedentary lifestyle and insufficient protein intake. People who do not exercise and do not build muscle mass can fall into the TOFI category despite normal weight. The term “metabolic obesity” is used to describe this condition.
How to Measure Body Fat Percentage?
In addition to BMI, there are several methods to measure body fat percentage. Bioelectrical Impedance Analysis (BIA) sends a light electrical impulse through the body and calculates the ratio of fat to muscle. It is simple, fast, and relatively inexpensive, but can be affected by hydration status. DEXA measurement (Dual-Energy X-ray Absorptiometry) measures bone density and body fat percentage with very high accuracy and is considered very reliable.
Skinfold measurement is performed with a simple caliper instrument. Skinfold thickness is measured at specific body locations and body fat percentage is calculated via formulas. This method depends on the experience of the person measuring. To understand that BMI alone is insufficient, knowledge about body fat percentage is absolutely necessary.
Assessment Approach of Dr. Türker Karabuğa
Dr. Türker Karabuğa does not use BMI alone in patient assessment in Izmir. A much more comprehensive evaluation is performed: waist circumference, body fat percentage, blood tests, family history, and patient lifestyle habits are examined in detail. This holistic approach enables determination of actual health status.
Detailed conversations are held with patients in which diet habits, physical activity, sleep quality, and stress levels are discussed. When necessary, cardiologists, endocrinologists, and nutritionists are consulted. This multidisciplinary approach by Dr. Türker Karabuğa enables determination of actual health status of patients and establish the appropriate treatment pathway.
Can Metabolic Risk Exist With Normal BMI?
At the clinic of Dr. Türker Karabuğa in Izmir, the question is frequently asked: “My BMI is normal — why do I still have problems?” The answer lies in the fact that BMI alone is not a sufficient health indicator. BMI measures the relationship of body height and weight but does not show where fat accumulates in the body. Individuals who appear slim but have much visceral fat around their internal organs can be classified as metabolically obese.
This condition is referred to in medical literature as TOFI. In these individuals, metabolic syndrome criteria such as insulin resistance, elevated triglycerides, low HDL cholesterol, and high blood pressure can occur. Dr. Türker Karabuğa evaluates waist circumference, body fat percentage, and blood parameters together with BMI.
Why Are Waist Circumference and Body Fat Percentage Important?
According to Dr. Türker Karabuğa, waist circumference is a more reliable indicator of metabolic risk than BMI. According to WHO criteria, a waist circumference over 94 cm in men and over 80 cm in women is considered a risk factor; over 102 cm in men and over 88 cm in women is considered high risk. At the clinic in Izmir, waist circumference is routinely measured at every patient evaluation.
For body fat percentage, over 25% in men and over 35% in women is considered the obesity threshold. This measurement can be performed via Bioelectrical Impedance Analysis or DEXA scan. Dr. Türker Karabuğa also recommends lifestyle changes and, if necessary, medical intervention for normal-weight individuals with high visceral fat percentage.
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