Latest news with #BMI
Reuters
an hour ago
- Business
- Reuters
African central banks' gold rush faces liquidity, price risks, Fitch unit says
NAIROBI, July 30 (Reuters) - Sub-Saharan African central banks that have added gold to their reserves in recent years could face price and liquidity crises if the value of the precious metal slides, BMI, a unit of Fitch Group, said on Wednesday. Ghana, Tanzania and Nigeria have been buying gold domestically to beef up their reserves, BMI said, a move accelerated by this year's broader market volatility stoked by U.S. trade tariffs and other geopolitical risks. Policymakers in Kenya and Uganda are exploring a move into gold, Rwanda and Namibia have taken active steps towards adding the metal into their reserves, while Burkina Faso has indicated it will build up its stockpile and Zimbabwe has said its new ZIG currency is backed by gold reserves, BMI said. "Gold is increasingly being used by sub-Saharan African markets as a strategic store of value," said Orson Gard, senior Sub-Saharan Africa analyst at BMI, during an investor presentation. The move, however, comes with various risks, he said, citing Ghana where an aggressive gold purchase programme has led to the metal accounting for a third of its reserves according to BMI calculations, driving a surge in the cedi currency and potentially making the country's exports less competitive. Ghana's central bank was not immediately available for comment. The price of gold, which touched a record high earlier this year, may have peaked, BMI said, and it faces potential downward pressure from any reduction in U.S. interest rates. "Any sudden drop in global gold prices would have significant implications for those markets in sub-Saharan Africa which have rapidly increased gold as a share of their total reserves portfolio," Gard said. A gradual price decline over the medium-term could also have a negative impact for countries that started buying gold around its recent peak, he added. "This would not only weigh on reserve adequacy but would also undermine the perceived credibility of central bank policy," he said. Ghana and Tanzania, which also rely on gold exports, could be hit by the "double whammy" of a drop in the value of their reserves and lower export earnings, he said. Governments could also struggle to convert their gold holdings into liquid assets like hard currencies, Gard said, pointing to India and Argentina when they faced acute balance of payments challenges in the 1990s and 2000s, respectively.
Medscape
2 hours ago
- Health
- Medscape
‘Clinical Obesity' Definition Shifts Obesity Prevalence
The adoption of the new 'clinical obesity' definition alters prevalence estimates of obesity in many parts of the world compared with BMI-based definitions, new data suggested. In January 2025, a Lancet Commission proposed that the diagnosis of obesity first be made via confirmation of excess adiposity using measures such as waist circumference or waist-to-hip ratio in addition to BMI. Next, a clinical assessment of signs and symptoms of organ dysfunction due to obesity and/or functional limitations determines whether the individual has the disease 'clinical obesity' or 'preclinical obesity,' a condition of health risk but not an illness itself. That definition, although endorsed by more than 75 professional medical organizations, has proved controversial, with a commonly cited concern that people in the 'preclinical obesity' category might be denied needed care. But the Lancet authors counter that the 'preclinical' obesity category should be treated as a health risk factor, no differently than hypertension or dyslipidemia. A new analysis of nationally representative surveys from 56 mostly low- and middle-income countries (LMICs) showed that application of a modified version of the 'clinical obesity' definition would reduce obesity prevalence by more than 50% in some regions. It was published on July 24, 2025, in PLOS Global Public Health . 'Our results emphasize the need to carefully consider how obesity is defined in population surveillance to ensure its relevance to health outcomes. While the clinical obesity framework offers a more precise measure of obesity-related disease burden, its implementation in routine surveillance will require further adaptation to overcome data availability challenges,' the authors wrote. Lead author Rodrigo M. Carrillo-Larco, MD, PhD, of the Department of Global Health at Emory University, Atlanta, told Medscape Medical News that there is a need for 'agreement on whether the definition has to change and for what purposes so that the right tools and specific definitions are in place. If for clinical purposes, what definition should be used to start pharmacologic treatment, for claims and reimbursement, and for risk stratification of other diseases?' In the paper, Carrillo-Larco and colleagues express the concern that with the new definition, 'there is little to no opportunity for primary prevention of clinical obesity, as its definition already includes a cardiometabolic condition that most likely warrants secondary prevention or treatment.' However, Lancet Commission Chair Francesco Rubino, MD, professor and chair of metabolic and bariatric surgery at King's College London, London, England, told Medscape Medical News that this perception is incorrect. 'Clinical obesity represents only a subset of the broader obesity spectrum. Total obesity prevalence should include both clinical and preclinical obesity.' Added Lancet Commission member Ricardo Cohen, MD, director of the Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil, 'The published paper demonstrates that prevalence estimates shift because the clinical definition targets those with higher medical need and not because fewer people require care. This is about better risk stratification, not exclusion.' Clinical Obesity Prevalence Differs From BMI-Only Obesity The study included nationally representative data from the World Health Organization's STEPS Survey for a total of 142,250 people in 56 countries in six world regions, including Africa (n = 49,438 from 18 countries), the Americas ( n = 3083 from one country), the Eastern Mediterranean (n = 19,292 from nine countries), Europe (n = 17,536 from seven countries), Southeast Asia (n = 27,334 from six countries), and the Western Pacific ( n = 25,567 from 15 countries). Carrillo-Larco told Medscape Medical News that LMICs were sampled because 'obesity may impose a greater burden in LMICs, given the limitations in access to treatment and counseling for obesity as well as for related comorbidities.' The clinical obesity definition used for the study included objective measures of weight, height, waist circumference, blood pressure, fasting plasma glucose, and total cholesterol. The Lancet definition includes a longer list of conditions, but the authors note that those data are not routinely available in many LMICs. Rubino said this could lead to an underestimate of the true prevalence of obesity. On the other hand, Carrillo-Larco and colleagues noted that the lack of such data in many countries represents a limitation of the definition. At the national level, the prevalence of clinical obesity in men ranged from less than 1% in Timor-Leste, Rwanda, Malawi, Ethiopia, Eritrea, and Cambodia to 29% in American Samoa, the Cook Islands, and Tokelau. In women, clinical obesity prevalence was as low as ≤ 1% in Vietnam, Timor-Leste, Rwanda, Ethiopia, Eritrea, and Cambodia, and as high as 28% in American Samoa and Tuvalu. Among men, the age-standardized prevalence of clinical obesity was < 10% in 41 countries, mostly in Africa (18/41). Among women, the age-standardized prevalence of clinical obesity was less than 10% in 30 countries, also mostly in Africa (14/30). The largest shift in prevalence occurred in Malawi, with BMI-only obesity in 0.7% vs clinical obesity in 0.2%, a relative reduction of 67.7%. However, the absolute change was less than 1 percentage point. Countries experiencing both a relative change of ≥ 10% and an absolute change of ≥ 10 percentage points were Nauru (-35.5% relative change and 13.3 percentage points in absolute change; prevalence of clinical obesity was 24.2% and that of BMI-only obesity was 37.5%) and Qatar (-49.2% and 10.3; prevalence of clinical obesity was 10.6% and that of BMI-only obesity was 20.9%). In women, the relative change in prevalence exceeded 50% in Malawi (relative reduction of 52.8%; 5.6% for BMI-only obesity and 2.6% for clinical obesity) and Rwanda (-52.4%; 2.7% for BMI-only obesity and 1.3% for clinical obesity). In Malawi and Rwanda, the absolute change was 2.9 and 1.4 percentage points, respectively. Countries with both relative and absolute changes exceeding 10% and 10 percentage points, respectively, were in the Western Pacific (American Samoa, Nauru, Niue, Samoa, Tokelau, and Tuvalu). Rubino told Medscape Medical News , 'Distinguishing clinical from preclinical obesity doesn't reduce urgency — it ensures timely treatment for those who need it and directs prevention toward those for whom it remains possible.' Regardless, Carrillo-Larco said, 'Clinicians should always consider obesity as a multifactorial condition for which nonpharmacologic conditions are very important and social determinants of health play a key role.' The authors received no specific funding. Rubino declared having received research grants from Ethicon (Johnson & Johnson), Novo Nordisk, and Medtronic; consulting fees from Morphic Medical; and speaking honoraria from Medtronic, Ethicon, Novo Nordisk, Eli Lilly, and Amgen. He has also served (unpaid) as a member of the scientific advisory board for Keyron and as a member of the data safety and monitoring board for GI Metabolic Solutions. Cohen declared having received research grants from Johnson & Johnson and Medtronic; honoraria for lectures and presentations from Johnson & Johnson, Medtronic, and Novo Nordisk; and serving on scientific advisory boards for Morphic Medical, Johnson & Johnson, and Medtronic.
WebMD
a day ago
- Health
- WebMD
Why BMI Still Won't Die
July 29, 2025 — The body mass index was born in judgment. Its creator, the 19th-century Belgian astronomer and statistician Adolphe Quetelet, believed that greatness arose from averageness. The closer an individual was to the average size and shape of their time and place, the closer they were to perfection. Any sports fan instantly sees the flaw in this logic: How boring would basketball be if the average NBA player was 5-foot-9 instead of 6-foot-7? But it gets worse: Quetelet asserted that the further someone deviated from the population average, the more flawed they were. First, however, he had to figure out what 'average' was. Starting with a database of measurements from Scottish soldiers, Quetelet developed a formula of weight (in kilograms) divided by height (in meters) squared. More than a century later, in 1972, legendary nutrition scientist Ancel Keys coined a new name for Quetelet's formula: body mass index, or BMI. What was conceived in judgment remains quite judge-y. BMI continues to serve as a demarcation between a 'normal' or 'healthy' body weight (a BMI between 18.5 and 24.9) and the deviance of being 'overweight' (a BMI of 25 to 29.9) or 'obese' (a BMI of 30 or more). Today, there's nothing 'normal' about a sub-25 BMI. Not when the average American adult has a BMI of 30 — just a couple of sandwiches past 'overweight' —and the CDC estimates that 42% of U.S. adults have obesity. That's why, over the past decade, a growing number of doctors and scientists have argued that BMI as a health metric is past its sell-by date. But before we talk about what's wrong with BMI and what health professionals can use instead, we need to look at how it became so ubiquitous and what it tells us — and doesn't. What BMI Can and Can't Tell Us 'The advantage of BMI,' said obesity specialist Yoni Freedhoff, MD, is that 'it's easily calculable.' Just run your height and weight through a BMI calculator. Freedhoff, an associate professor of family medicine at the University of Ottawa and medical director of the Bariatric Medical Institute, also acknowledges that 'BMI has a basis in statistical risk.' We've known for a long time that a person with obesity has a higher risk of developing heart disease, diabetes, and some cancers. During the COVID-19 pandemic, we learned that someone with a BMI over 30 was statistically more likely to develop a severe or even fatal illness. But when we look at overall risk of dying early from any cause, the link to excess body weight doesn't line up with expectations. A 2023 study found that, among U.S. adults, the likelihood of early death was 5%-7% lower among people with a BMI in the 'overweight' range, compared to those with a BMI between 22.5 and 24.9. The results varied significantly for older vs. younger groups. For those 65 and older, the chance of early death was about the same across BMIs from 22.5 to 34.9 — from the high end of 'healthy' to the low end of 'obese.' But for participants younger than 65, the lowest death rates were more constrained: from 22.5 to 27.4. 'BMI alone does not capture metabolic risk well,' said study author Aayush Visaria, MD, an instructor of medicine and clinical researcher at Rutgers University. That's because it can't distinguish between fat mass and lean tissue (muscle, bone, water), much less account for how a person's fat is distributed. That's important, Visaria said, because health professionals may overlook potential health risks in a patient who has a 'normal' BMI but poor body composition — the ratio of fat to muscle. The combination isn't as rare as it sounds. Research shows that many people with a 'healthy' BMI have excess body fat, defined as 25% or more in men and 35% or more in women. So what are the alternatives to using BMI to assess a patient's health risks? A New Paradigm for Diagnosing Obesity 'BMI by itself doesn't do anything for me,' said Fatima Cody Stanford, MD, MPH, an obesity medicine specialist at Massachusetts General Hospital and an associate professor of medicine and pediatrics at Harvard Medical School. 'I call it street-corner medicine. You're looking at the person like you're sitting on the street corner and you're like, 'That person has this issue.'' That's the message of a recent report that Stanford developed along with dozens of obesity experts from across the globe. The report puts obesity on a continuum. Where a person lands depends on how much body fat they have and how it affects their health and abilities. Toward the healthier end, you'd have someone whose BMI puts them in the overweight or obesity range but who has no weight-related health problems. They also wouldn't have excess fat mass, which you can indirectly measure with a tape measure. If their waist circumference, measured at the belly button, is less than 35 inches (for a woman) or 40 inches (for a man), you can assume they have a healthy body composition. A lot of athletes and other highly active people would fit into this category. At the other end of the continuum is clinical obesity: a chronic illness caused by excess body fat. Clinical obesity affects the person's health and/or quality of life at a functional level. They might have sleep apnea or joint pain; high blood pressure or heart problems; or high blood sugar or low HDL cholesterol. Or it might be some combination. Whatever the symptoms are, clinical obesity has a significant effect on the patient's present and future health status. Somewhere in between is preclinical obesity. In this category, a person has objectively high body fat (whether measured directly with DEXA or indirectly via waist circumference) but doesn't yet have obesity-related complications. Those complications are by no means exclusive to people with obesity. In a recent study, Stanford and her co-authors found that 61% of participants with a BMI of 30 or higher had at least one obesity-related complication — typically muscle or joint pain, high cholesterol, and high blood pressure. But so did 50% of participants with a 'normal' BMI. 'I don't know anything about [a patient] until I do a full assessment,' Stanford said. In fact, she won't see a new patient until she has access to a full metabolic workup, including fasting blood lipids and glucose, as well as their height and weight measurements. 'I don't even go over BMI with patients until it gets very severe, which is that 40-plus group.' What No Measurement Can Tell Us Someone with such a high BMI is unlikely to be surprised by hearing it. 'People who have excess weight know they have excess weight,' Freedhoff said. 'The doctors know. Everybody knows.' That's why Freedhoff doesn't think it matters if we replace or combine BMI with any other metrics. 'None of those numbers tell you if the individual in front of you has health consequences of their excess adiposity,' he said. Even more important, he added, is whether they themselves have any concerns about their weight. 'And if the answer to all those questions is no' — they have no medical conditions that require treatment, and they don't think their weight affects their quality of life — 'they're good to go. Just monitor, like we would with any other medical condition.' Why BMI Won't Go Away So if BMI doesn't offer uniquely valuable information, why is it still so ubiquitous? Why is it still used to assess who is or isn't at risk for diabetes or heart disease? Why is BMI the basis for prescribing in-demand weight loss medicines or for approving a range of procedures from joint replacements to organ transplants? 'It all comes down to what's the easiest, best number to use?' Freedhoff said. 'I'm not saying it's BMI, but I'm not saying it isn't.' If excess body fat is what medical providers should be monitoring, he added, 'BMI is pretty darned good' at detecting it. That's supported by a new study in the Journal of the American Medical Association. It showed that an overwhelming majority of participants with a BMI above the obesity threshold do, in fact, have excess body fat, as measured by DEXA. Still, Freedhoff said, no number has perfect prognostic value. That applies to any tool doctors use for any chronic condition. The difference with BMI is that it comes with the onus of personal responsibility. Whereas a doctor would never suggest that a patient's cardiac arrhythmia is a choice, that implication is almost always part of the conversation when it comes to obesity. 'I marvel at how challenging it seems to be for society as a whole, including health care, to consider obesity to be just another chronic medical condition that the person did not choose, that does not always guarantee problems, that does respond to treatment, and that should be free from blame,' Freedhoff said.
New Straits Times
a day ago
- Business
- New Straits Times
BMI maintains positive outlook for consumer spending in Malaysia over 2025, 2026
KUALA LUMPUR: BMI, a Fitch solutions company, has maintained its broadly positive outlook for consumer spending in Malaysia over 2025, with the country's healthy macroeconomic outlook driving real terms growth in household incomes. With inflation averaging lower than expected in May, BMI lowered its forecast for headline inflation to an average of 1.9 per cent year-on-year (y-o-y) in 2025, down from 2.1 per cent previously, and only slightly up from an average of 1.8 per cent in 2024. It noted this remained low enough to support household purchasing power. Overall, the firm forecasted household spending to grow by 3.8 per cent y-o-y over 2025, in real terms, to a value of RM930.7 billion, up from RM896.9 billion in 2024. "As a result, household spending has returned close to pre-COVID levels of growth, where it grew at a real average rate of 5.2 per cent y-o-y during the 2015-2019 period. "However, spending will continue to be restrained by Malaysian consumers' high levels of indebtedness and the correspondingly high debt servicing costs," it said in its latest "Malaysia Consumer Outlook: Strong Growth Forecast Over 2025 and 2026". Looking ahead to 2026, BMI expected consumer spending to accelerate, underpinned by strong gross domestic product growth and a stable employment outlook. It said consumer confidence and willingness to spend would be further supported by a stable inflationary environment and the Bank Negara Malaysia returning to a loosening mode, cutting its benchmark interest rate by a further 25 basis points from a forecast of 2.75 per cent in December 2025 to 2.50 per cent by end-2026. "Across the year, therefore, we forecast total household spending growth in Malaysia of 5.0 per cent y-o-y in real terms, taking spending to RM977.3 billion," it said. BMI said that over the 2025-2029 forecast period, solid household incomes and tourism-related retail sales would further support a steady uptick in spending.
The Star
a day ago
- Business
- The Star
BMI maintains positive outlook for consumer spending in Malaysia over 2025, 2026
KUALA LUMPUR: BMI, a Fitch solutions company, has maintained its broadly positive outlook for consumer spending in Malaysia over 2025, with the country's healthy macroeconomic outlook driving real terms growth in household incomes. With inflation averaging lower than expected in May, BMI lowered its forecast for headline inflation to an average of 1.9 per cent year-on-year (y-o-y) in 2025, down from 2.1 per cent previously, and only slightly up from an average of 1.8 per cent in 2024. It noted this remained low enough to support household purchasing power. Overall, the firm forecasted household spending to grow by 3.8 per cent y-o-y over 2025, in real terms, to a value of RM930.7 billion, up from RM896.9 billion in 2024. "As a result, household spending has returned close to pre-COVID levels of growth, where it grew at a real average rate of 5.2 per cent y-o-y during the 2015-2019 period. "However, spending will continue to be restrained by Malaysian consumers' high levels of indebtedness and the correspondingly high debt servicing costs,' it said in its latest "Malaysia Consumer Outlook: Strong Growth Forecast Over 2025 and 2026'. Looking ahead to 2026, BMI expected consumer spending to accelerate, underpinned by strong gross domestic product growth and a stable employment outlook. It said consumer confidence and willingness to spend would be further supported by a stable inflationary environment and the Bank Negara Malaysia returning to a loosening mode, cutting its benchmark interest rate by a further 25 basis points from a forecast of 2.75 per cent in December 2025 to 2.50 per cent by end-2026. "Across the year, therefore, we forecast total household spending growth in Malaysia of 5.0 per cent y-o-y in real terms, taking spending to RM977.3 billion,' it said. BMI said that over the 2025-2029 forecast period, solid household incomes and tourism-related retail sales would further support a steady uptick in spending. - Bernama
