Beyond body mass index: prevalence of normal weight obesity in a primary care population in Turkey

Obesity is a chronic, recurrent, and progressive disease that impairs health due to abnormal accumulation of adipose tissue. One of the most commonly used methods for the assessment of obesity is the Body Mass Index (BMI), and individuals with a BMI value of ≥ 30 kg/m² are defined as “obese.” However, BMI alone is not always sufficient to characterize obesity. Individuals who fall within the normal BMI range (18.5–24.9 kg/m²) but have a high body fat percentage are classified as having Normal Weight Obesity. The aim of this cross-sectional study is to determine the prevalence of normal-weight obesity in a primary care subpopulation in Turkey by evaluating body fat percentage among individuals within the normal BMI range. This cross-sectional analytical study was conducted on 683 volunteer participants (212 men, 471 women) who applied to a Family Medicine outpatient clinic. Body fat percentage was assessed using a Tanita BC601 bioelectrical impedance analyzer. Total body fat percentage of 30% and above in women and 25% and above in men was considered normal weight obesity. According to our findings, the prevalence of normal-weight obesity in this primary care cohort was determined to be 28.4%. When evaluated according to gender, the frequency of normal-weight obesity was found to be 37.7% in women and 3.8% in men. Accordingly, normal-weight obesity is much more common in women than in men. In addition, waist circumference, waist-to-hip ratio, and visceral fat levels were significantly higher in the normal-weight obesity group ( p < 0.05). Normal-weight obesity appears to have a considerable prevalence in this primary care setting. These findings highlight the need to consider not only BMI but also body fat percentage and distribution in the assessment of obesity.