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The Optimal Body Mass Index Range for Patients With Colorectal Cancer.

The Optimal Body Mass Index Range for Patients With Colorectal Cancer To the Editor We are intrigued by the article by Kroenke et al1 showing evidence that a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) range defined by the World Health Organization (WHO) as “highoverweight” (BMI, 28 to <30) is optimal when considering overall and colorectal cancer (CRC)–related mortality, indicating a U-shaped survival relationship with the best survival observed at a BMI of 28. The authors concluded that “recommendations for weight loss in the immediate postdiagnosis period among patients with CRC who are overweight may be unwarranted.”1(p1137) Weight management strategies for cancer survivors have been gaining a lot of attention, and the relationship between obesity and cancer prognosis is complex. Commonly, BMI is used as the standard measuring tool for classifying patients based on obesity risk and susceptibility to disease. However, there are several important facts that we should consider when recommending weight management using solely BMI. First, it is reasonable to consider that non-Western populations define obesity differently. For example, within Asian-Pacific populations, the cutoff BMI classified as overweight is 23 to less than 25 and obesity is 25 or greater, compared with the WHO definitions of 25 to less than 30 and 30 or greater, respectively.2 Particularly, Asians have a higher body fat percentage compared with whites of the same age, sex, and BMI, which makes them more susceptible to illnesses such as cardiovascular disease, diabetes, and various cancers associated with obesity at a lower BMI compared with their white counterparts.3 A study suggests that when the criterion of BMI of 30 or greater is applied to define obesity, the prevalence of obesity in Japan is less than 3% despite the rapid increase in incidence of obesity-associated chronic diseases such as diabetes, hypertension, and hyperlipidemia.4 In the cohort reported by Kroenke et al,1 a substantial number of participants (n = 531 [15.5%]) identified themselves as AsianPacific Islander and it is questionable whether the WHOdefined high-overweight range (BMI, 28 to <30) could still be the optimal range in Asian-Pacific Islanders as well. Second, BMI has been used as the most common measure of indicating obesity due to its simplicity of measurement and availability, but waist circumference and actual body composition, particularly fat and muscle percentages, may be more reflective of the degree of someone’s obesity.5 Until we can find the optimum body weights in different ethnic groups and validate them in a different large prospective cohort, one should be cautious about altering current guidelines that emphasize physical activity in cancer survivors.