{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T14:06:54Z","timestamp":1785506814212,"version":"3.56.0"},"reference-count":13,"publisher":"The Endocrine Society","issue":"8","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"U.S. Department of Veterans Affairs Rehabilitation Research Development & Translation Merit Awards","award":["RX003644"],"award-info":[{"award-number":["RX003644"]}]},{"name":"U.S. Department of Veterans Affairs Rehabilitation Research Development & Translation Merit Awards","award":["RX004770"],"award-info":[{"award-number":["RX004770"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 DK141988-01A1"],"award-info":[{"award-number":["K23 DK141988-01A1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percent body fat (%BF) is a common measurement reported on dual-energy X-ray absorptiometry (DXA) to assess for obesity. %BF is calculated as fat mass divided by total body mass, and thereby increases with either higher fat mass or reduced muscle mass. In contrast, fat mass index (FMI; kg\/m2) quantifies fat mass independent of muscle mass. It is unknown whether patients classified as obese by %BF have low muscle mass, and whether individuals with sarcopenia are labeled as obese by %BF vs FMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We utilized whole-body DXA data from 1999-2006 NHANES in adults \u226520 years of age (N = 14 850) to estimate the prevalence obesity by %BF, FMI, BMI, and waist circumference. We compared body composition across definitions and examined obesity prevalence among those with sarcopenia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>More patients met criteria for obesity when defined by %BF (76.8%) compared to BMI (33.9%), FMI (35.8%), and WC (51%). Participants classified as obese by %BF had lower lean (muscle) mass, FMI, and BMI compared to participants obese by FMI (all P &amp;lt; .001). Among patients with sarcopenia, 62.4% were classified as obese by %BF compared with 0.5% if BMI was used to define obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients who are classified as obese by %BF had the lowest muscle mass and fat mass compared to participants who met other definitions of obesity. The majority of patients with sarcopenia are labeled as obese by %BF. We believe these findings support the use of FMI, a measurement not confounded by muscle mass, for research and clinical assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jendso\/bvag139","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T11:39:09Z","timestamp":1782214749000},"source":"Crossref","is-referenced-by-count":1,"title":["Percent body fat misclassifies patients with sarcopenia as obese: support for fat mass index in obesity assessment"],"prefix":"10.1210","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0785-598X","authenticated-orcid":false,"given":"Susan L","family":"Ziolkowski","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Stanford University School of Medicine , Palo Alto, CA 94304 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Weber","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Pediatrics, Children\u2019s Hospital of Philadelphia , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua F","family":"Baker","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Department of Medicine, Corporal Michael J. Crescenz VA Medical Center , Philadelphia, PA 19104 ,","place":["USA"]},{"name":"Department of Epidemiology and Biostatistics, University of Pennsylvania , Philadelphia, PA 19104 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"3","key":"2026073109214066300_bvag139-B1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S2213-8587(24)00316-4","article-title":"Definition and diagnostic criteria of clinical obesity","volume":"13","author":"Rubino","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"10","key":"2026073109214066300_bvag139-B2","doi-asserted-by":"crossref","first-page":"e2537619","DOI":"10.1001\/jamanetworkopen.2025.37619","article-title":"Implications of a new obesity definition among the all of us cohort","volume":"8","author":"Fourman","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"9","key":"2026073109214066300_bvag139-B3","doi-asserted-by":"crossref","first-page":"e7038","DOI":"10.1371\/journal.pone.0007038","article-title":"Dual energy X-Ray absorptiometry body composition reference values from NHANES","volume":"4","author":"Kelly","year":"2009","journal-title":"PLoS One"},{"key":"2026073109214066300_bvag139-B4","author":"National Health and Nutrition Examination Survey"},{"key":"2026073109214066300_bvag139-B5","first-page":"1","year":"1995"},{"issue":"12","key":"2026073109214066300_bvag139-B6","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.2215\/CJN.02140214","article-title":"Association of sarcopenia with eGFR and misclassification of obesity in adults with CKD in the United States","volume":"9","author":"Sharma","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"issue":"8","key":"2026073109214066300_bvag139-B7","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1093\/oxfordjournals.aje.a009520","article-title":"Epidemiology of sarcopenia among the elderly in New Mexico","volume":"147","author":"Baumgartner","year":"1998","journal-title":"Am J Epidemiol"},{"key":"2026073109214066300_bvag139-B8","doi-asserted-by":"crossref","unstructured":"Ziolkowski S, Weber D, Baker JF. 2026. Data from: percent body fat misclassifies patients with sarcopenia as obese: support for fat mass index in obesity assessment. Dryad. doi:10.5061\/dryad.rjdfn2zss. Date of deposit 12 June 2026.","DOI":"10.1210\/jendso\/bvag139"},{"issue":"7","key":"2026073109214066300_bvag139-B9","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jacc.2025.05.024","article-title":"2025 concise clinical guidance: an ACC expert consensus statement on medical weight management for optimization of cardiovascular health: a report of the American College of Cardiology solution set oversight committee","volume":"86","author":"Gilbert","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026073109214066300_bvag139-B10"},{"key":"2026073109214066300_bvag139-B11"},{"key":"2026073109214066300_bvag139-B12"},{"issue":"9","key":"2026073109214066300_bvag139-B13","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1038\/s41366-022-01165-5","article-title":"Body fat and risk of all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies","volume":"46","author":"Jayedi","year":"2022","journal-title":"Int J Obes (Lond)"}],"container-title":["Journal of the Endocrine Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jes\/advance-article-pdf\/doi\/10.1210\/jendso\/bvag139\/68594893\/bvag139.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/10\/8\/bvag139\/68594893\/bvag139.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/10\/8\/bvag139\/68594893\/bvag139.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:21:48Z","timestamp":1785504108000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jes\/article\/doi\/10.1210\/jendso\/bvag139\/8715134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":13,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,7,8]]}},"URL":"https:\/\/doi.org\/10.1210\/jendso\/bvag139","relation":{},"ISSN":["2472-1972"],"issn-type":[{"value":"2472-1972","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,6,24]]},"article-number":"bvag139"}}