{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T11:25:04Z","timestamp":1779103504646,"version":"3.51.4"},"reference-count":69,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ADEMA University School"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Body mass index (BMI) remains the standard tool for obesity screening; however, it does not account for body fat distribution or visceral adiposity, potentially leading to clinically relevant misclassification\u2014particularly in young adults. Evidence on this issue in healthcare professionals is limited. Objective: To evaluate the extent of obesity misclassification when using BMI compared with alternative anthropometric and body composition indices, and to examine sex-specific associations between lifestyle factors and different adiposity phenotypes in young healthcare professionals. Methods: A large cross-sectional study was conducted in 12,874 medical residents, nursing residents, and age-matched controls (22\u201330 years). Obesity was defined using BMI (\u226530 kg\/m2), waist-to-height ratio (WtHR \u2265 0.5), Cl\u00ednica Universidad de Navarra\u2013Body Adiposity Estimator (CUN-BAE), body fat percentage, and bioimpedance-derived visceral fat. Multivariable logistic regression models adjusted for age, sex, professional group, smoking, physical activity, and Mediterranean diet adherence were fitted separately for each adiposity definition. Sex interaction terms were formally tested. Agreement between indices was assessed using Cohen\u2019s kappa. Results: Obesity prevalence varied substantially according to the index applied and was consistently higher when central or visceral adiposity measures were used. Agreement between BMI and alternative indices was only fair to moderate, with the lowest concordance observed for visceral fat (\u03ba = 0.29; 95% CI 0.26\u20130.32). Male sex was strongly associated with visceral fat-defined obesity (aOR 4.76; 95% CI 3.82\u20135.92), while effect sizes were attenuated for BMI-defined obesity (aOR 1.41; 95% CI 1.32\u20131.51). Significant sex interactions were detected for visceral adiposity, particularly for physical activity (p = 0.001) and smoking (p = 0.002), indicating differential lifestyle associations according to fat distribution phenotype. Conclusions: BMI substantially underestimates clinically relevant central and visceral adiposity in young healthcare professionals. Sex-specific differences were observed in the association between lifestyle behaviors and visceral fat. These findings highlight the limitations of relying exclusively on BMI for obesity screening. Incorporating waist-based or body composition-derived measures may improve early risk identification and support targeted preventive strategies.<\/jats:p>","DOI":"10.3390\/medsci14020234","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T16:54:07Z","timestamp":1777654447000},"page":"234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-Specific Misclassification of Obesity When Using Body Mass Index in Young Healthcare Professionals: A Large Cross-Sectional Study Using Multiple Adiposity Indices"],"prefix":"10.3390","volume":"14","author":[{"given":"Alberto","family":"Ramirez Gallegos","sequence":"first","affiliation":[{"name":"Balearic Islands Health Service, 07010 Palma, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5222-5784","authenticated-orcid":false,"given":"Pedro Juan","family":"T\u00e1rraga L\u00f3pez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Castilla La Mancha (UCLM), 02008 Albacete, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00f3nica Silu","family":"Pi\u00f1a Dabreu","sequence":"additional","affiliation":[{"name":"ADEMA-University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3848-687X","authenticated-orcid":false,"given":"Lluis","family":"Rodas Ca\u00f1ellas","sequence":"additional","affiliation":[{"name":"ADEMA-University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7439-8117","authenticated-orcid":false,"given":"\u00c1ngel Arturo","family":"L\u00f3pez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"ADEMA-University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6887-4562","authenticated-orcid":false,"given":"Jos\u00e9 Ignacio","family":"Ram\u00edrez-Manent","sequence":"additional","affiliation":[{"name":"Balearic Islands Health Service, 07010 Palma, Spain"},{"name":"ADEMA-University School, University of the Balearic Islands, 07009 Palma, Spain"},{"name":"Faculty of Medicine, University of the Balearic Islands, 07120 Palma, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023). 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