# Situation: The public health nurse of a Rural Health Unit (RHU) holds a Philippine Package of Essential NCD Interventions (PhilPEN) screening day for noncommunicable diseases (NCDs) at the barangay hall. Barangay health workers (BHWs) help register the residents. A 50-year-old man has a body mass index (BMI) of 24.1 kg/m² and a waist circumference of 92 cm. Using the Asia-Pacific cut-offs adopted locally, how should the nurse classify him?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a Rural Health Unit (RHU) holds a Philippine Package of Essential NCD Interventions (PhilPEN) screening day for noncommunicable diseases (NCDs) at the barangay hall. Barangay health workers (BHWs) help register the residents.

A 50-year-old man has a body mass index (BMI) of 24.1 kg/m² and a waist circumference of 92 cm. Using the Asia-Pacific cut-offs adopted locally, how should the nurse classify him?

## 보기

1. Normal weight, with abdominal obesity
2. Obese, with abdominal obesity
3. Overweight, without abdominal obesity
4. Overweight, with abdominal obesity **✔ 정답**

**정답: 4**

## 해설

Two cut-offs must be applied at once. Under the Asia-Pacific BMI cut-offs used locally, 23 to 24.9 kg/m² is overweight and 25 kg/m² or more is obese, so 24.1 kg/m² is overweight. A waist circumference of 90 cm or more in men (80 cm or more in women) is abdominal obesity, so 92 cm qualifies.

## 심화 해설

The classification requires simultaneous application of two anthropometric criteria. The first is the Asia-Pacific BMI cut-off, which defines overweight as a BMI of 23.0–24.9 kg/m² and obesity as ≥25.0 kg/m². The second is the waist circumference threshold for abdominal obesity, set at ≥90 cm in men and ≥80 cm in women under the local adaptation used in the Philippine setting.

For this 50-year-old man, the BMI of 24.1 kg/m² falls within the 23.0–24.9 range, placing him in the overweight category rather than normal weight or obese. His waist circumference of 92 cm exceeds the male cut-off of 90 cm, which independently qualifies him for abdominal obesity. Therefore, the correct classification is overweight, with abdominal obesity.

The rationale for using lower BMI thresholds in Asian populations stems from evidence that cardiometabolic risk rises at a lower body mass index than in Caucasian populations. The WHO Western Pacific Regional Office recommended these lower cut-offs in 2000 because Asian individuals tend to accumulate visceral adipose tissue at relatively lower BMI levels, and this visceral fat is strongly associated with insulin resistance, dyslipidemia, and cardiovascular disease [1][2]. A BMI of 23 kg/m² or higher is already associated with a meaningful increase in obesity-related morbidity in Asian populations, which is why the overweight category begins at 23 rather than 25 [2][4].

The waist circumference criterion captures central adiposity, which reflects visceral fat deposition around intra-abdominal organs. This visceral fat is more metabolically active than subcutaneous fat and is a stronger predictor of type 2 diabetes, hypertension, and coronary artery disease than BMI alone [3][4]. Key point! A person can have a normal BMI but still have abdominal obesity if waist circumference exceeds the sex-specific threshold, and this combination carries elevated cardiometabolic risk. In this case, however, both BMI and waist circumference are elevated, reinforcing the need for lifestyle intervention and cardiovascular risk screening.

The PhilPEN protocol uses these anthropometric measures as initial screening tools to identify individuals who require further assessment of blood pressure, fasting glucose, and lipid profile. The presence of both overweight and abdominal obesity doubles the indication for aggressive risk factor modification, because the two measures capture overlapping but not identical aspects of adiposity-related risk [3][4].

| Category | BMI (kg/m²) | Waist circumference (men) | Waist circumference (women) |
| --- | --- | --- | --- |
| Normal weight | 18.5–22.9 | Less than 90 cm | Less than 80 cm |
| Overweight | 23.0–24.9 | 90 cm or more | 80 cm or more |
| Obese | 25.0 or more | Same as above | Same as above |

Watch out! Do not apply the standard WHO cut-offs of 25 kg/m² for overweight and 30 kg/m² for obesity when the question specifies Asia-Pacific or local Philippine criteria. The lower thresholds of 23 and 25 kg/m² must be used, and failing to recognize this distinction is a common source of error on licensure examinations. Watch out! Waist circumference is interpreted independently of BMI. Even if this man had a BMI below 23, a waist circumference of 92 cm would still classify him as having abdominal obesity, which is a separate and clinically significant finding.References (research sources)

- [1]Impact of different grades of body mass index on left ventricular structure and function.Research articleRajesh G Kathrotia, Swapnil Paralikar, Pinkesh V Rao, Elvy R. Oommen (2010)

- [2]Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for AsiansResearch articleChi Pang Wen, Ting Yuan David Cheng, Shan Pou Tsai, Hui Ting Chan, Hui Ling Hsu, Chih Cheng Hsu (2008) · DOI: 10.1017/s1368980008002802

- [3]Perspective on Diagnostic Criteria for Obesity and Abdominal Obesity in Korean Adults.Research articleNam GE, Park HS (2018) · DOI: 10.7570/jomes.2018.27.3.134

- [4]Diagnosis of Obesity: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity.GuidelineHaam JH, Kim BT, Kim EM, Kwon H, Kang JH, Park JH (2023) · DOI: 10.7570/jome23031

## 임상 시나리오

PhilPEN NCD Screening: Anthropometric ClassificationApplying Asia-Pacific BMI and waist circumference cut-offs together
Classify using two simultaneous criteria. Under Asia-Pacific cut-offs, overweight is BMI 23.0–24.9 kg/m² and obesity is ≥25.0 kg/m². A BMI of 24.1 kg/m² is therefore overweight, not normal or obese.

For abdominal obesity, use waist circumference ≥90 cm in men and ≥80 cm in women. A waist of 92 cm in a man meets this threshold, so he has abdominal obesity.

CautionDo not apply standard WHO BMI cut-offs in this setting. Asian populations accumulate visceral fat at lower BMI, so the overweight threshold starts at 23 kg/m² rather than 25. Missing the lower cut-off can underclassify cardiometabolic risk.

## 핵심 개념

- **Asia-Pacific BMI cut-off** — Overweight is BMI 23.0–24.9 kg/m² and obesity is ≥25.0 kg/m², lower than standard WHO cut-offs due to higher cardiometabolic risk at lower BMI in Asian populations.
- **Abdominal obesity** — Defined by waist circumference ≥90 cm in men or ≥80 cm in women under local Philippine adaptation, reflecting central adiposity and visceral fat risk.
- **PhilPEN** — Philippine Package of Essential NCD Interventions, a primary care strategy for screening and managing noncommunicable diseases in community settings.

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