Body Fat Percentage is a Better Health Risk Measure for Africans
By Adebowale Bello. B.Tech Microbiology, Freelance Health Writer. Medically reviewed by the DLHA team.
A shirtless African man standing and using a flexible tape to measure his waist circumference. AI generated image from Freepik.
Body Mass Index (BMI) is generally viewed as the simple way to know if your weight is healthy for your height. You may have been told you're “fit and fine” because your BMI falls in the so-called normal range but what if that simple calculation is missing the bigger picture?
A recent scientific study has shown that body fat percentage and waist circumference may actually tell you much more about your long-term health than BMI ever could. This blog explores what the study found, why it matters to you as an African and how you can use this knowledge to stay healthy.
The research comes from a team at the University of Florida in the US. They looked at a nationally representative group of over 4,200 adults in the US, aged between 20 and 49, whose health information was collected between 1999 and 2004 through NHANES—the National Health and Nutrition Examination Survey. They then followed up to see who had died within 15 years, using records from the National Death Index.
The study aimed to use statistical methods to determine the best approach for predicting death risk from all causes, including heart disease. To achieve this, the researchers compared three different body composition measurement techniques:
Body Mass Index (BMI): a number calculated using weight and height (healthy range: 18.5–24.9kg/m²; overweight or obese: 25 or more)
Body Fat Percentage (BF %): measured using bioelectrical impedance analysis (BIA), with unhealthy thresholds set at 27% or higher for men and 44% or higher for women.
Waist Circumference (WC): unhealthy levels defined as more than 40 inches in men and more than 35 inches in women.
Adults with high body fat percentage had a 78 percent higher risk of dying from any cause within 15 years, even after adjusting for factors like age, race and income. These same adults were more than three times as likely to die from heart disease compared with those in the healthy body fat range.
In comparison, people with large waist circumference had a 59 percent higher risk of any cause of death and four times higher risk of heart disease death.
BMI, on the other hand, showed no significant link to overall death when adjusted for those same factors. BMI only showed a link to heart disease death in the unadjusted model but that link disappeared once the data were adjusted.
In short, body fat percentage and waist size were much stronger predictors of mortality risk than BMI.
In many African societies, body shape and composition vary considerably. Muscle mass and build vary by region and ethnicity. BMI can misclassify you as healthy when your body fat is deceptively high, a condition sometimes called “normal weight obesity”. That means you may look healthy or your BMI falls in the normal range but might still be at higher risk due to ventrally hidden fat in your belly.
Body fat percentage, especially when measured using modern bioimpedance devices, is affordable and easy to use. Some community clinics and gyms in African cities already have BIA scales. Waist circumference is even easier: a simple tape measure around the waist offers a clue to risk level that BMI simply can’t match.
Many people in urban communities are moving away from traditional whole-food diets towards more processed foods. Combined with sedentary lifestyles, this shift often leads to fat gain around the waist. BMI doesn’t show this clearly, but waist circumference does and that change in fat can greatly raise the risk of heart disease and early death.
Current obesity standards rely heavily on foreign body fat and waist measurement data, which may not accurately reflect African populations. Research already demonstrates that BMI thresholds for obesity risk vary significantly by ethnicity; however Africans often have different healthy ranges for waist size and body fat percentage due to distinct body composition patterns.
This gap highlights the need to conduct local studies to establish African-specific health benchmarks. Researchers and clinicians should prioritize establishing population-specific standards that accurately reflect African body shape, metabolism and associated health risks.
This study should be a reminder that BMI, while easy and familiar, is often not the best tool for understanding health risk, especially heart disease and premature death. Body fat percentage and waist circumference are far more telling, even with simple, affordable tools.
So, make better health choices, ask better questions at clinics, and advocate for measurements that truly reflect your body and your risk.
Source: Mainous AG 3rd, Yin L, Wu V, Sharma P, Jenkins BM, Saguil AA, Nelson DS, Orlando FA. Body Mass Index vs Body Fat Percentage as a Predictor of Mortality in Adults Aged 20-49 Years. Ann Fam Med. 2025 Jul 28;23(4):337-343. Available from here
Related:
Estimating Chronic Health Risks in Africans: Is Waist Circumference Better Than BMI?
What BMI Tells You about Your Health Status as an African
Published: August 26, 2025
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