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By Nancy Lapid, Health Science Editor

Welcome to Health Rounds! The American Medical Association warned last week that having a "normal" body mass index (BMI) does not mean you're at a healthy weight, and today we feature a study showing that many adults with BMI in the normal range are in fact obese. We also share study results showing that men with low testosterone can take hormone replacements without increasing their risk for cardiovascular problems, and survey results suggesting that many new fathers are not following safety recommendations when it's time to put babies to sleep.
        
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People with a "normal" body mass index (BMI) are often overweight or obese when waist circumference and body fat percentage are taken into account. REUTERS/Regis Duvignau.

A normal body mass index (BMI) can be very misleading, according to findings from a study presented just days after a leading U.S. physicians group said less attention should be paid to the measure in determining health risks.

The BMI was introduced in the early 1800s by a Belgian mathematician. It does not take into account how much of a person's weight comes from bone, muscle or fat, even though healthy bones and muscles weigh more than unhealthy fat. It also fails to consider waist size, which is a clear indicator of fat level.

The researchers studied 9,784 individuals, ages 20 to 59, who participated in nationwide U.S. health surveys between 2011 and 2018. All underwent a type of scan known as DEXA (dual-energy X-ray absorptiometry) to analyze body composition.

Overall, when obesity was defined as body fat percentage greater than or equal to 25% in males and 32% in females, nearly 75% of participants met the criteria for an obesity diagnosis, Dr. Aayush Visaria of Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey and colleagues reported on Friday at ENDO 23, the Endocrine Society's annual meeting.

Among those with supposedly normal BMI, 44% of whites, 49% of Hispanics, and 49% of Asians had obesity based on body fat percentage. That rate in Blacks was significantly lower at 27%.

Last week, the American Medical Association (AMA) said it will advise doctors to pay less attention to BMI in determining if a patient is at a healthy weight, saying the measure does not predict disease risk equally well across racial and ethnic groups.

Read more about BMI and obesity on Reuters.com

• U.S. doctors' group adopts new policy on healthy weight assessment

Men who used a gel to boost levels of testosterone did not increase their risk of heart problems in a large trial, researchers reported on Friday at the ENDO 2023 medical meeting.

There was also no increased risk for development of diabetes or diagnosis of prostate cancer associated with the testosterone gel, the researchers found.

Years ago, a small study suggested testosterone replacement therapy in men with low levels of the hormone might increase the long-term risks of heart disease, stroke or death. The U.S. Food and Drug Administration ordered manufacturers of testosterone pharmaceuticals to conduct a randomized, controlled trial to assess the safety of the treatment.

Researchers enrolled 5,246 men, ages 45 to 80, with a diagnosis of low testosterone who also had cardiovascular disease or were at high risk for it. They received either daily treatment with a testosterone gel from AbbVie or placebo gel for nearly two years, on average.

Roughly three years after the start of the study, the two groups had similar rates of cardiovascular events, defined as heart attack, stroke or heart-related death - 7.0% for the testosterone group and 7.3% for placebo - according to a report published in The New England Journal of Medicine.

Men treated with testosterone did have a higher rate of atrial fibrillation, kidney problems, and life-threatening blood clots in the lungs, along with a higher risk for fractures, researchers reported.

The trial results "should not be used as a justification for widespread prescription of these products to large numbers of men," senior author Dr. Steven Nissen of the Cleveland Clinic said in a statement.

And men should not attempt to treat low testosterone on their own, Nissen added.

"The market is booming with so-called 'natural' testosterone boosters," he said. "These products have not been evaluated in rigorous clinical trials and they have not been approved by the FDA to treat low testosterone levels."

The study was sponsored by AbbVie, Acerus Pharmaceuticals, Endo Pharmaceuticals, and Upsher–Smith Laboratories.

Nearly all U.S. fathers say they have put their infant to sleep, but only 16% report implementing all three recommendations from the American Academy of Pediatrics (AAP) on infant sleep practices.

Roughly 81% reported putting their infants to sleep on their backs, as the AAP advises, while only 44% reported avoiding soft bedding and 32% reported using a flat surface, according to a report published on Friday in Pediatrics.

Black fathers were less likely to use the back sleep position and more likely to use soft bedding than white fathers, the U.S. study conducted in the state of Georgia found.

Nationally, the rate of sudden unexpected infant death - also known as Sudden Infant Death Syndrome or SIDS - is more than twice as high among Black infants, and unsafe sleep practices may contribute to this disparity, the researchers said.

For the study, they surveyed 250 fathers in Georgia before and after their babies were born.

The survey also found that when fathers encouraged breastfeeding, mothers were more likely to start and more likely to continue for at least eight weeks, compared to when fathers didn't encourage the practice or had no opinion.   

Among fathers who had wanted their infant's mother to breastfeed, 95% reported breastfeeding initiation and 78% reported that it continued for at least eight weeks. Among fathers who had been opposed to breastfeeding or had no opinion, 69% reported breastfeeding initiation, dropping to 33% at eight weeks.

Fathers with college degrees were more likely to report that their baby breastfed and to say they had received guidance on infant sleep safety.

"To improve child health outcomes, we need to make sure breastfeeding and safe sleep guidance reach all new parents equitably," study coauthor Dr. Craig Garfield of Northwestern University Feinberg School of Medicine in Chicago said in a statement.

This newsletter was edited by Bill Berkrot. Additional reporting by Shawana Alleyne-Morris.

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