NARRATIVE REVIEW How should we assess body fatness? 1. Qualitative field methods available to the epidemiologist and the practitioner.

Abstract

Objective. The objectives of this narrative review are to consider the simple qualitative field methods that have been used to describe inter-individual differences in body form over the centuries, to explore attempts to use such measures in predicting personality characteristics, susceptibility to disease, and athletic aptitudes, to understand the significance of regional differences in the distribution of body fat, and to decide the current relevance of subjective descriptions of body build.  Methods. Information obtained from Ovid/Medline and Google Scholar through to January 2018 was supplemented by a search of the author's personal files.  Results. Although a variety of nomenclature has been proposed, most observers from antiquity to the present day have described 3 main body types, now generally termed ectomorphic (a lean and elongated body form), mesomorphic (a thick-set, muscular individual) and endomorphic (the person with a rounded figure, and a substantial accumulation of body fat). Although extreme examples of each of these body types are readily recognized, most people have an intermediate body form, incorporating feature of 2 if not 3 of the potential body types, and this seriously limits the usefulness of such a classification. Correlations between body type and personality have now been largely discredited, and correlations with disease susceptibility reflect in part the effect of disease on body build rather than the converse. Top athletes in a given sport discipline tend to have a common somatotype, but a substantial range of body builds are still compatible with outstanding performance. An android distribution of body fat continues to be of prognostic value; this body type is more common in men than in women, and is associated with a substantial increase in the risk of cardiovascular disease.  Conclusions. Earlier interest in the subjective assessment of body build has waned as it has become recognized that extreme body types are uncommon, and that numerical classifications of somatotype make little contribution to the definition of an individual's personality, susceptibility to disease or athletic aptitude. Nevertheless, simple subjective ratings of body fatness ad muscularity can help to distinguish the cause of an excessive body mass in relation to height, and simple determinations of the distribution of body fat provide helpful prognostic information.