Understanding BMI: One in three Singaporeans are overweight!

Did you know that 40 per cent of Singaporeans are either overweight or obese? The most recent National Population Health Survey also reported that one in 10 Singaporeans are obese. In adults aged 30 to 59 years, the prevalence of obesity was found to be twice as high compared to adults aged 18 to 29 years.

In recent years, Singapore has experienced lifestyle changes and urbanisation, which have contributed to shifts in dietary habits and physical activity levels. Sedentary lifestyles, high-calorie diets, and limited physical activity can increase the risk of overweightness and obesity. As chiropractors, this concerns us because of back pain, neck pain, and even slipped discs are linked to overweightness!

What is overweightness?

Overweightness refers to a state of having excess body weight, particularly in the form of excess body fat, beyond what is considered healthy or within a normal range. It is typically determined by calculating a person’s body mass index (BMI), which takes into account their height and weight. According to World Health Organisation, a body mass index (BMI) over 25 is considered overweight, and over 30 is obese.

While BMI is a widely used indicator, it is important to note that it does not provide a comprehensive assessment of an individual’s overall health and body composition. The American Medical Association (AMA) recently cautioned healthcare providers against using the BMI as a stand-alone clinical tool during patient consultations.

Understanding how BMI works

bmi score, singapore obesity
Did you know BMI scores cutoff are different for Asians? In Singapore, the healthy BMI range is from 18.5 to 22.9.

Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters. A BMI of 18.5 to 22.9 is considered healthy weight in Singapore.

BMI only provides a general estimation of body weight relative to height. It does not take into account body composition. Body composition refers to the proportion of fat, muscle, and bone in an individual’s body. Two individuals with the same BMI may have different body compositions, one with a higher proportion of muscle and lower body fat, while the other may have more body fat and less muscle. Therefore, body composition can significantly impact health outcomes and the risk of certain diseases.

BMI also does not take into account where a person stores their body fat. Two individuals with the same BMI may have different patterns of fat distribution. This can impact their risk for certain health conditions. Fat stored around the organs, known as visceral fat, has been linked to a higher risk of developing type 2 diabetes, heart disease, and other metabolic disorders. It also is associated with release of inflammatory substances that contribute to insulin resistance, high blood pressure, dyslipidemia, and chronic pain.

BMI can be used with waist circumference

The accumulation of fat in the abdominal region is often referred to as central obesity. It is considered to be more detrimental to health compared to fat stored in other areas of the body, such as the hips or thighs.

Measuring waist circumference in addition to BMI can provide a more comprehensive assessment of central obesity and the associated health risks. A waist circumference greater than the cutoff values is often used as an indicator of increased abdominal fat and potential health concerns. In Singapore, the cutoff values are 90 cm for men and 80 cm for women.

What is the best measure of body composition?

dexa singapore
DEXA, more common used to diagnose osteoporosis, is also the gold standard measurement for body composition analysis. Using a very low amount of radiation, it measures fat tissue to great precision.

The gold standard for measuring body composition is considered to be Dual-Energy X-ray Absorptiometry (DXA). DXA scans use low-dose X-rays to assess body composition by differentiating between lean mass (muscle, bones, organs) and fat mass. It provides detailed information about the distribution of fat and lean tissue throughout the body, including regional analysis of specific areas.

DXA scans are highly accurate and can provide precise measurements of fat mass, lean mass, and bone mineral content. They are commonly used in research settings, clinical practice, and sports science to assess body composition changes and monitor progress over time. It’s important to note that DXA scans are more expensive and less accessible compared to other methods.

What are the alternatives to BMI besides DXA?

There are several alternatives to BMI for assessing body composition. These methods may provide a more comprehensive understanding of an individual’s body fat percentage and overall health. Here are some commonly used alternatives:

Bioelectrical Impedance Analysis (BIA)

bioelectrical impedance analysis, body fat percentage
You can get a BIA machine for home use in Singapore for less than $200!

BIA measures body composition by passing a low-level electrical current through the body. The current encounters different levels of resistance from fat, muscle, and water, allowing the estimation of body fat percentage. BIA is relatively quick, non-invasive, and affordable, making it a popular choice for home scales and handheld devices. However, its accuracy can be influenced by factors such as hydration status and electrode placement.

To use a BIA device at home, place it on a flat surface and remove your shoes and socks. Step onto the scale with bare feet, ensuring both feet make contact with the metal electrodes. Enter any necessary information, such as age and gender, into the scale. Wait for the scale to calculate your body composition measurements, which may include body weight, body fat percentage, muscle mass, and other relevant data. Once the measurements are displayed, record or take note of them. Remember that BIA scales provide estimates and should be used consistently over time for the most accurate results.

BIA scales are a convenient but less accurate method compared to more specialised techniques like DEXA scans. For reliable results, use the BIA scale under consistent conditions and compare measurements over time rather than relying on a single reading. Additionally, keep in mind that factors such as hydration levels and time of day can influence the readings. BIA scales can be a useful tool for tracking general trends in body composition, but for precise and comprehensive assessments, it may be necessary to consult a healthcare professional or use more advanced methods.

Skinfold Thickness Measurements

Skinfold measurements involve using calipers to measure the thickness of subcutaneous fat at specific sites on the body. These measurements are then used to estimate overall body fat percentage. Skinfold measurements require trained professionals to ensure accurate and consistent readings. While they can provide a cost-effective and portable option, accuracy may vary depending on the skill of the person performing the measurements.

Air Displacement Plethysmography (ADP) or Bod Pod

ADP involves measuring body composition by determining body volume through air displacement. It calculates body fat percentage based on the relationship between body volume and body density. ADP is non-invasive and provides reasonably accurate results, comparable to DXA. However, availability may be limited, and the equipment can be expensive.

Hydrostatic Weighing

hydrostatic weighing

Hydrostatic weighing involves submerging an individual in water to measure their body density. From the density, body fat percentage can be estimated. This method is based on the principle that fat is less dense than lean tissue. While hydrostatic weighing can provide accurate results, it requires specialized equipment and expertise, and the process can be challenging for some individuals.

It’s important to note that no method for assessing body composition is perfect, and each has its limitations and potential sources of error. It’s recommended to consult with healthcare professionals or experts in the field to determine the most appropriate method based on individual circumstances and goals.

Why is it important to know your body composition?

Understanding your body composition is essential for setting individualised health goals. It provides valuable insights into the proportions of body fat, muscle mass, and bone density. Thus, allowing you to identify areas that require attention for optimal health outcomes. Armed with this knowledge, you can direct your efforts towards addressing specific areas of concern.

If your goal is to reduce body fat, understanding your body composition helps you determine the appropriate amount of fat loss needed to achieve a healthy level. By focusing on reducing body fat while preserving lean muscle mass, you can achieve a more desirable body composition and improve metabolic health.

On the other hand, if you aim to increase muscle mass, knowing your body composition provides a baseline to track muscle growth and evaluate the effectiveness of your exercise and nutrition strategies. By setting specific goals for muscle development, you can tailor your workout routine and nutritional intake to support muscle growth and enhance overall body composition.

Don’t forget that muscle is more dense than fat

You may near people saying that muscle weigh more than fat. This is not entirely true. A kilogram of muscle weighs the same as a kilogram of fat. What they mean is that muscle is more dense than fat. This means that for the same weight, muscle occupies less space and contributes to a more compact and leaner appearance. This is why heavier individuals with a higher proportion of muscle mass may still appear leaner.

It is important to know this because chasing number on the scales may lead you to think that you are getting “fatter” when in fact you could just be putting on muscle mass. By understanding your body composition, which includes assessing the proportion of muscle mass and body fat, you can better evaluate your progress. This knowledge allows you to focus on improving body composition rather than solely focusing on weight loss. As you engage in strength training exercises and build muscle, your body composition will change, even if the scale doesn’t show a significant decrease in weight.

Body composition not just a vanity matrix

body fat assessment, inbody weighing scale
At Square One Active Recovery, we also do track your body composition to help you achieve peak physical well-being.

Understanding your body composition is not just about vanity. It is a crucial aspect of your overall health and well-being. Body composition analysis provides valuable insights into the distribution of fat and muscle mass in your body. This information helps assess potential health risks and provides an understanding of your metabolic health. It goes beyond mere appearances and has a significant impact on your functional capacity, bone health, and long-term weight management. By striving for a balanced body composition, you can reduce the risk of chronic diseases and improve your overall health.

As a chiropractor, we care about your body composition because it plays a vital role in musculoskeletal health. Did you know that individuals who are obese have a two-fold increased likelihood of experiencing chronic pain? Those who are severely obese are four times more likely to suffer from chronic pain.

Overweightness is closely associated with an increased risk of chronic pain. The additional stress on the joints can lead to pain in weight-bearing joints such as the knees, hips, and low back. Overweightness is also linked to systemic inflammation. Adipose tissue, especially visceral fat, secretes inflammatory substances that can sensitise pain receptors and contribute to your pain experience.

As a chiropractor, our goal is to provide you with holistic care that addresses your health concerns. By assessing your body composition, our treatment can consider factors like nutrition, exercise, and lifestyle modifications. This allows us to tailor our treatments and recommendations specifically for you, promoting overall wellness and vitality.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.