Prevalence of Normal Weight Obesity in the Turkish Population: A Preliminary Report

Prevalence of Normal Weight Obesity in the Turkish Population: A Preliminary Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Normal Weight Obesity in the Turkish Population: A Preliminary Report Hakan GÜLMEZ, Hicret CIN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9160897/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract BACKGROUND. Obesity is a chronic, recurrent, and progressive disease that impairs health due to abnormal accumulation of adipose tissue. One of the most commonly used methods for the assessment of obesity is the Body Mass Index (BMI), and individuals with a BMI value of ≥ 30 kg/m² are defined as “obese.” However, BMI alone is not always sufficient to characterize obesity. Individuals who fall within the normal BMI range (18.5–24.9 kg/m²) but have a high body fat percentage are classified as having Normal Weight Obesity. AIM. The aim of this cross-sectional study is to determine the prevalence of normal-weight obesity in the Turkish population by evaluating body fat percentage among individuals within the normal BMI range. MATERIALS AND METHODS. This cross-sectional analytical study was conducted on 683 volunteer participants (212 men, 471 women) who applied to a Family Medicine outpatient clinic. Body fat percentage was assessed using a Tanita BC601 bioelectrical impedance analyzer. Total body fat percentage of 35% and above in women and 25% and above in men was considered normal weight obesity. RESULTS. According to our findings, the prevalence of normal-weight obesity in the Turkish population was determined to be 28.4%. When evaluated according to gender, the frequency of normal-weight obesity was found to be 37.7% in women and 3.8% in men. Accordingly, normal-weight obesity is much more common in women than in men. In addition, waist circumference, waist-to-hip ratio, and visceral fat levels were significantly higher in the normal-weight obesity group (p < 0.05). CONCLUSION. Normal-weight obesity appears to have a considerable prevalence in the Turkish population. These findings highlight the need to consider not only BMI but also body fat percentage and distribution in the assessment of obesity. Normal weight obesity abdominal obesity body fat distribution body mass index Turkish people 1. RATIONALE Obesity is a chronic, recurrent, and progressive disease that impairs health due to abnormal accumulation of adipose tissue. The World Health Organization (WHO) defines obesity as one of the most important public health problems of the 21st century. Over the past four decades, the prevalence of obesity has increased at least threefold, and it is currently estimated that more than 1 billion individuals worldwide are obese[ 1 ]. According to the WHO European Region Obesity Report 2022, Turkey is among the countries with the highest obesity rates in the region. The findings indicate that more than 65% of the adult population in Turkey is overweight or obese[ 2 ]. Furthermore, when obesity prevalence is analyzed by sex, higher rates are observed in women (39.1%) compared to men (24.6%)[ 3 ]. One of the most commonly used criteria for defining obesity is the Body Mass Index (BMI). However, BMI does not always adequately reflect body composition. In particular, BMI values can be misleading in athletes with high muscle mass, in elderly individuals with sarcopenia, and in clinical conditions that alter body fluid balance. Moreover, BMI does not provide information about the distribution of adipose tissue and is therefore insufficient in distinguishing obesity phenotypes. For this reason, additional anthropometric and metabolic parameters are needed alongside BMI to define obesity. There are alternative anthropometric methods used in the assessment of obesity, which are waist circumference, body fat percentage, and metabolic indicators are among the measures that more accurately demonstrate obesity-related risks. In addition, total fat mass, visceral fat amount, waist-to-hip ratio, waist-to-height ratio, neck circumference, skinfold thickness, and wrist circumference[ 1 ]. In conclusion, obesity is a complex clinical condition that cannot be evaluated using a single measurement method and must be approached in a multidimensional and comprehensive manner. Although their BMI values fall within the normal range (18.5–24.9 kg/m²), individuals with high body fat percentage are classified in the literature as having “Normal Weight Obesity (NWO).” Despite appearing to be of normal weight, these individuals are associated with metabolic syndrome, insulin resistance, dyslipidemia, and an increased risk of cardiovascular disease. The concept of NWO originates from Ruderman et al., who in 1981 defined individuals as “metabolically obese normal weight (MONW).” Ruderman demonstrated that individuals with normal BMI but metabolic risk profiles resembling obesity do exist, and it was emphasized that relying solely on BMI is insufficient to detect metabolically unhealthy individuals. Thus, it has been proposed that even normal-weight individuals constitute a hidden risk group and that both body composition and metabolic markers should be considered together in the evaluation of obesity[ 4 ]. The “Normal Weight Obesity Syndrome” was first defined in 2007 by De Lorenzo and colleagues. According to this definition, individuals with a BMI < 25 kg/m² but a body fat percentage greater than 30% are classified as NWO. MONW and NWO are concepts that indicate similar phenotypes but differ in certain aspects. While MONW refers to the presence of metabolic syndrome components in normal-weight individuals, NWO describes individuals who do not yet have overt metabolic syndrome but are characterized by a high body fat percentage (> 30%), reduced lean mass, and early inflammatory changes. Accordingly, MONW represents a distinct subgroup within the NWO spectrum, and differentiating these two phenotypes is crucial for both conceptual understanding and clinical practice[ 4 – 7 ]. There is still no full consensus on the boundaries and diagnostic criteria of the NWO concept in the literature. The threshold values used for body fat percentage vary according to sex, age, and ethnic groups, while the measurement methods employed (DXA, BIA, CT) differ from study to study. This reduces the comparability of epidemiological data and complicates the standardization of diagnostic criteria. Studies in the literature indicate that the prevalence of NWO varies across different populations and is generally observed more frequently in women. Previous studies have suggested that a body fat percentage greater than 25% in men and 35% in women represents the threshold for diagnosing obesity; these cutoff values were also adopted in 2004 by the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE). In some studies, a body fat percentage of 30–35% for women and 25–30% for men has been accepted as the threshold value. Furthermore, environmental, cultural, and genetic factors may influence the prevalence of NWO, and therefore, it may be observed at different rates in different populations. Based on our literature review, no study has investigated the prevalence or sex-specific distribution of NWO in Türkiye[ 8 – 17 ]. 2. AIM OF THE STUDY In our study, the aim was to determine the prevalence of NWO in the Turkish population by evaluating body fat percentage among individuals with a body mass index within the normal range, and to compare total body fat percentages between sexes. Furthermore, the data obtained may contribute to the development of bioimpedance-based screening algorithms that can be integrated into clinical practice, the establishment of national screening protocols in healthcare institutions, and the shaping of gender-sensitive health policies. Early recognition of NWO is expected to prevent obesity-related cardiometabolic diseases, reduce healthcare expenditures, and decrease long-term workforce loss. 3. MATERIALS AND METHODS This was a cross-sectional analytical study. Site and time of the study Study site. Study was conducted at the family medicine outpatient clinic of Buca Seyfi Demirsoy Training and Research Hospital. Time of the study. The study was conducted between November 1, 2023, and August 1, 2025. Study populations Inclusion criteria : Volunteers aged 18 years and older, Exclusion criteria : Participants with chronic diseases, pregnancy, or menopause were excluded. Sampling method from the study population According to the Turkey Health Survey (2022) data, the proportion of normal-weight women and men aged 15 and over is reported as 40.6% for both sexes. According to the Address-Based Population Registration System results, in 2022, the female population was 42 575 441 and the male population was 42 704 112. Based on this data, the sample size calculated using Raosoft.com's sample size calculation method is 387 people, with a 5% margin of error, a 95% confidence interval, and a significance level of p = 0.05. Study design This study is a single-center, observational, single-sample, uncontrolled, and non-comparative cross-sectional study. Methods Body composition was assessed using the Tanita BC-601 bioimpedance device, which operates based on the bioelectrical impedance analysis (BIA) principle, estimating body fat, muscle mass, and total body water by measuring the resistance and reactance of body tissues to a low, safe electrical current. According to literature, NWO was defined as a BMI between 18.5 and 24.9 kg/m² and a total body fat percentage ≥ 35% in women and ≥ 25% in men[ 9 , 11 , 14 , 15 , 17 ]. Statistical analysis Data analysis was performed using IBM SPSS version 26.⁠ ⁠The suitability of continuous variables to a normal distribution was tested with the Shapiro-Wilk test. As the data were non-normally distributed, non-parametric tests were used. The Mann-Whitney U test was employed for comparisons between independent groups, while the Wilcoxon signed-rank test was applied for repeated measurements. Distribution of categorical variables was analyzed using Pearson’s chi-squared test or Fisher’s exact test. A value of p < 0.05 was considered statistically significant, and all tests were performed two-tailed. Ethics Approval and Consent to Participate The study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Izmir Buca Seyfi Demirsoy Training and Research Hospital (Approval No: 2023/167, Date: 27.09.2023). Written informed consent was obtained from all participants. 4. RESULTS A total of 683 individuals participated in the study, including 471 women and 212 men. Descriptive statistics showed that the mean age of participants was 25.86 ± 9.05 years (18–65). Detailed analyses were performed on the data of 387 participants classified as normal weight (Table 1). When examining the BMI distribution, it was found that 62.6% of the participants were in the normal weight category, 35 % were in the overweight/obese group, and a very small proportion were underweighted (Table 2). It was determined that 91.2% (n=618) of the participants did not have any chronic disease Among individuals with a normal BMI range (N = 387), the proportion with a high body fat percentage was calculated as 28.4% (N = 110). NWO was found to be much more prevalent in women (37.7%) compared to men (3.8%). A significant association was observed between female sex and NWO status (χ² = 43.60; p < 0.001). In individuals with NWO, waist circumference, waist-to-hip ratio, and visceral fat levels were significantly higher (Table 3). In the comparison of anthropometric and body composition variables by sex among the individuals included in the study, men were found to have a younger mean age, as well as significantly higher height and weight compared to women. Men also had higher BMI, waist circumference, hip circumference, and waist-to-hip ratio than women. On the other hand, women had a significantly higher total body fat percentage, whereas men had higher visceral fat levels. These results indicate that women have greater overall body fat, while men show more pronounced abdominal adiposity and visceral fat accumulation (Table 4). 5. DISCUSSION Representativeness of Samples In this study, the prevalence of normal-weight obesity (NWO) was evaluated in a Turkish population, and the anthropometric and body composition characteristics of 683 participants were recorded. To minimize the confounding effects of fat distribution differences and to more accurately reflect the prevalence of NWO, individuals with chronic diseases and postmenopausal women were excluded. Analyses showed that 62.6% of participants had a BMI within the normal range, and among this group, 28.4% had a high total body fat percentage. Comparison with other publications According to our research, the number of studies investigating the prevalence of NWO in the literature is limited. In a recent review by Angriani et al. (2024), studies conducted over the last decade were analyzed, and the prevalence of NWO was reported to range between 10% and 46%[8]. A nationwide study conducted in China reported an overall prevalence of 4.76% [18] . De Lorenzo et al. (2016) estimated the global prevalence of NWO to be approximately 10%, emphasizing that it is significantly higher in women than in men[19]. Similarly, Wijayatunga et al. (2019) reported that the prevalence of NWO varies between 4.5% and 22%, depending on study design and population characteristics [15] . Correa-Rodríguez et al. (2020) found a prevalence of 29.1% among young Colombian adults, which is consistent with our findings[20]. Studies conducted in Asian countries also demonstrate a wide variation in NWO prevalence. Jia et al. (2018) analyzed data from 23,748 individuals (9,633 men and 14,115 women) in the China National Diabetes and Metabolic Disorders Study and reported NWO prevalence rates of 9.5% in men and 6.06% in women. Kapoor et al. found a prevalence of 31.7% in India, whereas Moy et al. reported a rate of 19.8% among 6,854 women in Malaysia. In Korea, Mee Kyoung Kim et al. found a prevalence of approximately 32%, and a study among government physicians in India revealed a remarkably high rate of 48.7%. Variations in reported prevalence are thought to result from differences in study populations, body fat percentage cut-off values, and measurement techniques[10, 18, 21–23]. Research focusing on older adults indicates that NWO prevalence varies depending on diagnostic criteria. Using data from the NHANES III (1988–1994) survey, the prevalence of NWO among individuals aged 60 years and older ranged between 20% and 31%, with rates of 21.4–27.9% in men and 20.4–31.3% in women. In that study, individuals with NWO exhibited higher rates of dyslipidemia, hypertension, and reduced muscle mass, and NWO was shown to increase the risk of cardiovascular mortality independently of BMI[24]. Similarly, a study from Switzerland reported that NWO prevalence remained below 1% among men but increased with age among women, ranging from 1.4% to 27.8%[25]. When examining sex differences, most studies indicate that NWO is more common among women. In an Israeli study of 1,779 adults, 26% of men and 38% of women were classified as having NWO based on excess body fat[9]. Oliveros et al. (2014) reported NWO prevalence ranging from 2–28% in women and below 3% in men[7]. In our study, the prevalence of NWO was 37.7% in women and 3.8% in men, showing a clear predominance among females, consistent with previous findings. These results suggest that NWO occurs more frequently in women and that sex may be an important determinant. Previous research has shown that women generally have a higher total body fat percentage, whereas men exhibit greater visceral adiposity. Our findings are consistent with this evidence. The higher NWO prevalence in women may be explained by biological and hormonal factors. Women physiologically possess more adipose tissue, which is mainly stored in peripheral regions, whereas men tend to accumulate fat viscerally. Estrogen promotes subcutaneous fat storage and suppresses visceral adiposity; however, declining estrogen levels after menopause lead to increased visceral fat accumulation and a higher metabolic risk. These biological differences may contribute to higher total fat mass in women and earlier onset of metabolic complications in men[26]. In our study, individuals classified as NWO had significantly higher waist circumference, waist-to-hip ratio, and visceral fat levels. This finding indicates that metabolic risks can be elevated even in individuals with normal body weight. It also supports the notion that central adiposity is an early indicator of cardiometabolic risk. Central obesity is typically defined by waist circumference, one of the best-known components of the metabolic syndrome. According to globally accepted cut-off values, central obesity is defined as a waist circumference exceeding 102 cm in men and 88 cm in women. The International Diabetes Federation (IDF) recommends the use of population-specific waist circumference thresholds. In Turkey, large-scale community-based studies such as TEKHARF, TURDEP-II, and the Metabolic Syndrome Study have defined these thresholds as 96 cm for men and 91 cm for women. Waist circumferences above these limits are significantly associated with cardiovascular diseases and clustering of multiple metabolic risk factors. Therefore, evaluating obesity solely based on BMI does not adequately reflect true metabolic risk[27]. Recent multicenter studies have emphasized that BMI alone is insufficient to capture metabolic risk and that body composition and fat distribution assessments are essential. The literature consistently demonstrates that the NWO phenotype is closely associated with cardiometabolic abnormalities. Individuals with a normal BMI but elevated body fat percentage show significantly higher rates of dyslipidemia, metabolic syndrome, cardiovascular risk, and mortality. Furthermore, visceral fat accumulation has been identified as a strong predictor of metabolic syndrome even among metabolically healthy individuals. The central obesity frequently observed in NWO reflects increased visceral fat, which places individuals at a higher risk of cardiometabolic diseases and mortality—a risk comparable to or even greater than that observed in overweight or obese individuals[9–11, 14, 16, 17, 19, 28, 29]. Clinical significance of results Taken together, these findings highlight the critical importance of early identification of the NWO phenotype for risk stratification and targeted lifestyle interventions. This underscores the clinical relevance of body fat distribution and visceral adiposity, suggesting that early detection of NWO could play a key role in preventing cardiometabolic complications. Study limitations, The main limitations of our study include its single-centre and cross-sectional design. However, the relatively large sample size increases the reliability and generalizability of the results. Based on an extensive literature review, this appears to be the first study to report NWO prevalence and related anthropometric characteristics in the Turkish population. Therefore, it fills an important gap in the existing literature and provides a foundation for future epidemiological and clinical research in this area. Next studies These data should be supported by future large-scale, multicenter studies. 6. CONCLUSION Our study is the first to investigate the prevalence of NWO in Türkiye, making it a unique and pioneering study. Our findings demonstrate the significant prevalence of NWO in Türkiye and are consistent with the literature. NWO was significantly more common in women. Consequently, individuals with normal body weight may appear healthy but still be at increased cardiometabolic risk. Therefore, obesity assessments should not be based solely on BMI; body fat percentage and fat distribution should also be routinely assessed. Obesity should not be limited to excess body weight but should also encompass total fat mass and its distribution. In this context, the use of practical methods such as bioelectrical impedance analysis in primary care, the development of screening programs for at-risk groups, and raising awareness that obesity is not synonymous with body weight are crucial. Lifestyle modifications aimed at reducing cardiometabolic risk should be encouraged, and large-scale national studies are needed to standardize diagnostic criteria for NWO. Such a comprehensive approach will facilitate early identification of cardiometabolic risks and timely implementation of appropriate interventions. Declarations Funding. The Tanita BC-601 bioimpedance device used in the study was procured within the scope of a Scientific Research Project supported by Izmir Democracy University Faculty of Medicine. We would like to express our gratitude to Izmir Democracy University for enabling the acquisition of the device within the project, and to the volunteer patients of the Family Medicine Clinic at Buca Seyfi Demirsoy Training and Research Hospital for their valuable contributions to the study. Conflict of interest. "The authors declare no obvious and potential conflicts of interest related to the content of this article." Contribution of authors . Hakan Gülmez 1 - contribution of author 1 according to criterion 1, significant contributions to the conceptualization or design, analysis, or interpretation of the study, according to criterion 2, drafting the study and critically reviewing it for significant intellectual content; Hicret Cin 2 - contribution of author 2 according to criterion 1, significant contributions to the collection, analysis, or interpretation of data for the study, according to criterion 2, drafting the study; According to criterion 3; AND according to criterion 4; "All of the authors read and approved the final version of the manuscript before publication, agreed to be responsible for all aspects of the work, implying proper examination and resolution of issues relating to the accuracy or integrity of any part of the work". Acknowledgment Information about the authors Hakan GÜLMEZ , MD, Associate Professor; address: Özmen Str., No:147 35390 Buca, İzmir, Türkiye; ORCID: https://orcid.org/0000-0001-5467-3743; e-mail: [email protected] * Hicret CİN , MD; ORCID: https://orcid.org/0009-0002-1272-3129; e-mail: [email protected] *Corresponding author. TO CITE THIS ARTICLE: (Vancouver, AMA) Gülmez H, Cin H. Prevalence of Normal Weight Obesity in the Turkish Population: A Preliminary Report. Obesity and metabolism . 202X;XX(X):XXX-XXX. doi: https://doi.org/10.14341/ometXXXXX References Türkiye Endokrinoloji ve Metabolizma Derneği-OBEZİTE TANI ve TEDAVİ KILAVUZU .; 2024, Ankara. ISBN: 978-625-95378-0-1. DSÖ Avrupa Bölgesel Obezite Raporu. 2022. Accessed September 8, 2025. https://iris.who.int/handle/10665/353747 Türkiye Ministry of Health General Directorate of Public Health. TÜRKİYE BESLENME VE SAĞLIK ARAŞTIRMASI (TBSA). Türkiye Ministry of Health General Directorate of Public Health; 2019. www.tirajbasim.com. 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Mean SD Age 387 18 65 25.49 8.42 Metabolic Age 313 12 50 23.26 8.96 Height 387 147 196 167.75 9.01 Weight 387 41.62 95.02 61.87 9.32 BMI 387 18.5 24.99 21.92 1.98 Waist Circumference 381 54 105 74.52 9.46 Hip Circumference 381 75 175 96.97 7.47 Waist-to-Hip Ratio 381 0.57 1.08 0.76 0.07 Total Body Fat Percentage 387 7.2 40.7 25.31 6.94 Visceral Fat Level 386 1 21 2.50 1.90 BMI: Body Mass Index Table 2. Distribution of participants without chronic diseases by body mass index N % BMI Underweight 15 2.4 Normal weight 387 62.6 Overweight 216 35 Total 618 100 BMI: Body Mass Index Table 3. Distribution of normal weight obesity by sex NWO Total None Present Sex Female N 175 106 281 % 62.3 37.7 100 Male N 102 4 106 % 96.2 3.8 100 Total N 277 110 387 % 71.6 28.4 100 X 2 =43.60 p<0.001 Table 4. Comparison of anthropometric and body composition variables by sex among the study participants Sex Mean SD p value Age Female 26.27 8.69 0.003* Male 23.42 7.31 Metabolic Age Female 23.50 8.87 0.45 Male 22.67 9.20 Height Female 163.54 5.62 0.000** Male 178.91 6.41 Weight Female 58.11 6.28 0.000** Male 71.84 8.71 BMI Female 21.72 1.95 0.002* Male 22.43 1.97 Waist Circumference Female 71.24 7.62 0.000** Male 83.03 8.43 Hip Circumference Female 96.34 7.88 0.008* Male 98.61 6.03 Waist-to-Hip Ratio Female 0.74 0.06 0.000** Male 0.84 0.06 Total Body Fat Female 28.26 5.09 0.000** Male 17.49 4.81 Visceral Fat Female 2.25 1.78 0.000** Male 3.15 2.05 BMI: Body Mass Index *p<0.05 **p<0.001 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9160897","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617278530,"identity":"fe414277-ac59-4be9-9278-a1ae8548bb7b","order_by":0,"name":"Hakan GÜLMEZ","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"prefix":"","firstName":"Hakan","middleName":"","lastName":"GÜLMEZ","suffix":""},{"id":617278532,"identity":"23095d1a-3426-453d-b02c-616a74e3822a","order_by":1,"name":"Hicret CIN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACA2YIzcPA3gDiWhCrJQGohecAiCtBhBYGiBYGBgkQwUCEFnN25mcfPv6wkzGXfH51w48CCQb+9u4EvFosm9mMZ85ISOaxnJ1TdrMH6DCJM2c34HfYYR5mZp6EAzwGt3PSbvAAtRhI5BKh5Q9Iy80zaTf/EK2FAaTlBvux20TawmbM2JOWzGNwJofttoyBBA9hv5w//Jjhh42dvcHx489uvvljI8ff3otfCxLgAccRD7HKQYD9ASmqR8EoGAWjYAQBABzXQcDK3V9UAAAAAElFTkSuQmCC","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":true,"prefix":"","firstName":"Hicret","middleName":"","lastName":"CIN","suffix":""}],"badges":[],"createdAt":"2026-03-18 15:08:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9160897/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9160897/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106403377,"identity":"ffa8bd81-0743-4b26-afa1-372819005387","added_by":"auto","created_at":"2026-04-08 09:14:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":978190,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9160897/v1/7b3e0b69-d6bb-455f-aa55-9449274866ce.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrevalence of Normal Weight Obesity in the Turkish Population: A Preliminary Report\u003c/p\u003e","fulltext":[{"header":"1. RATIONALE","content":"\u003cp\u003eObesity is a chronic, recurrent, and progressive disease that impairs health due to abnormal accumulation of adipose tissue. The World Health Organization (WHO) defines obesity as one of the most important public health problems of the 21st century. Over the past four decades, the prevalence of obesity has increased at least threefold, and it is currently estimated that more than 1\u0026nbsp;billion individuals worldwide are obese[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the WHO European Region Obesity Report 2022, Turkey is among the countries with the highest obesity rates in the region. The findings indicate that more than 65% of the adult population in Turkey is overweight or obese[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, when obesity prevalence is analyzed by sex, higher rates are observed in women (39.1%) compared to men (24.6%)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the most commonly used criteria for defining obesity is the Body Mass Index (BMI). However, BMI does not always adequately reflect body composition. In particular, BMI values can be misleading in athletes with high muscle mass, in elderly individuals with sarcopenia, and in clinical conditions that alter body fluid balance. Moreover, BMI does not provide information about the distribution of adipose tissue and is therefore insufficient in distinguishing obesity phenotypes. For this reason, additional anthropometric and metabolic parameters are needed alongside BMI to define obesity. There are alternative anthropometric methods used in the assessment of obesity, which are waist circumference, body fat percentage, and metabolic indicators are among the measures that more accurately demonstrate obesity-related risks. In addition, total fat mass, visceral fat amount, waist-to-hip ratio, waist-to-height ratio, neck circumference, skinfold thickness, and wrist circumference[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In conclusion, obesity is a complex clinical condition that cannot be evaluated using a single measurement method and must be approached in a multidimensional and comprehensive manner.\u003c/p\u003e \u003cp\u003eAlthough their BMI values fall within the normal range (18.5\u0026ndash;24.9 kg/m\u0026sup2;), individuals with high body fat percentage are classified in the literature as having \u0026ldquo;Normal Weight Obesity (NWO).\u0026rdquo; Despite appearing to be of normal weight, these individuals are associated with metabolic syndrome, insulin resistance, dyslipidemia, and an increased risk of cardiovascular disease. The concept of NWO originates from Ruderman et al., who in 1981 defined individuals as \u0026ldquo;metabolically obese normal weight (MONW).\u0026rdquo; Ruderman demonstrated that individuals with normal BMI but metabolic risk profiles resembling obesity do exist, and it was emphasized that relying solely on BMI is insufficient to detect metabolically unhealthy individuals. Thus, it has been proposed that even normal-weight individuals constitute a hidden risk group and that both body composition and metabolic markers should be considered together in the evaluation of obesity[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;Normal Weight Obesity Syndrome\u0026rdquo; was first defined in 2007 by De Lorenzo and colleagues. According to this definition, individuals with a BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 kg/m\u0026sup2; but a body fat percentage greater than 30% are classified as NWO. MONW and NWO are concepts that indicate similar phenotypes but differ in certain aspects. While MONW refers to the presence of metabolic syndrome components in normal-weight individuals, NWO describes individuals who do not yet have overt metabolic syndrome but are characterized by a high body fat percentage (\u0026gt;\u0026thinsp;30%), reduced lean mass, and early inflammatory changes. Accordingly, MONW represents a distinct subgroup within the NWO spectrum, and differentiating these two phenotypes is crucial for both conceptual understanding and clinical practice[\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is still no full consensus on the boundaries and diagnostic criteria of the NWO concept in the literature. The threshold values used for body fat percentage vary according to sex, age, and ethnic groups, while the measurement methods employed (DXA, BIA, CT) differ from study to study. This reduces the comparability of epidemiological data and complicates the standardization of diagnostic criteria. Studies in the literature indicate that the prevalence of NWO varies across different populations and is generally observed more frequently in women. Previous studies have suggested that a body fat percentage greater than 25% in men and 35% in women represents the threshold for diagnosing obesity; these cutoff values were also adopted in 2004 by the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE). In some studies, a body fat percentage of 30\u0026ndash;35% for women and 25\u0026ndash;30% for men has been accepted as the threshold value. Furthermore, environmental, cultural, and genetic factors may influence the prevalence of NWO, and therefore, it may be observed at different rates in different populations. Based on our literature review, no study has investigated the prevalence or sex-specific distribution of NWO in T\u0026uuml;rkiye[\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e"},{"header":"2. AIM OF THE STUDY","content":"\u003cp\u003eIn our study, the aim was to determine the prevalence of NWO in the Turkish population by evaluating body fat percentage among individuals with a body mass index within the normal range, and to compare total body fat percentages between sexes. Furthermore, the data obtained may contribute to the development of bioimpedance-based screening algorithms that can be integrated into clinical practice, the establishment of national screening protocols in healthcare institutions, and the shaping of gender-sensitive health policies. Early recognition of NWO is expected to prevent obesity-related cardiometabolic diseases, reduce healthcare expenditures, and decrease long-term workforce loss.\u003c/p\u003e"},{"header":"3. MATERIALS AND METHODS","content":"\u003cp\u003eThis was a cross-sectional analytical study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSite and time of the study\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eStudy site.\u003c/em\u003e Study was conducted at the family medicine outpatient clinic of Buca Seyfi Demirsoy Training and Research Hospital.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTime of the study.\u003c/em\u003e The study was conducted between November 1, 2023, and August 1, 2025.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy populations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eInclusion criteria\u003c/em\u003e: Volunteers aged 18 years and older,\u003c/p\u003e \u003cp\u003e \u003cem\u003eExclusion criteria\u003c/em\u003e: Participants with chronic diseases, pregnancy, or menopause were excluded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSampling method from the study population\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAccording to the Turkey Health Survey (2022) data, the proportion of normal-weight women and men aged 15 and over is reported as 40.6% for both sexes. According to the Address-Based Population Registration System results, in 2022, the female population was 42 575 441 and the male population was 42 704 112. Based on this data, the sample size calculated using Raosoft.com's sample size calculation method is 387 people, with a 5% margin of error, a 95% confidence interval, and a significance level of p\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy design\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study is a single-center, observational, single-sample, uncontrolled, and non-comparative cross-sectional study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBody composition was assessed using the Tanita BC-601 bioimpedance device, which operates based on the bioelectrical impedance analysis (BIA) principle, estimating body fat, muscle mass, and total body water by measuring the resistance and reactance of body tissues to a low, safe electrical current.\u003c/p\u003e \u003cp\u003eAccording to literature, NWO was defined as a BMI between 18.5 and 24.9 kg/m\u0026sup2; and a total body fat percentage\u0026thinsp;\u0026ge;\u0026thinsp;35% in women and \u0026ge;\u0026thinsp;25% in men[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eData analysis was performed using IBM SPSS version 26.⁠ ⁠The suitability of continuous variables to a normal distribution was tested with the Shapiro-Wilk test. As the data were non-normally distributed, non-parametric tests were used. The Mann-Whitney U test was employed for comparisons between independent groups, while the Wilcoxon signed-rank test was applied for repeated measurements. Distribution of categorical variables was analyzed using Pearson\u0026rsquo;s chi-squared test or Fisher\u0026rsquo;s exact test. A value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, and all tests were performed two-tailed.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Izmir Buca Seyfi Demirsoy Training and Research Hospital (Approval No: 2023/167, Date: 27.09.2023). Written informed consent was obtained from all participants.\u003c/p\u003e"},{"header":"4. RESULTS","content":"\u003cp\u003eA total of 683 individuals participated in the study, including 471 women and 212 men. Descriptive statistics showed that the mean age of participants was 25.86 \u0026plusmn; 9.05 years (18\u0026ndash;65). Detailed analyses were performed on the data of 387 participants classified as normal weight (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen examining the BMI distribution, it was found that 62.6% of the participants were in the normal weight category, 35 % were in the overweight/obese group, and a very small proportion were underweighted (Table 2).\u003c/p\u003e\n\u003cp\u003eIt was determined that 91.2% (n=618) of the participants did not have any chronic disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong individuals with a normal BMI range (N = 387), the proportion with a high body fat percentage was calculated as 28.4% (N = 110). NWO was found to be much more prevalent in women (37.7%) compared to men (3.8%). A significant association was observed between female sex and NWO status (\u0026chi;\u0026sup2; = 43.60; p \u0026lt; 0.001). In individuals with NWO, waist circumference, waist-to-hip ratio, and visceral fat levels were significantly higher (Table 3).\u003c/p\u003e\n\u003cp\u003eIn the comparison of anthropometric and body composition variables by sex among the individuals included in the study, men were found to have a younger mean age, as well as significantly higher height and weight compared to women. Men also had higher BMI, waist circumference, hip circumference, and waist-to-hip ratio than women. On the other hand, women had a significantly higher total body fat percentage, whereas men had higher visceral fat levels. These results indicate that women have greater overall body fat, while men show more pronounced abdominal adiposity and visceral fat accumulation (Table 4).\u003c/p\u003e"},{"header":"5. DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003eRepresentativeness of Samples\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the prevalence of normal-weight obesity (NWO) was evaluated in a Turkish population, and the anthropometric and body composition characteristics of 683 participants were recorded. To minimize the confounding effects of fat distribution differences and to more accurately reflect the prevalence of NWO, individuals with chronic diseases and postmenopausal women were excluded. Analyses showed that 62.6% of participants had a BMI within the normal range, and among this group, 28.4% had a high total body fat percentage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison with other publications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to our research, the number of studies investigating the prevalence of NWO in the literature is limited. In a recent review by Angriani et al. (2024), studies conducted over the last decade were analyzed, and the prevalence of NWO was reported to range between 10% and 46%[8]. A nationwide study conducted in China reported an overall prevalence of 4.76%\u003cw:sdt docpart=\"2978A70E77C04F75B1203E94668637A4\" sdttag=\"MENDELEY_CITATION_v3_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\" id=\"-457339910\"\u003e[18]\u003c/w:sdt\u003e. De Lorenzo et al. (2016) estimated the global prevalence of NWO to be approximately 10%, emphasizing that it is significantly higher in women than in men[19]. Similarly, Wijayatunga et al. (2019) reported that the prevalence of NWO varies between 4.5% and 22%, depending on study design and population characteristics\u003cw:sdt docpart=\"2978A70E77C04F75B1203E94668637A4\" sdttag=\"MENDELEY_CITATION_v3_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\" id=\"1137682256\"\u003e[15]\u003c/w:sdt\u003e. Correa-Rodr\u0026iacute;guez et al. (2020) found a prevalence of 29.1% among young Colombian adults, which is consistent with our findings[20].\u003c/p\u003e\n\u003cp\u003eStudies conducted in Asian countries also demonstrate a wide variation in NWO prevalence. Jia et al. (2018) analyzed data from 23,748 individuals (9,633 men and 14,115 women) in the China National Diabetes and Metabolic Disorders Study and reported NWO prevalence rates of 9.5% in men and 6.06% in women. Kapoor et al. found a prevalence of 31.7% in India, whereas Moy et al. reported a rate of 19.8% among 6,854 women in Malaysia. In Korea, Mee Kyoung Kim et al. found a prevalence of approximately 32%, and a study among government physicians in India revealed a remarkably high rate of 48.7%. Variations in reported prevalence are thought to result from differences in study populations, body fat percentage cut-off values, and measurement techniques[10, 18, 21\u0026ndash;23].\u003c/p\u003e\n\u003cp\u003eResearch focusing on older adults indicates that NWO prevalence varies depending on diagnostic criteria. Using data from the NHANES III (1988\u0026ndash;1994) survey, the prevalence of NWO among individuals aged 60 years and older ranged between 20% and 31%, with rates of 21.4\u0026ndash;27.9% in men and 20.4\u0026ndash;31.3% in women. In that study, individuals with NWO exhibited higher rates of dyslipidemia, hypertension, and reduced muscle mass, and NWO was shown to increase the risk of cardiovascular mortality independently of BMI[24]. Similarly, a study from Switzerland reported that NWO prevalence remained below 1% among men but increased with age among women, ranging from 1.4% to 27.8%[25].\u003c/p\u003e\n\u003cp\u003eWhen examining sex differences, most studies indicate that NWO is more common among women. In an Israeli study of 1,779 adults, 26% of men and 38% of women were classified as having NWO based on excess body fat[9]. Oliveros et al. (2014) reported NWO prevalence ranging from 2\u0026ndash;28% in women and below 3% in men[7]. In our study, the prevalence of NWO was 37.7% in women and 3.8% in men, showing a clear predominance among females, consistent with previous findings.\u003c/p\u003e\n\u003cp\u003eThese results suggest that NWO occurs more frequently in women and that sex may be an important determinant. Previous research has shown that women generally have a higher total body fat percentage, whereas men exhibit greater visceral adiposity. Our findings are consistent with this evidence. The higher NWO prevalence in women may be explained by biological and hormonal factors. Women physiologically possess more adipose tissue, which is mainly stored in peripheral regions, whereas men tend to accumulate fat viscerally. Estrogen promotes subcutaneous fat storage and suppresses visceral adiposity; however, declining estrogen levels after menopause lead to increased visceral fat accumulation and a higher metabolic risk. These biological differences may contribute to higher total fat mass in women and earlier onset of metabolic complications in men[26].\u003c/p\u003e\n\u003cp\u003eIn our study, individuals classified as NWO had significantly higher waist circumference, waist-to-hip ratio, and visceral fat levels. This finding indicates that metabolic risks can be elevated even in individuals with normal body weight. It also supports the notion that central adiposity is an early indicator of cardiometabolic risk. Central obesity is typically defined by waist circumference, one of the best-known components of the metabolic syndrome. According to globally accepted cut-off values, central obesity is defined as a waist circumference exceeding 102 cm in men and 88 cm in women. The International Diabetes Federation (IDF) recommends the use of population-specific waist circumference thresholds. In Turkey, large-scale community-based studies such as TEKHARF, TURDEP-II, and the Metabolic Syndrome Study have defined these thresholds as 96 cm for men and 91 cm for women. Waist circumferences above these limits are significantly associated with cardiovascular diseases and clustering of multiple metabolic risk factors. Therefore, evaluating obesity solely based on BMI does not adequately reflect true metabolic risk[27].\u003c/p\u003e\n\u003cp\u003eRecent multicenter studies have emphasized that BMI alone is insufficient to capture metabolic risk and that body composition and fat distribution assessments are essential. The literature consistently demonstrates that the NWO phenotype is closely associated with cardiometabolic abnormalities. Individuals with a normal BMI but elevated body fat percentage show significantly higher rates of dyslipidemia, metabolic syndrome, cardiovascular risk, and mortality. Furthermore, visceral fat accumulation has been identified as a strong predictor of metabolic syndrome even among metabolically healthy individuals. The central obesity frequently observed in NWO reflects increased visceral fat, which places individuals at a higher risk of cardiometabolic diseases and mortality\u0026mdash;a risk comparable to or even greater than that observed in overweight or obese individuals[9\u0026ndash;11, 14, 16, 17, 19, 28, 29].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical significance of results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTaken together, these findings highlight the critical importance of early identification of the NWO phenotype for risk stratification and targeted lifestyle interventions. This underscores the clinical relevance of body fat distribution and visceral adiposity, suggesting that early detection of NWO could play a key role in preventing cardiometabolic complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy limitations,\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe main limitations of our study include its single-centre and cross-sectional design. However, the relatively large sample size increases the reliability and generalizability of the results. Based on an extensive literature review, this appears to be the first study to report NWO prevalence and related anthropometric characteristics in the Turkish population. Therefore, it fills an important gap in the existing literature and provides a foundation for future epidemiological and clinical research in this area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNext studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese data should be supported by future large-scale, multicenter studies.\u003c/p\u003e"},{"header":"6. CONCLUSION","content":"\u003cp\u003eOur study is the first to investigate the prevalence of NWO in T\u0026uuml;rkiye, making it a unique and pioneering study. Our findings demonstrate the significant prevalence of NWO in T\u0026uuml;rkiye and are consistent with the literature. NWO was significantly more common in women. Consequently, individuals with normal body weight may appear healthy but still be at increased cardiometabolic risk. Therefore, obesity assessments should not be based solely on BMI; body fat percentage and fat distribution should also be routinely assessed. Obesity should not be limited to excess body weight but should also encompass total fat mass and its distribution.\u003c/p\u003e\n\u003cp\u003eIn this context, the use of practical methods such as bioelectrical impedance analysis in primary care, the development of screening programs for at-risk groups, and raising awareness that obesity is not synonymous with body weight are crucial. Lifestyle modifications aimed at reducing cardiometabolic risk should be encouraged, and large-scale national studies are needed to standardize diagnostic criteria for NWO. Such a comprehensive approach will facilitate early identification of cardiometabolic risks and timely implementation of appropriate interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e The Tanita BC-601 bioimpedance device used in the study was procured within the scope of a Scientific Research Project supported by Izmir Democracy University Faculty of Medicine. We would like to express our gratitude to Izmir Democracy University for enabling the acquisition of the device within the project, and to the volunteer patients of the Family Medicine Clinic at Buca Seyfi Demirsoy Training and Research Hospital for their valuable contributions to the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest.\u0026nbsp;\u003c/strong\u003e\u0026quot;The authors declare no obvious and potential conflicts of interest related to the content of this article.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution of authors\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eHakan G\u0026uuml;lmez 1 - contribution of author 1 according to criterion 1, significant contributions to the conceptualization or design, analysis, or interpretation of the study, according to criterion 2, drafting the study and critically reviewing it for significant intellectual content;\u003c/p\u003e\n\u003cp\u003eHicret Cin 2 - contribution of author 2 according to criterion 1, significant contributions to the collection, analysis, or interpretation of data for the study, according to criterion 2, drafting the study;\u003c/p\u003e\n\u003cp\u003eAccording to criterion 3; AND according to criterion 4;\u003c/p\u003e\n\u003cp\u003e\u0026quot;All of the authors read and approved the final version of the manuscript before publication, agreed to be responsible for all aspects of the work, implying proper examination and resolution of issues relating to the accuracy or integrity of any part of the work\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eInformation about the authors\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eHakan G\u0026Uuml;LMEZ\u003c/strong\u003e, MD, Associate Professor; address: \u0026Ouml;zmen Str., No:147 35390 Buca, İzmir, T\u0026uuml;rkiye; ORCID: https://orcid.org/0000-0001-5467-3743; e-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e* \u003cstrong\u003eHicret CİN\u003c/strong\u003e, MD; ORCID: https://orcid.org/0009-0002-1272-3129; e-mail:\u0026nbsp;[email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e*Corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTO CITE THIS ARTICLE:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(Vancouver, AMA)\u003c/p\u003e\n\u003cp\u003eG\u0026uuml;lmez H, Cin H. Prevalence of Normal Weight Obesity in the Turkish Population:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA Preliminary Report. \u003cem\u003eObesity and metabolism\u003c/em\u003e. 202X;XX(X):XXX-XXX. doi: https://doi.org/10.14341/ometXXXXX\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e\u003cem\u003eT\u0026uuml;rkiye Endokrinoloji ve Metabolizma Derneği-OBEZİTE TANI ve TEDAVİ KILAVUZU\u003c/em\u003e.; 2024, Ankara. ISBN: 978-625-95378-0-1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDS\u0026Ouml; Avrupa B\u0026ouml;lgesel Obezite Raporu. 2022. 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Eur Heart J. 2010;31(6):737\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/EURHEARTJ/EHP487\u003c/span\u003e\u003cspan address=\"10.1093/EURHEARTJ/EHP487\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Descriptive characteristics of participants with normal body mass index\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"497\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e25.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetabolic Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e23.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e167.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e41.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e95.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e61.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e24.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e21.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaist Circumference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e74.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHip Circumference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e96.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e7.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaist-to-Hip Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Body Fat Percentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e25.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVisceral Fat Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI: Body Mass Index\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eTable\u0026nbsp;2.\u0026nbsp;Distribution of participants without chronic diseases by body mass index\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"437\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnderweight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal weight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e62.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverweight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI: Body Mass Index\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eTable\u0026nbsp;3.\u0026nbsp;Distribution of normal weight obesity by sex\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"428\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"bottom\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNWO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e106\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e62.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e37.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e96.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e110\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e71.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e=43.60 p\u0026lt;0.001\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eTable\u0026nbsp;4.\u0026nbsp;Comparison of anthropometric and body composition variables by sex among the study participants\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"519\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e26.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e23.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetabolic Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e23.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e22.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e9.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e163.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e178.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e58.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e71.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e21.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e22.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaist Circumference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e71.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e83.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHip Circumference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e96.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e98.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaist-to-Hip Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Body Fat\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e28.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e17.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVisceral Fat\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI: Body Mass Index *p\u0026lt;0.05 **p\u0026lt;0.001\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Normal weight obesity, abdominal obesity, body fat distribution, body mass index, Turkish people","lastPublishedDoi":"10.21203/rs.3.rs-9160897/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9160897/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND.\u003c/h2\u003e \u003cp\u003eObesity is a chronic, recurrent, and progressive disease that impairs health due to abnormal accumulation of adipose tissue. One of the most commonly used methods for the assessment of obesity is the Body Mass Index (BMI), and individuals with a BMI value of \u0026ge;\u0026thinsp;30 kg/m\u0026sup2; are defined as \u0026ldquo;obese.\u0026rdquo; However, BMI alone is not always sufficient to characterize obesity. Individuals who fall within the normal BMI range (18.5\u0026ndash;24.9 kg/m\u0026sup2;) but have a high body fat percentage are classified as having Normal Weight Obesity.\u003c/p\u003e\u003ch2\u003eAIM.\u003c/h2\u003e \u003cp\u003eThe aim of this cross-sectional study is to determine the prevalence of normal-weight obesity in the Turkish population by evaluating body fat percentage among individuals within the normal BMI range.\u003c/p\u003e\u003ch2\u003eMATERIALS AND METHODS.\u003c/h2\u003e \u003cp\u003e This cross-sectional analytical study was conducted on 683 volunteer participants (212 men, 471 women) who applied to a Family Medicine outpatient clinic. Body fat percentage was assessed using a Tanita BC601 bioelectrical impedance analyzer. Total body fat percentage of 35% and above in women and 25% and above in men was considered normal weight obesity.\u003c/p\u003e\u003ch2\u003eRESULTS.\u003c/h2\u003e \u003cp\u003eAccording to our findings, the prevalence of normal-weight obesity in the Turkish population was determined to be 28.4%. When evaluated according to gender, the frequency of normal-weight obesity was found to be 37.7% in women and 3.8% in men. Accordingly, normal-weight obesity is much more common in women than in men. In addition, waist circumference, waist-to-hip ratio, and visceral fat levels were significantly higher in the normal-weight obesity group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eCONCLUSION.\u003c/h2\u003e \u003cp\u003eNormal-weight obesity appears to have a considerable prevalence in the Turkish population. These findings highlight the need to consider not only BMI but also body fat percentage and distribution in the assessment of obesity.\u003c/p\u003e","manuscriptTitle":"Prevalence of Normal Weight Obesity in the Turkish Population: A Preliminary Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 04:34:58","doi":"10.21203/rs.3.rs-9160897/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-13T20:49:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T13:41:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174473740135349010230132385075378110617","date":"2026-04-07T11:16:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331195478284817442490162692966093383512","date":"2026-04-03T17:23:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39408579845616755694741440831218340746","date":"2026-04-01T15:20:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T13:49:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-24T05:14:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T08:35:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T08:35:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-03-18T15:00:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"77aeeb22-8584-4606-92b1-299a8c953706","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T04:34:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 04:34:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9160897","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9160897","identity":"rs-9160897","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}