How healthy are your massage clients? According to new research, perhaps less so than they believe they are.

The scope of the obesity epidemic in the U.S. has been greatly underestimated, according to a new study. Researchers found that the Body Mass Index (BMI) substantially under-diagnoses obesity when compared to the Dual Energy X-ray Absorptiometry (DXA) scan, a direct simultaneous measure of body fat, muscle mass and bone density.

The disparity is particularly significant for women of advancing age, those with high blood leptin levels, and the normal weight obese, the researchers noted.

The study found that as many as 39 percent of Americans who are classified as overweight based on BMI are actually obese as measured by DXA.

The study was published in the open access journal PLoS ONE.

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