August 25, 2026 · Science · Body composition · Measurement
What the Guideline Says
A federal work group reviewed the ways of measuring body fat and endorsed none of them. A synopsis of the 2025 US Department of Veterans Affairs and Department of Defense (VA/DoD) clinical practice guideline for the management of adult overweight and obesity was published in Annals of Internal Medicine on August 24, 2026. The full guideline, dated September 2025, runs 219 pages and contains 23 recommendations built on evidence published from April 1, 2019 to January 6, 2025.
The first of those 23 recommendations is a new addition in the 2025 revision, and it is the one this site should care about. It reads: "There is insufficient evidence to recommend either for or against a particular measure of adiposity to manage clinical outcomes in patients with overweight or obesity." It is rated Neither for nor against. The accompanying discussion draws a distinction that gets lost almost everywhere else. Data comparing the accuracy of one body-composition modality against another does exist. The guideline describes minimal data on the clinical utility of using those modalities to define excess adiposity and improve clinical outcomes.
The guideline has not abandoned measurement. Its own screening algorithm instructs clinicians to calculate body mass index (BMI) to screen for overweight or obesity at medical visits, and to consider measuring waist circumference. Its discussion notes that BMI is an indirect measure influenced by factors such as edema and muscular composition. Someone with high muscle mass can be classified as having overweight or obesity. Someone with reduced lean mass can carry a low BMI that leads to what the guideline calls decreased recognition of their true adiposity and elevated cardiometabolic risk.
The short version
What It Means for You
The longevity testing market sells measurement precision as the product. A DEXA scan is offered as an upgrade over a tape measure. A bioimpedance device prints a visceral fat level to one decimal place. A membership panel adds a body-composition module. The implied argument is that a better number produces a better decision, and this guideline is the clearest recent statement that the second half of that argument is where the evidence runs out. Its work group could compare the modalities against each other on accuracy, because that literature exists. It found minimal data on whether using any of them to define excess adiposity improves clinical outcomes.
That has a practical shape for a buyer. It argues against paying repeatedly for precision as an end in itself. It argues for whatever you will genuinely repeat under identical conditions, because a single reading of any modality is one data point and only a series carries information. Our visceral fat guide makes the same distinction from the measurement side. Magnetic resonance imaging (MRI) and computed tomography (CT) measure visceral fat directly, DEXA estimates it with a manufacturer's algorithm, waist circumference and waist-to-height ratio are the validated field measures, and the visceral fat rating printed by a bioimpedance scale is a proprietary index rather than a measurement at all. Our visceral fat level chart covers why the same number means different things on different brands of device. The guideline does not resolve which of these is best. It reports that the resolution does not exist yet, which differs materially from the message on a scan provider's pricing page.
A second recommendation in the document speaks to another category we publish. Recommendation 23 states that the work group suggests against using dietary supplements or nutraceuticals for clinically meaningful weight management, rated Weak against, with a discussion citing insufficient evidence for clinically significant short-term weight loss or long-term weight management through those approaches. Readers browsing our supplement guides should read that as what it is: a formal, evidence-graded negative recommendation in one specific domain, weight management, from a work group that reviewed the trials. It is not a statement about every supplement for every purpose, and the guideline's own framework marks it as the weaker of its two negative grades.
Who Should Ignore This Finding
Anyone who has never measured anything should not read a "no modality wins" result as permission to skip measurement. The guideline's own algorithm still starts with a BMI calculation and a considered waist measurement, and the population most poorly served by BMI alone is the one carrying a normal weight with central adiposity, covered in our visceral fat guide. Anyone already under a clinician's care for weight, diabetes or cardiovascular risk should also treat this as background rather than as a reason to change what they are doing. The finding concerns which instrument the evidence supports, not whether an individual's current plan is sound.
What Would Change This Read
A randomized trial showing that assigning people to one adiposity measure rather than another produced better clinical outcomes would change it, and that is precisely the trial the guideline says is missing. A revision moving Recommendation 1 from Neither for nor against to a positive grade for a named modality would change it too. Short of either, a scan sold on precision alone is being sold on a claim the reviewed evidence does not yet support.
Related Coverage
This is the second finding in a week pointing the same direction. An earlier briefing covered a Finnish cohort in which conventional risk factors outpredicted epigenetic clocks for incident chronic disease, with measures including BMI and waist-to-hip ratio beating the more expensive instrument. Now a systematic guideline review reports that no measure of adiposity has been shown superior for managing outcomes. Neither result says the sophisticated tests are worthless, and neither is a reason to skip measurement. Together they describe a market where instrument precision has advanced faster than the evidence that acting on the more precise instrument changes anything, and that gap is what a buyer is being asked to fund. The practical next step is cheap: take a waist measurement the same way each month and bring the trend to your next appointment, using the thresholds in our visceral fat guide.
Sources
- VA/DoD, "Clinical Practice Guideline for the Management of Overweight and Obesity in Adults," September 2025, Recommendations 1 and 23, healthquality.va.gov (full guideline PDF accessed August 25, 2026).
- Annals of Internal Medicine, "Adult Overweight and Obesity Management: Updates From the 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines," August 24, 2026, DOI 10.7326/ANNALS-26-00676.
- Medical Xpress, "Updated obesity guideline supports personalized care and continued use of effective weight-loss medications," August 24, 2026, medicalxpress.com (accessed August 25, 2026).
Frequently Asked Questions
Does the guideline say BMI is useless?
No, and it is careful not to. Its screening algorithm still instructs clinicians to calculate body mass index (BMI) at medical visits and to consider measuring waist circumference alongside it. What the guideline declines to do is endorse any one measure of adiposity over another for managing clinical outcomes. Its discussion describes BMI as an indirect measure that can be influenced by factors like edema and muscular composition, while still calling BMI measurements a useful tool for assessing adiposity-associated complications.
What does "Neither for nor against" mean in a guideline?
It is a formal category in this guideline framework, alongside Strong for, Weak for, Weak against and Strong against. It signals that the evidence reviewed did not support a recommendation in either direction. It does not mean the measurement was found to be harmful, and it does not mean it was found to be useless. In this case the guideline states there is insufficient evidence to recommend either for or against a particular measure of adiposity to manage clinical outcomes.
So which body fat measurement should I use?
The guideline does not answer that, and reporting otherwise would overstate it. What its own algorithm does is pair a BMI calculation at medical visits with consideration of waist circumference. For someone tracking at home, the practical consequence is that consistency matters more than the instrument. A measure taken the same way, at the same time of day, over years gives you a trend, and no single scan gives you a trend from one reading. Which measure suits your situation is a determination for your clinician.
What does the guideline say about supplements for weight management?
It suggests against them. Recommendation 23 states that the work group suggests against using dietary supplements or nutraceuticals for clinically meaningful weight management, rated Weak against. The discussion cites insufficient evidence demonstrating clinically significant short-term weight loss, and insufficient support for long-term weight management, through nutraceutical or dietary approaches of that kind.
Does this guideline apply to me?
It was developed by the Department of Veterans Affairs and the Department of Defense to assist their providers in managing patients with overweight or obesity, and the guideline itself states it is designed to assist decision-making and is not intended to define a standard of care. It is not a set of instructions for a consumer, and nothing in it tells any individual what treatment they qualify for. It is useful here as a recent, systematic, publicly readable review of what the evidence does and does not support about measurement, which is what this site benchmarks.