Are we saying goodbye to BMI?
Body mass index (BMI) BMI, a measure of body fat based on height and weight, has been around for decades. For years, BMI has been used to determine whether you are in a “healthy” weight range based on guidelines set by the World Health Organization.
Since its inception in 1972, BMI has been a standard measure of health and a screening tool for diseases, including obesity. It is also used to track population-level trends in public health.
But it turns out there are some serious problems with using BMI as an indicator of health, especially for women and people who were assigned female at birth.
Limitations of BMI
Fatima Cody Stanford, MD, MPH, MPA, Associate professor of medicine at Harvard Medical School and a physician-scientist specializing in obesity medicine, said BMI has been flawed from the start considering it is based on White men measurements“We are not men,” Stanford said. “I really find it problematic that we just assume that men are the reference and the standard because we have differences.”
For example, women tend to have more body fat compared to men with the same BMI, but BMI does not assess body fat percentage, which can impact your health.
Stanford noted that women also experience hormonal changes throughout life that can affect body fat distribution. She finds it frustrating that differences between women and men are not taken into account.
For women of color, the BMI story becomes even more problematic. So much so that the American Medical Association (AMA) recently issued a policy change considering BMI as a measure of medicine because of “its use for racist exclusion and because BMI is based primarily on data collected from older generations of non-Hispanic white populations.”
Under the new policy, the AMA recommends that health care providers take into account different body shapes and compositions based on racial or ethnic groups, sexes, genders and ages, as well as other risk factors. 6 of 10 Black women are living with overweight or obesity in the U.S., and BMI is the only indicator for disease diagnosis, which can have a major impact on how providers approach diagnosis and health conditions, from treatment options to insurance costs.
Read: The importance of making obesity treatment accessible >>
“I’ve been one of those people who is really trying to sound the alarm about BMI as a single measure,” Stanford said. “BMI is not an indicator of health, it only tells us height and weight. It doesn’t tell me anything about an individual’s health.”
The “M” does not stand for muscle
Another major flaw is that BMI does not take into account body fat versus muscle mass, and muscle mass weighs more than fat. For example, investigation shows that black people may have less body fat and more lean muscle mass than white people with the same BMI.
This can also be a problem for people who are athletic and have more muscle, and muscles carry more weight, making BMI an inaccurate measure of health.
You may have recently seen the American rugby star Ilona Maher addresses the issue of BMI on social media. In a viral TikTok video, Maher responds to a commenter who criticized her weight and says that Maher has a BMI of 30, which would put her at number 10. Obesity category according to BMI standards.
Maher responded that she has been labeled “overweight” her entire life despite being an athlete. “BMI doesn’t tell you what I can do. It doesn’t tell you what I can do on the field. How fit I am. It’s just a couple of numbers put together,” Maher said in the video. “It doesn’t tell you how much muscle I have or anything like that.”
Just days later, Maher and the U.S. women’s rugby team won a historic bronze medal at the Olympics. So it seems current and future plans to change the way we view BMI couldn’t start soon enough.
New BMI guidelines
Currently, BMI is the only way to diagnose obesity. Stanford is one of the experts on a committee working on a clinical definition of obesity and updated guidelines for diagnosing and treating the disease.
Read: Is obesity a disease? Yes, and the medical community is finally recognizing it >>
Stanford said he has dedicated his life and career to helping people living with obesity, and that BMI doesn’t work on an individual level. “People are so used to the idea that this number tells me something about their health without having to dig deeper than the surface,” Stanford said. “What’s the cholesterol that goes with that number? What’s the blood pressure that goes with that number?”
Stanford said the commission’s new recommendations, which are expected to be released in September, put less emphasis on BMI and offer a more comprehensive view of the actual science behind obesity, which is key to treating the disease.
“In 2024, we are at a point where medicine needs to take an active stance and really think about health, and that is what we are doing,” Stanford said. “Obesity is a chronic disease and we should treat it as such.”
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