BMI or body mass index has often been a source of debate and conversation – and yet because BMI is constantly referenced as a marker of health by providers in our healthcare system, it continues to be a thorn in the work I do with my clients of all body sizes. I’ve certainly been guilty of using this metric in my career. It is what we were taught in school, and frankly it is sadly often required by insurance companies to document a nutrition-related diagnosis for coverage in many cases. But, when you really dig in and understand the history of BMI and the reasons we continue to depend on this measure, it’s really disappointing that as a medical science and healthcare system, we haven’t figured out how to move beyond it.
So, what’s the big deal? Well, for one, too many people are victims of weight bias because of the BMI classifications and are unfairly dismissed, misdiagnosed or mistreated because of the belief that a certain BMI classification = health (which has been challenged and disproven in numerous research studies). Plus, consider the fact that in the 21st century, our healthcare providers, insurance companies, and researchers continue to rely on a 19th century mathematical equation based on a person’s height and weight as an indication of health and health status. We have the technology and the ability to do better for our patients!
Consider these facts about BMI:
- BMI was introduced in the early 19th century by Adolphe Quetelet, a Belgian astronomer and mathematician (not a physician). Not only was this formula based on European white males from that era, but Quetelet never intended the formula for individual use.
- There is no physiological reason to support the formula (weight in kilograms / height in meters squared). A high or low number does not tell us anything about whether the person is fit or healthy.
- The formula ignores relative proportions of bone, muscle, fat, blood volume, hydration, etc.
- The classifications of “underweight, normal, overweight, and obese” are each separated by a single decimal point and are not based on sound science (nor do the categories take into account genetics and ethnic variability).
- Based on #4 – there is dangerous racial bias!
- It promotes fat phobia or the fear of having an “unhealthy” BMI.
- When doctors, healthcare providers, researchers, and insurance companies continue to rely on BMI, there’s less of a need to use more scientifically sound methods to assess one’s overall health.
- Finally, it’s the 21st century. We can (and should) do better!
Can you imagine a world without BMI? This would mean no longer seeing a number (with a stigmatizing word like “normal” vs “overweight”) in “MyChart.”
It would mean that your doctor would have to work harder to consider your overall health status, or problem you are seeking help for, versus assumptions based on BMI. With today’s technology, a more comprehensive approach to patient’s concerns, including lifestyle or other social determinants of health is not only possible, but it’s vital – but this means providers need to take time to ask you about these kind of things. On the flipside, when “you need to lose weight” (or “your weight is ‘normal’ thus there’s nothing to worry about”) becomes the answer to a potentially serious health concern, be mindful that this is not comprehensive care.
And, in response to the persistent strong held belief that “you just need to lose weight” because weight = health, I wonder if the prescribing physician has considered the fact that a significant percent of the population have tried to lose weight – multiple times! It’s well-documented that 50% of adults in the U.S. have attempted to lose weight and 60% of women have dieted in the past year. Moreover, it would be meaningful for doctors to screen for eating disorders and trauma history, and understand the role these issues have on a person’s health (and weight). It’s merely wishful thinking on my part, but it would be even better if these same clinicians had training in eating disorders and trauma-informed care – even if just so that they can recognize and then refer to providers who can compassionately and appropriately treat these conditions.
If you are concerned about your weight (or your BMI), I encourage you to consider what you can control. Consider a self-assessment of your lifestyle. How is your overall dietary intake and eating pattern? Are you fairly active and moving your body regularly? How is your sleep quality/quantity? Do you need to address how you manage stress or begin to say no to certain activities or relationships? After assessing your lifestyle behaviors, begin to identify small steps that you can take to address any areas of concern. From a nutrition standpoint, here’s a few ideas:
- Eat more (and more variety) of fruits and vegetables
- Prioritize whole grains (oats, bran, quinoa, etc)
- Cook more with beans, legumes, soy, fish, nuts, seeds
- Add natural herbs and spices to home-cooked meals (cinnamon, ginger, garlic, turmeric, rosemary, cayenne pepper)
- Enjoy pleasurable foods in moderation
- Work on building strength and cardiovascular fitness
- Take time to relax Address your emotional and spiritual needs
Until the day that we abolish the use of BMI, remember to ask questions about your health that goes beyond weight, height and BMI. Remember: if you are unsatisfied with your care, advocate for yourself – or you may need to find a weight-neutral health provider. They do exist!