What is happening?
On June 14, the American Medical Association announced its recommendation that physicians no longer use body mass index (BMI) exclusively as a means of assessing well-being.
The decision to no longer rely on the controversial height-to-weight ratio stems in part from the fact that the original data collected was based only on previous generations of non-Hispanic white populations.
In the statement, the AMA said it “recognizes that relative body shape and compositional differences between racial/ethnic groups, genders, genders and age range are critical to consider when application of BMI as a measure of adiposity and that BMI should not be used as the sole criterion for denying appropriate insurance reimbursement.
Instead, the AMA suggests that BMI should be used in conjunction with other tools to measure obesity, such as “measurements of visceral fat, body adiposity index, body composition , relative fat mass, waist circumference and genetic/metabolic factors”.
Why there is debate
At the individual level, BMI has several drawbacks. But it can be a good tool for tracking rising or falling obesity rates in a population.
One of the reasons people love BMI is its simplicity: To assess your BMI, you take your weight in kilograms and divide it by the square of your height in meters. Those with a BMI between 25 and 29.9 are considered overweight, while those above 30 fall into the category of obese.
However, it is the simplicity of this formula that also makes it problematic when evaluating individuals. BMI does not take into account muscle versus fat. For example, an athlete may have a low body fat percentage, but a high BMI, due to their muscles.
In terms of health, it may also matter more Or you’re carrying fat, which BMI can’t tell you. Belly fat, for example, has been linked to high blood pressure, type 2 diabetes, and heart disease.
It’s also possible to have an above-average BMI and be generally healthy, a condition called metabolically benign obesity. This may be due, at least in part, to how different bodies react to fat. Different racial and ethnic groups may also carry and hold different weights.
There is also an important economic reason why BMI should not be the marker of weight and health. Insurance companies may not cover treatment costs for people who do not fall into the appropriate category under BMI. For example, in May 2021, the washington post reported that a black woman with an eating disorder was told her BMI was too high for her insurance to cover the treatment. She had to pay $800 out of pocket per month.
The tool may also underestimate the number of obese people. A new study presented at the Endocrine Society’s annual meeting suggests that BMI misses cases of obesity when obesity is determined by the percentage of fat to muscle.
Perspectives
BMI is an imperfect tool, but one of the few screening options we have
“Right now, the best tool we have that is readily available in any clinic will be BMI-based screening. We need better things. [The AMA policy] is a step in the right direction, but we also have to accept the reality of what we have right now. — Doctor of Obesity Medicine Carolynn Francavilla Brown, STAT News
Focusing on BMI can harm the relationship between doctors and patients
“Clinicians’ focus on BMI can lead to unproductive weight-related conversations that break the doctor-patient relationship and can introduce mistrust. This can lead patients to choose not to follow doctor’s advice , even when such advice is not focused on weight, and failing to pursue follow-up care due to faltering trust, a critical component of effective doctor-patient relationships. can unnecessarily divert the clinician’s attention to weight, an easy but often mistaken default explanation for various signs and symptoms, and can lead to missed diagnoses, sometimes with serious consequences.- S. Bryn Austin, Professor of Social Sciences and behavioral studies at Harvard TH Chan School of Public Health, and Dr. Tracy K. Richmond, assistant professor of pediatrics at Harvard Medical School, MedPage Today
BMI may be more accurate than we assume for finding excess body fat
“Despite its limitations and notorious counterexamples, BMI is strongly related to body fat and correctly classifies people as having excess body fat more than 80% of the time. Additional simple measures such as waist circumference may be even more informative because they provide information about where fat is distributed in the body.—Kevin D. Hall, senior researcher at the National Institute of Diabetes and Digestive and Kidney Diseases, Washington Post
Waist-to-hip ratio can assess where the most dangerous fat is better than BMI
“A person’s waist-to-hip ratio is by far a better tool to use than BMI because it considers the area where fat is most likely to be problematic – the waistline. ‘When we carry fat ( body fat) in our abdomen, it increases our risk of cardiometabolic diseases such as heart disease and type 2 diabetes.”” – Dr. Fatima Cody Stanford, Obesity Physician, VeryWell Health
Relative Fat Mass Index (RFM) may be a better measure, without the need for a scale
“The team of researchers behind RFM say it’s more accurate than BMI, and can also be calculated with a simple tape measure – so you don’t need a set of scales to calculate it, like you do with BMI. In the case of RFM, it’s the distance around your height from your height that counts, rather than your weight. Researchers say this gives a better idea of whether a person’s body fat is at a healthy level or not is a reliable, simple, and inexpensive method to assess body fat percentage without using fancy equipment,” says lead researcher Orison Woolcott, Cedars-Sinai Medical Center in California. “Our results confirmed the value of our new formula in a large number of subjects. Relative fat mass is a better measure of body fat than many indices currently used in medicine and science, including the ‘BMI.’ – ScienceAlert
Weight is always a topic to discuss with your health care provider, even if BMI is not used
“What I don’t want to happen as a result of this is people of color and black people in particular ignoring BMI and discussing excess weight with a medical professional because that they misunderstand the intent here. The goal is to personalize how BMI is used in medical decision-making and move away from sweeping generalizations that can lead to stigma and bias. — Dr. Jamy Ard, professor of epidemiology and prevention at Wake Forest University School of Medicine, CNN
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