Did you learn that the American Medical Association (AMA) has publicly stated that Body Mass Index (BMI) is an imperfect measurement and discourages its use by doctors?
We know people with obesity are treated differently, don’t receive evidence-based care, are fatally misdiagnosed, unable to donate their bodies to science, denied access to certain medical treatments and prescribed weight loss as a panacea based solely on their weight and BMI. This change in WADA policy happened in June and is finally a step in the right direction for the medical field.
A new policy has been adopted by the AMA acknowledging the issues with BMI due to the historic harms of this measure, including its racial biases, which we will discuss shortly. The policy also states that there are limits to what BMI considers and that it should NOT be used as the sole denial criteria by insurance companies.
THE report of the WADA Council on Science and Public Health States, “Numerous comorbidities, lifestyle issues, gender, ethnicity, family-determined medically significant mortality effectors, length of time spent in certain BMI categories, and expected fat accumulation with aging are likely to affect significant interpretation of BMI data, especially with regard to morbidity and mortality rates. Additionally, the use of BMI is problematic when used to diagnose and treat people with eating disorders because it does not take into account all abnormal eating disorders.
The history of BMI
Let’s get into some history behind the BMI and explain why the AMA is on the right track with its new recommendations. The formula later used to calculate BMI was created by a mathematician in the early 19th century named Lambert Adolphe Jacques Quetelet. At the time, it was called the Quetelet Index.
The purpose of his formula was to have a quick and easy way to measure the general population. It was not intended for use on an individual basis and is based on data collected from generations of non-Hispanic white men. It does not take into account a person’s gender, race or ethnicity.
According to research, different ethnicities and races have different “healthy weights.” According to United States Department of Health and Human Services Office of Minority Health (OHM)black women have the highest rates of “obesity” and “overweight” compared to other American groups.
But it probably means that since BMI does not include black men or women, or women in general, the healthy weight of the black community may be different. In fact, a 2003 study published in the Journal of the American Medical Association (JAMA) showed that a higher BMI tends to be more ideal for black people.
In China and Japan, they changed the threshold for the “overweight” category from the American version, probably because people of Asian descent are 2 times more likely to develop type 2 diabetes than people of white race.
In the late 20th century, health and life insurance companies replaced their own height and weight tables with the Quetelet Index and correlated an increased amount of body fat with an increased risk of heart disease. This is important because insurance companies then used this information to determine a person’s coverage, and doctors used it to determine whether they would accept a patient into their practice.
In a 1972 article titled “Relative weight and obesity indices,“Angel Keys gave the Quetelet measure its modern name, BMI, and also supported its use. Researchers, medical professionals, government and, most importantly, insurance companies wanted an easy way to track “health risks” among the American population.
Keys analyzed the adiposity density and subcutaneous fat thickness of 7,400 men from 5 European countries, used the Quetelet index, and proposed BMI as a simple way to measure body weight by relative to size.
In 1985, the National Institutes of Health (NIH) began using BMI as a way to “identify obesity.” So not only is this measurement based on an old formula, which is not used for its intended purpose and based only on white males, but it also does not take into account different body proportions in terms of the amount of bone, muscle and fat in the body. body. A person with strong bones, lots of muscle and low body fat will have a high BMI.
The way BMI is applied today tends to assume that you cannot be healthy if you are over a certain weight. But there are people who fall into the “obese” category based on their BMI and are in perfect metabolic health, just as there are people who can fall into the “normal weight” category and are in poor health. metabolic.
The impact of the new WADA policy
When news of WADA’s new policy broke, our first thought was “what about the new AAP pediatric guidelines?!” You can read more about these guidelines here. But basically, in January 2023, the AAP released new guidelines recommending behavioral treatment, obesity medications, and even bariatric surgery for children. These guidelines are based on the child’s BMI.
So if the AMA recommends against using BMI alone and acknowledges that it is not an excellent clinical measure of health, how does that affect the AAP recommendations? Will this change? Or will children be further stigmatized because of their weight?
We hope that with the new WADA policy, this means that the medical world changes. We hope this means more providers will adopt a Healthy at Every Size model and change what providers learn in medical school about obesity.
We hope this will lead to evidence-based care for every person, no matter their size.