Millions of Americans now misclassify their health based on BMI

Good housekeeping is exploring how we think about our weight, the way we eat, and how we try to control or change our bodies in the pursuit of being happier and healthier. While GH also publishes weight loss content and strives to do so in a responsible, science-based manner, we believe it is important to bring a broad perspective to a more holistic understanding of complex thinking about health and weight. Our goal is not to tell you how to think, eat, or live—nor to judge how you choose to nourish your body—but to start a discussion about food culture, its impact, and how we challenge the messages we receive and what makes us change Be attractive, successful and healthy. The more we report on body mass index, a widely used but flawed measure of health, the more accurate and less stigmatized we can see the overall health metrics included in our coverage.

It’s nearly impossible to see a doctor without jumping on the scale and being told your body mass index (BMI), which is calculated by dividing your weight in kilograms by the square of your height in meters. The concept originated in the 1800s as a way to classify populations by weight, said Amy Lee, MD, a Southern California physician and weight expert. People are “in the ‘underweight’, ‘normal’, ‘overweight’ or ‘obese’ range,” she said. As mild as this may sound, many experts are aware that there are real problems with the measurement, and that the way it is applied does more harm than good. This question is complicated, but here are a few reasons:

“Overweight” is not synonymous with “unhealthy.”
While higher BMI is associated with certain conditions at the population level, there is little evidence that higher body weight causes these conditions in individuals. However, with so much emphasis on slimming and BMI in our culture, things can get too simplistic. In some cases, people with a high BMI are denied treatment (such as in vitro fertilization or surgery), or weight loss is seen as a panacea. Consider a patient with knee pain: “If the person is obese, a doctor may diagnose a weight problem, prescribe weight loss as treatment, and then put them on the road without further diagnostic testing or treatment,” said Dr. Paula Brochu, Nova Southeast Associate Professor at the University’s School of Psychology, who studies weight stigma. “But if the person isn’t obese, they’re more likely to have a scan and treatment for knee pain at the time of the complaint.” Not only could doctors miss a problem that’s visible on an X-ray or other imaging, but being abused can prevent a larger person from seeking medical care service, may worsen health problems.

In fact, you can be heavy and fit — or skinny and not so skinny. “A large study examined people’s cardiometabolic health across the BMI range and found that nearly half of those who were ‘overweight’ and nearly a third of those who were ‘obese’ were metabolically healthy,” Brochu said. Almost one-third of “normal” weight people are not. “Researchers estimate that nearly 75 million adults in the United States have their health status misclassified based on BMI,” she said.

Race and ethnicity matter.
While everyone’s BMI is calculated the same way, research shows that the meaning of this number is different for different groups. “For Indians, we know that their odds of developing metabolic syndrome (problems associated with diabetes and heart disease) like diabetes and heart disease go up at 27,” said Saniea Majid, MD, a board-certified obesity specialist in Livingston. , F.A.C.S., FASMBS said, NJ. That’s below the 30 BMI associated with the same problem in whites. For people of Taiwanese ancestry, the numbers are even lower, Dr. Majid added. So people who think they have a BMI below 30 may actually be at serious risk.

Other studies have shown that the BMI associated with longest life is around 23 to 25 for whites and 23 to 30 for blacks—that is, a higher BMI may be beneficial for blacks. While medical weight stigma and inadequate care are bad for all, misclassifying black people as “overweight” may exacerbate already wide racial health disparities.

BMI does not take into account body shape or composition.
As a result, muscular people are often classified as “overweight,” Dr. Lee said, leading to stigma and denial of treatment. The BMI calculation also doesn’t take your weight into account. Studies have shown that a higher waist-to-hip ratio is more strongly associated with heart attack risk than BMI, while larger hips do not appear to carry a similar risk. Higher BMI does not mean higher mortality.
“Many people were surprised to find that ‘overweight’ people had a lower risk of death than people of ‘normal’ weight, and that ‘obese’ people had the same risk of death as people of ‘normal’ weight,” Brochu said.

Why still use BMI?
This data point is easy to calculate and inexpensive to measure, and has underpinned decades of health research. It’s also ingrained in our healthcare system. For example, BMI is incorporated into the coding system doctors use to let insurance companies know what they charge. In addition, many doctors, including Dr. Majid, found it a useful screening tool when combined with other measures. These include blood pressure, pulse, cholesterol, fasting blood sugar, fatty liver disease and body composition, as well as “conversations based on the patient’s race, family history, lifestyle, age, activity level, and whether someone is in perimenopause,” Dr. Majid said.

However, other doctors, as well as psychologists such as Brochu, argue that the use of BMI leads to an overemphasis on weight in medical settings and fuels the false belief that thin equals health. “It focuses on weight loss as a health outcome, and in general, promoting weight loss at all costs often leads to harm,” Brochu explained. “Focusing on health rather than weight can provide more support for patients of all sizes.”

Our Promise: Good housekeeping will avoid relying on BMI as an indicator of health in our reports, and if we determine that it must be mentioned, we will point out its limitations. How much you value this measurement or weight depends on the relationship between you and your provider. If you decide to de-emphasize your weight as a measure of your own health or well-being, you can ask your provider to take the other tests mentioned here (such as blood pressure, pulse, and cholesterol) without you stepping on the scale. “People have the right not to weigh themselves and to disagree with discussing their weight,” Brochu said. If you don’t want to be weighed but don’t know what to say, visit more-love.org for helpful phrases and little cards you can give your provider to express your preferences.