Audio long read: Why BMI is flawed — and how to redefine obesity
Oct 30, 2023
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This podcast discusses the limitations of BMI as a measure of obesity. Scientists are calling for alternative metrics that consider age, sex, and race. The history and flaws of BMI are explored, highlighting the lack of correlation between BMI and mortality risk. The importance of considering factors other than weight in assessing health outcomes is emphasized. Challenges of using BMI as a diagnostic tool and efforts to redefine obesity are discussed. The introduction of EOSS as a more comprehensive measure of obesity is explored, taking into account physical, mental, and functional health.
BMI does not measure body fat and overlooks factors such as age, sex, and race that affect a person's health at a given weight.
Different populations have varying body compositions and fat distributions, leading to the need for additional metrics alongside BMI to assess obesity more comprehensively.
Deep dives
The flaws of BMI as a measure of obesity
BMI, or Body Mass Index, has been used for decades as an international standard to determine healthy weights. However, it does not measure body fat and overlooks factors such as age, sex, and race that affect a person's health at a given weight. Studies have shown that individuals with similar BMI values can have different levels of body fat, and being in the overweight category does not necessarily indicate higher health risks. BMI's simplicity and cost-effectiveness have kept it prominent, but experts argue that it should be used as a screening tool rather than a sole diagnostic tool.
The variability of body fat and the limitations of BMI
Different populations have varying body compositions and fat distributions, which BMI does not account for. For example, women tend to have more body fat than men at the same BMI, but their fat tends to be located in healthier areas like the hips and thighs. On the other hand, men accumulate belly fat, which is associated with poorer health outcomes. Additionally, ethnic and racial groups may have different risks and health associations at certain BMI values. The American Medical Association recommends combining other metrics with BMI to provide a more comprehensive assessment of obesity.
Alternative approaches to defining obesity
Efforts to redefine obesity beyond BMI have emerged, recognizing the need for a more nuanced understanding of weight and health. The Edmonton Obesity Staging System (EOSS), for instance, considers physical, mental, and functional health in addition to BMI to prioritize urgent care and treatment. The EOSS has been incorporated into clinical guidelines in Canada, Chile, and Ireland. However, transitioning these alternative approaches into clinical practice remains a significant challenge.
For decades, BMI — calculated by dividing weight by height squared — has been as an international standard to determine healthy weights.
However, BMI does not measure body fat, and ignores many other factors that can affect how healthy someone it.
Now, a small but growing movement of reseachers and clinicians are calling for other metrics to be used in conjunction with BMI when diagnosing and treating obesity.