Content warning: This piece discusses weight. For as much as I use doctor’s appointments as an excuse to get out of just about any commitment, they are pretty much the last place I want to be. The sterile waiting room, the stinging smell of rubbing alcohol, and the looming anxiety of some unknown health crisis make the doctor’s office a recipe for one big stomach ache. If you didn’t show up sick, fifteen minutes in the waiting room will do just the trick.
But, what takes the doctor’s office from purgatory to a full-blown hellscape, is when your doctor assesses the entirety of your health based upon your Basal Metabolic Rate (BMI), or the ratio between your height and weight. We’ve been trained to trust our doctor’s expertise, but it’s difficult to trust someone who learned your BMI before learning your name.
The title that a doctor assigns you based on your BMI (underweight, overweight, etc) becomes tethered to your identity and seemingly presumptive of health outcomes. Many people experiencing real health troubles are dismissed by doctors who blame their “unhealthy” BMI. Alternatively, some people are dismissed because they “look healthy” according to their charts. Weight bias and stigma within the medical field led me to question the limitations of using BMI to assess one’s health. So, I spoke to medical professionals Dr. Praveen Guntipalli, Dr. Ido Weinberg, and Dr. Ila Dayananda about whether or not BMI is total BS.
There is no “One Size Fits All” Health Model.
It would be fair to assume that measuring BMI is a modern medical tool. However, it was actually established in 1832 as a mechanism to categorize the “normal man.” In 1972, physiologist, Ancel Keys, built a scientific basis around the measurement by analyzing 12 samples of “healthy men.” His studies exclusively included white men, yet his conclusions about health were projected to everyone, regardless of gender or race.
The practice of measuring BMI has developed over the past several decades, but the simple measurement remains standard. “BMI offers a straightforward method to classify weight status by correlating an individual’s mass and height,” Dr. Praveen Guntipalli tells Her Campus. “Recognized globally, it’s a primary tool endorsed by the World Health Organization (WHO) for identifying weight categories that may lead to health issues.”
Why is BMI even used?
There is no medical barrier keeping people from measuring their own BMI, meaning that it’s an accessible way to gain personal health insights.“There is quite a bit of data supporting the association of abnormal BMI with poor health outcomes,” Dr. Ido Weinberg tells Her Campus. “This is especially true for high BMI, but also to an extent with low BMI.”
For instance, a 2019 report by The World Health Organization states that a “higher than optimal” BMI caused roughly 5 million deaths from noncommunicable diseases, which include conditions like cancer, diabetes, and cardiovascular disease. But, the conclusion is based on a strong correlation, not a direct causation, which means that other factors should be considered. “BMI is a limited tool for assessing an individual’s total well-being,” says Dr. Ila Dayananda. “It doesn’t account for fat distribution, muscle mass, age, or bone density in its assessment.”
However, calculating BMI can be pretty misleading.
One person who is a certain weight is entirely unique from a person with the exact same weight. “For instance, a muscular athlete might be classified as overweight or obese, not due to excess fat but because of their muscle composition,” says Dr. Guntipalli.
Oh, and thinking back to our little history lesson from earlier, our health is being stacked up against the expectations for a fully grown white man. Not only do age, gender, and race play a role in weight, but also ethnicity, geographic region, lifestyle needs, and ability. Luckily, modern medicine is playing catch up. “Abdominal fat, particularly visceral fat (around internal organs), has been correlated to a higher risk of cardiovascular disease and diabetes,” says Dayananda. “In comparison, thigh or hip fat (subcutaneous fat) may have different implications for health that are less severe.” Women carry more weight in their breasts, hips, and thighs, meaning that a higher BMI may not be related to grim health outcomes. They just simply have bodies.
On the other hand, a person with a “healthy” BMI may have low muscle mass and high visceral fat, making them more at risk for disease, but less likely to be tested for them. “A better measure of ascertaining overall health is considering individual factors such as bone density (and age), muscle mass, and body fat distribution,” says Dayananda.
So, Is BMI total BS?
BMI can be a tool if analyzed with a critical eye; however, doctors recommend more accurate alternatives. it is recommended to incorporate measures such as the waist-to-hip ratio and body fat percentage,” says Dr. Guntipalli, which provides more detailed insights into body composition and fat distribution.” A waist-to-hip ratio can be self-measured and body fat percentage can be measured through skinfold thickness tests, smart scales, and DEXA scans. “But none of these has data to support its use that is even close to the robust data that BMI has”, says Dr. Weinberg. Therefore, BMI, despite its plentiful limitations, can be a useful tool in healthcare. But, it is certainly not the only option.
These are body-centric ways of measuring health, which can be useful for understanding your health status. But, health is not conducive to any particular size. It’s important to recognize that genetics, lifestyle, nutrition, mental health, and a whole host of other factors contribute to your overall well-being. So, next time your doctor tries to blame your health issues solely on your height-to-weight ratio, remind them that BMI is BS.
If you or someone you know has an eating disorder and needs help, call the National Eating Disorders Association helpline at 1-800-931-2237, text 741741, or chat online with a Helpline volunteer here.