I remember as a teenager going into my small-town Dr. for my annual physical. Inevitably a chart would be pulled out that showed weight & height. Then my Dr. would talk to me about whether I was in the “normal”, “overweight” or “obese” section. I remember feeling anxiety build as the chart was pulled out, but I never questioned why I was getting weighed or what the point of the BMI was.
As an adult reflecting on this experience I get frustrated, for several reasons. The first is, this type of interaction did nothing to assess my health. As a teenager, I had poor body image and a worse relationship with food. Yet if I was in the “thin” range my Dr. just assumed I was healthy. My second issue with this interaction is that it put way too much emphasis on my body size. I felt like I was “acceptable” as long as I was thin and it created an idea that to be healthy, I had to be within a certain weight range, no matter the cost.
In my current work as a therapist specializing in eating disorders and as a woman who identifies as fully recovered from an eating disorder, I wonder how the BMI got to be so important? What’s the science behind this tool? I know that weight doesn’t indicate health so why do Dr.’s still emphasize it? I decided to do a little research on debunking the BMI and here’s what I found.
The BMI was created by a guy named Lambert Adolphe Jacques Quetelet in the 1800’s. This guy was a mathematician, not a doctor. The BMI was originally developed to help governments figure out which people needed food assistance. Furthermore when the BMI was created Quetelet specifically stated it was not to be used as a measure of a persons fatness. It may be helpful to know that in the 1800’s giving cocaine to patients was standard practice and many doctors still believed that medical issues were due to an imbalance of “humors” in the body, not an infection. So, while cocaine is no longer given out in cough-drop form the BMI is still used. Others medical experts state that the BMI is not based in science and that the idea of distinctive overweight/obese/and “normal” categories exist is bogus stating that a decimal point should not push a person from a “healthy” to an “unhealthy” category. The BMI can also prevent medical professionals from looking at factors such as blood pressure, blood sugar levels, and cholesterol which are a much better indication of health than weight.
Thankfully many medical doctors are stepping up and calling BS on the BMI. Dr.’s such as Mitchell Lazar professor of Medicine & Genetics at the Institute of Diabetes explain that the BMI doesn’t account for muscle mass, bone density, overall body composition or racial or sexual differences. Lazar even points to the fact that recent studies have shown that obesity can protect against death from all causes as well as death from stroke, heart failure, and diabetes. This research that obesity can actually beneficial for your health is referred to as the “obesity paradox” and further proof that we need to ditch the BMI. If you’re dreading your next physical and your physician pulling out the BMI you’re not alone. But you do have options. You can request that your physician not weigh you or discuss with your physician the purpose of being weighed. If the goal is to assess your lifestyle perhaps talking about your activity and stress levels would be more beneficial that stepping on the scale. You have the right to advocate for your health and that starts with calling BS on the BMI.