Doctors admit BMI is racist and has caused historic damage

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The American Medical Association no longer recommends the use of BMI (body mass index) as a measure of health and weight, after years of controversy and criticism surrounding the metric. Last week, the AMA voted to adopt a new policy that recognizes not only BMI limits as an imperfect measure of health, but also its historical prejudice and use for of racist exclusion. Instead, the association, which is one of the largest medical groups in the United States, now recommends that alternative measures for diagnosing obesity in conjunction with BMI be used in clinical settings.

For a very long time, I’ve been in this situation of being an emperor without clothes, where I just couldn’t understand why really smart doctors keep relying on something that was so clearly flawed, A. Janet Tomiyama, Professor psychology at UCLA who studied BMI, told the New York Times in response to the news. The new policy also advises against the use of BMI in the diagnosis of eating disorders, saying it is problematic because it does not capture the full spectrum of abnormal eating disorders.

The BMI calculation takes someone’s weight in kilograms and divides it by the square of their height in meters. It then tells you whether you are underweight, healthy, overweight, or obese. The metric was invented in 1832 by Adolphe Quetelet, a Belgian astronomer and mathematician, and was adopted by governments around the world starting in the 1980s as a means of determining population health.

The problem with this, however, was that Quetelet’s calculation was intended as a method of finding out the average man (the average man) rather than someone’s individual health (Quetelet was, after all, not a doctor). He used BMI to define what was normal, and since the original study participants were all white European men, it was only normal for a very specific group of people. However, a healthy weight changes depending on your race, gender, and age. For example, Polynesians are generally healthier in a higher weight range, as are people over 65. Studies have also shown that BMI overestimates fat and health risks in black people and underestimates health risks in Asian communities.

BMI also does not distinguish between fat, muscle and bone density, which means that using BMI most professional athletes are classified as overweight. It also doesn’t take into account where in the body the fat is transported. Visceral fat around your organs is considered more dangerous than other areas of the body, for example around the hips. In 2016, a UCLA study concluded that tens of millions of overweight and obese people were completely healthy. And that 30% of people with a healthy BMI were actually not healthy at all.

The AMA’s recommendations are only suggestions, rather than strict regulations that physicians must follow. However, the association is influential in the medical community and the new policy indicates that accepted thinking around the metric and how obesity is measured is changing. It’s a pretty big change, Dr. Cynthia Romero, who helped craft the new policy, told The New York Times. Now we really need to be more mindful and more holistic when it comes to patient care.

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