Medical experts call for BMI review due to racist past

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Medical experts are once again questioning the accuracy and validity of the body mass index (BMI) after the American Medical Association noted the tool’s racist history and exclusion of unhealthy populations. white.

Having been commonly used by medical professionals as a measure of a person’s health and weight for decades in Australia and around the world, its effectiveness has been increasingly questioned in recent years as researchers are turning to more advanced ways of assessing a person’s well-being.

Now, experts are once again encouraging the medical industry to use BMI in conjunction with other health considerations rather than viewing it as the main test and determinant.

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In Australia, a BMI between 18.5 and 24.9 is considered healthy. Anything below 18.5 is considered underweight, while anything between 25 and 29.9 is considered overweight, and anything over 30 is considered obese.

Following its annual meeting in June 2023, the American Medical Association noted the “significant limitations associated with the widespread use of BMI in clinical settings”, noting its “historical harm” and its “use at purposes of racist exclusion”.

The use of BMI calculations began to gain popularity in a modern context in the 1970s after a physiologist, Dr. Ansel Keys, called body mass index a count and promoted the use of the tool as a beneficial way to perform rapid health assessments. But the roots of BMI actually go back almost 200 years.

Originally known as the Quetelet Index, the study is named after astronomer, mathematician and statistician Adolphe Quetelet, who wanted to discover what he called “the normal man”. By taking the measurements of a large group of people, he explained, a median could be identified and then used as a guide for what might be considered “normal”.

A set of numbers on the scale, like BMI, is only one aspect of health. Image: Getty

Although the basic premise seems correct in theory, there were two big problems with Quetelet’s plan from the start. First, he was not trained in medicine or the study of human biology. Second, and importantly to date, all of the participants in his study were Western European men, namely Scottish and French men. By completely ignoring the body types of non-white populations and women, the Quetelet Index not only supported the eugenics movement, but also served as a scientifically justified basis for extremely racist and brutal policies in the decades that followed.

When Keys revisited the index in the 1970s and suggested that the median be used as a way to measure body fat, he did his own measurements and studies, but again only men were measured. While Keys included at least participants from Japan, Italy, Finland and the Bantu people of Africa, the study measured only 7,426 people, and even he noted at the time of publishing his findings that the work “could not be suggested as a representative sample of Bantu men in general.

So how did an average measurement that cannot be considered representative of racial groups in general and which excluded women become a popularized method of measuring weight?

As Dr. Jamy Ard, professor of epidemiology and prevention at Wake Forest University School of Medicine in the United States, recently pointed out, “it’s easy to calculate and it costs next to nothing, so it’s very difficult to replace”.

According to 2021 census data, 39.9% of the US population identifies as non-white. Of that number, 18.5% were Hispanic and 12.2% were black.

Measurements can be part of understanding a person’s health. Image: Getty

In Australia, 27.6% of our population was born overseas, with India, China and the Philippines being among the five most common countries of birth. This population, combined with our Indigenous and Torres Strait Islander population, results in millions of Australians still receiving health advice from a metric created using data primarily from populations that do not represent the their.

As the AMA notes, “BMI is based primarily on data collected from previous generations of non-Hispanic and white populations.” And although the tool “is significantly correlated with the amount of fat mass in the general population”, it “loses predictability when applied at the individual level”.

The AMA also pointed out that “the relative differences in body shape and composition between racial/ethnic groups, genders, genders and age group are critical to consider when applying BMI “.

Instead of completely removing BMI, it is now recommended to be used in conjunction with other measures such as assessing where people carry fat, measuring cholesterol levels and monitoring blood pressure.

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