Does Your BMI Even Matter?

if you've ever had a checkup then BMI definitely appears somewhere in your medical record and it might be the most controversial term there BMI short for body mass index is a simple measure of height and weight used to estimate body fat but lately it's gotten a lot of flak I do have a BMI of 30 I've been considered overweight my whole life if you just look at the BMI I'm considered overweight the index did not take into consideration muscle mass body composition or even General Health are these knocks on BMI fair and if they are

why haven't doctors ditched the concept entirely let's talk about BMI the problems with it how I still use it and what I think might replace it in the Noto distant future the concept of BMI was invented in the 1830s by a Belgian mathematician named Adolf KET who had zero plans to create any sort of Health metric the guy was just obsessed with the ideal human body and wanted a way to calculate the size of an average person and person really meant white man since Kay only included Western European men in his experiments he came up

with a formula and called it the ketal index weight divided by height squared what happened next the ketal a index gathered dust for almost 150 years then in 1972 American physiologist anel Keys rebooted it and renamed it BMI keys and his colleagues ran a study to show that BMI could analyze obesity City at the population level it wasn't perfect but good enough their study was somewhat more inclusive than K's experiments but it wasn't that inclusive it involved healthy men from just a few ethnic groups who definitely didn't represent the entire spectrum of body types and

at that point experts had only recently realized that obesity was becoming a societal health problem in fact for a decent part of the 20th century weight wasn't even seen as relevant to health instead being overweight was mainly considered a cosmetic issue it was insurance companies who figured out that heavier policy holders had shorter life expectancies then of course they just charged larger people higher rates Give Me Your Money Punk today we obviously know a lot more about the health effects of obesity those with it have a heightened risk of developing various diseases and negative Health

outcomes including type 2 diabetes heart conditions multiple types of cancer and unfortunately death BMI wased used the way Andel Keys intended strictly for population Health until the '90s when medical organizations started using BMI ranges to categorize body weight a BMI of 30 became the cof point for an unhealthy weight and people with 30 or higher bmis were classified as overweight BMI wasn't actually calculated during most appointments until around the 2010s in an effort to focus on prevention the official recommendation for us Primary Care docs was to use BMI to screen for obesity for patients who

met the 30 BMI cut off doctors were supposed to offer counseling on diet and exercise by 2019 BMI was exploding and measured at almost all doctor's visits health insurance companies have also leaned into BMI they created cutoff points to approve or deny weight loss treatments very commonly I have patients who require medications like OIC or wovi get denied solely based on their BMI as BMI has become more widely used in healthare it's received more and more criticism BMI critics include doctors patients Public Health experts fat acceptance groups bodybuilders and more some people want to kick

BMI to the curve While others just want to see it used less at a high level there are three big problems with BMI that you need to know about BMI doesn't measure what it's supposed to having a larger body isn't inherently harmful the real risk factor the thing that's specifically link to obesity related diseases is having a high percentage of body fat more specifically a high amount of abdominal fat which strongly predicts obesity related diseases while fat around the hips and thighs matters less BMI doesn't even really measure body fat it can't determine fat versus

Muscle percentage or distinguish between good and bad fat types instead it just measures body size and uses that as a proxy essentially a guess a decent guess for body fat however you can weigh a lot for your height and still be healthy that means someone who's incredible shaped rip head to toe could have a high enough BMI to be considered clinically obese if any group of people proves this point it's elite athletes on the flip side you can fall within a normal weight range and have more abdominal fat and less muscle than you should the

BMI scale isn't inclusive I mentioned that BMI was basically developed from data on healthy white men both when it was first invented and then again when it was relaunched in the 70s this matters a lot because diseases can show up in different ways in different groups of people clinical obesity is defined as a BMI of 30 or higher for all adults 30 makes sense as a cut off for younger and middle-aged white men because their risk of type 2 diabetes increases starting at 30 but that's not the case for everyone one 2021 study from the

UK looked at the relationship between BMI and type 2 diabetes in more than a million people from five ethnic groups white South Asian black Chinese and Arab participants did not start off with diabetes but 6 and 1/2 years later researchers followed up to see which had developed diabetes and then figured out the BMI cutof associated with an increased risk for each group the number wasn't the usual 30 for any nonwhite group what does that mean well it means that many non-white people who wouldn't be diagnosed with obesity based on their BMI actually have an elevated

risk of type 2 diabetes and they're slipping through our cracks and our system but why is ethnicity even relevant why would a 24 BMI be healthy weight for a white person but not for a South Asian person the reasons are truly complex and aren't even fully understood yet one factor seems to be the relationship between ethnicity and body composition the amount of muscle and body fat someone has how fat is distributed and the type of fat are all aspects of body composition some research suggest that people of Asian descent tend to have more fat around

the organs called visceral fat which is a type more strongly linked to type 2 diabetes while there may be other ethnic based differences in body shape in composition like having longer or shorter legs relative to your height I got to point out that it's believed that those differences tend to be less impactful as compared to a dietary risk factor like excess sugar sweetened beverage consumption soda that's because overc consumption of sugar leads to direct metabolic harms that aren't instantly reflected in a person's weight and when that overc consumption does lead to weight gain it specifically

increases that riskier visceral weight gain it's not just ethnicity though the standard BMI scale isn't inclusive when it comes to age either it's not reliable for those 65 and over more than half would be classified as overweight or obese even though many older people wouldn't benefit from weight loss a somewhat higher BMI can actually be a sign of Better Health and Longevity for older people gender is also a problem the links between BMI and health he seem to be different for men and women and despite this the BMI scale isn't adjusted for sex BMI can

increase weight bias in healthcare no matter which way you slice it obesity is a significant health risk factor it's inaccurate to pretend it's not but when someone who's overweight gets sick their weight isn't always relevant this might seem like an obvious point but a common complain from heavier patients is that BMI comes up at every doctor's appointment no matter what symptoms they're having these patients are tired of feeling judged and being told weight loss might help for every single problem migraine diarrhea leg pain weird rash sad a lot well your BMI is a little high

yeah look that does go too far if a doctor gets hung up on a single number every time it can prevent them from zooming out and getting a more complete picture that type of bias leads to negative outcomes Mis diagnosed conditions delayed and ineffective treatment and patients not seeking care because they sto trusting us doctors all that is to ask if BMI is so flawed why don't we just stop using it well currently we don't have a better replacement that's widely available even with its limitations BMI can be effective for population Health you see population

Health focuses on Trends within and across large groups of people screening tools are used to understand how a certain disease is evolving and identify who's at risk an effective screening tool is one that can be easily rolled out on a massive scale being DMI checks all those boxes it's noninvasive inexpensive and can quickly be calculated at any doctor's visit and research has shown that BMI is significantly associated with body fat percentage in general so BMI for individual health usually not great on its own it just doesn't tell me enough most of the time what we

should do is learn to use BMI the right way the right way means using VMI alongside other medical information to get a more complete picture holistic hair also how about we put AI to good use here and have it find some patterns that allow us to better stratify risk we're always talking about AI taking over Health Care Why not start with crunching millions of numbers to find out the correct cutoffs for diverse groups so that the BMI number can be more valuable for the individual anyway it's more important for doctors to understand how BMI can

be both limiting and beneficial for patients we need to learn how to discuss weight and BMI with sensitivity this doesn't mean we need to downplay the risk but we should approach the subject with more care BMI shouldn't be with us forever and it won't in fact we already have several other tools for measuring body fat one old school device is body fat calipers they literally pinch your fat in several areas to make a measurement but their accuracy is usually meh a much higher Tech option is a dexa scan while it's reliable it also has several

drawbacks it's expensive it requires pricey equipment and it exposes you to ionizing radiation yeah that's the type that can cause cancer however there is one last method that has recently exploded in popularity and that's bioelectrical impedance analysis which uses electrical currents to distinguish body fat for muscle if you ever stepped on a body fat scale or a body composition scale then you use Bia some predict that'll eventually become the gold standard to assess obesity risk but not everyone's sold there's some evidence that Bia isn't really that that much more accurate than BMI also Bia can't

be measured without some sort of device while BMI requires nothing except some basic math for now BMI is the imperfect measure we have and I think we need to realize that it's a tool and like any tool it could be misused or misapplied but in order to use a tool optimally we need to continue studying and criticizing its pros and cons hopefully we did that here but what about your bones are they stronger after they break I answer that question and so many more directly from you and my comment section click here to check that

out and as always stay happy and healthy [Music]