Body Mass Index Is ‘Racist’ Says American Medical Association

Written by Naveen Athrappully on June 26, 2023. Posted in Current News

The announcement comes amid recent definition changes by major healthcare institutions that seek to view abnormalities as ‘inclusive’

The American Medical Association (AMA) has warned against using the Body Mass Index (BMI) as the sole metric to determine whether an individual is overweight or not—citing “historical harm” from the measurement.

BMI is measured by dividing an individual’s weight in kilograms by the square of height in meters. It does not measure body fat directly.

According to the U.S. Centers for Disease Control and Prevention (CDC), a BMI between 18.5 and 24.9 among adults aged 20 and above is seen as “healthy.” BMI between 25 and 29.9 is seen as “overweight” while a value of 30 and above is classified as “obese.”

In a June 14 press release, the AMA said that BMI as a measurement tool was “racist” as it has largely relied on data collected from generations of non-Hispanic white populations.

The organization said that the relative body shape and composition of human beings differ across racial and ethnic groups, genders, sexes, and ages. These factors are “essential” when applying BMI.

The AMA warned that BMI must not be used as a “sole criterion” to deny any appropriate insurance reimbursement.

Though BMI is “significantly correlated” with the amount of fat mass in the general populace, it loses predictability when applied to an individual, the group stated.

The AMA is now suggesting that BMI be used in conjunction with other factors like measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference, and genetic or metabolic factors.

“There are numerous concerns with the way BMI has been used to measure body fat and diagnose obesity, yet some physicians find it to be a helpful measure in certain scenarios,” said AMA Immediate Past President Dr. Jack Resneck.

“It is important for physicians to understand the benefits and limitations of using BMI in clinical settings to determine the best care for their patients.”

Normalizing Fatness

The AMA’s BMI  announcement comes as there has been a growing attempt to disregard the issue of body weight. Terms like “weight bias” have sprouted up as a form of discrimination, with doctors feeling pressured to avoid mentioning weight.

There are also “don’t weigh me” cards that patients can hand over to doctors during an office visit stating, “If you really need my weight, please tell me why so I can give you my informed consent.”

In a May 2021 commentary, Martha Rosenberg, an author whose work has been cited by the Mayo Clinic Proceedings, warned that recent movements like “fat acceptance,” which seeks to normalize obese and overweight bodies, is a “dangerous idea,” citing the negative health consequences resulting from excess weight.

Research has found that as BMI readings climb, an individual’s chances of contracting chronic conditions like heart disease and high cholesterol also rise.

Many experts see BMI as a helpful tool to predict health risks. “The best way to think about BMI is as a risk-prediction tool,” Brad Dieter, an exercise physiologist, told Health.

“Think about it like age. Regardless of what else is going on, the older you are, the more likely you are to have a chronic health condition… The same is true with BMI. The higher your BMI, the more at risk you are for a poor health outcome,” he said.

AMA’s attempt to disregard BMI is happening while similar attempts are being made in gender as well. Johns Hopkins University recently courted controversy for describing a woman as a “non-man.” The university was eventually forced to take down the glossary.

Meanwhile, transgender health issues, which used to be categorized as mental and behavioral disorders by the World Health Organization (WHO), were no longer classified as such by the organization beginning in 2019. And in 2021, the American Psychological Association also did away with such classifications.

Dangers of Excess Weight

Judging accurately whether an individual is obese or overweight is critical as excess weight is often associated with numerous health issues.

For one, around eight in 10 people suffering from type 2 diabetes are estimated to be overweight or obese. Individuals suffering from type 2 diabetes who are overweight are often advised to lose weight to keep the condition in check.

Obese and overweight individuals are at increased risk of various diseases and health conditions like high blood pressure, high LDL cholesterol, coronary heart disease, gallbladder disease, stroke, breathing issues, osteoarthritis, body pain, and mental illnesses like anxiety and clinical depression.

A 2019 meta-analysis of 17 studies that looked into 204,507 individuals found that “there is a significant positive association between depression and obesity in the general population, which appeared to be more marked among women.”

Obesity in the US

According to data from the CDC, the prevalence of obesity in the United States from 2017 to March 2020 was 41.9 percent—a big jump from 30.5 percent over the 1999–2000 period.

During this period, the prevalence of severe obesity rose from 4.7 percent to 9.2 percent. The agency estimated the medical costs for obese adults to be $1,861 higher than individuals with a healthy weight.

Results from the 2017–2018 National Health and Nutrition Examination Survey estimated that 42.5 percent of American adults over the age of 20 are obese, with an additional 31.1 percent being overweight. This would mean that 73.6 percent of Americans have excess weight.

The results stand in stark contrast to a Gallup poll published in January 2022 that found 53 percent of the American population thought their weight is “about right.” The survey asked respondents what they thought about their weight in the five years between 2017 and 2021.

Excess weight among Americans is posing a problem for the U.S. military as well. According to researchers from the Center for Health Services Research (CHSR) at the Uniformed Services University in Bethesda, Maryland, almost 10,000 U.S. Army soldiers slipped into obesity during the pandemic due to reduced physical training.

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Header image: Paras Hospitals

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