Written by: Shreya Arcot
Edited by: Ingrid Teng
Edited by: Ingrid Teng
The BMI, or body mass index scale, was created almost two hundred years ago by a Belgian mathematician named Lambert Adolphe Jacques Quetelet. However, Quetelet did not create it for the purposes that it is being used for today. During the 1800s, high death rates were being reported, so he created The Quetelet Index to observe whether there was a “correlation between weight, height and death” (Basile 2020) for a large mass of people, not individuals. In 1972, though, physiologist Ancel Keys declared that analyzing health in this way, but for a singular person, was important. That marked the change from The Quetelet Index to the Body Mass Index that we use today. Since then, the BMI has not changed much, except to adhere to the measurement system of pounds and inches used in the United States. The BMI formula itself is as follows: “weight (pounds) divided by height (inches)-squared, then multiplied by 703” (New Life Medical). Those whose BMI is between 18.5 and 24.9 are considered to have a healthy weight. Anything below that range is considered underweight, and anything above that is considered overweight. Above thirty is considered obese. However, this set of values and ranges is not very helpful in considering a person’s health, because it fails to consider various factors, including muscle quantity, age, activity level, lifestyle, genetics, and more. Thus, there are many misconceptions surrounding the BMI that do not make it a beneficial scale for assessing health and well being in a person, and it can cause more harm than good.
Race, ethnicity, and gender are three factors that are not considered by the BMI, and thus result in an incomplete analysis of a person’s health. When the BMI was created, it was done so with white men in mind, specifically those from the 1800s. However, there are several differences, such as genetic, lifestyle, and body type, between white men and the several other races, ethnicities, and genders that the BMI is being applied to. In the words of Sabrina Strings, an assistant professor at the University of California, Irvine (UCI), “‘It is racist, and also sexist, to use mostly white men within your study population and then try to extrapolate that and create norms and expectations for women and people of color’” (Basile 2020). In addition, during the time that the BMI was created, the “normal” body weight for women, who were much shorter and had less muscle than women today, was considered. Thus, the BMI scale and what is considered overweight and underweight cannot be accurately applied to women who are more athletic, taller, and have more muscle than women from the 1800s. This inherently makes the BMI scale inapplicable for a large portion of women today. For instance, for athletes with higher muscle mass, the BMI scale may label them as overweight, when in fact, they are not. This lack of comprehensive consideration makes the BMI unreliable and problematic.
One of the most commonly believed notions of the BMI is that it measures fat. It, however, does not. For instance, the body has muscles, bones, and different types of fat, and the muscle and bone are both more dense than fat. So, in an athlete with a high density of muscle mass and bones, the BMI will assess that they have a high amount of body fat, and thus a high BMI, when in actuality they do not (Ricciotti and Hur 2016). Thus, the BMI is not accurate for those who are “lean, fit, and healthy” (Devlin 2009), because it was created around those who lead a mainly inactive lifestyle, not athletes and health-conscious people. Age is also a factor in the inaccuracy of the BMI because elderly people typically have lower bone density and muscle mass, so the BMI would assume a low body fat amount, and thereby give them a low BMI (Ricciotti and Hur 2016). Therefore, both the athlete and elderly person would be given a BMI that labels them as unhealthy, even if they are not. This is why age, lifestyle, muscle mass, and bone density are factors that cause the BMI to not be the most efficient or accurate tool to assess health in an individual.
When the BMI is used as a point of disregard for others’ health, it becomes an even more dangerous system. Weight bias is what results when healthcare professionals do not provide quality care to their patients because of their weight. For instance, if a person whose BMI labels them as overweight or obese seeks medical guidance, their weight may be cited as the cause for all of the symptoms or problems they are facing, even if it is a simple cold (CCTC Staff Writer 2022). Instead of their health being assessed and proper care and treatment being provided, they are told to lose weight. This causes a lot of issues for the patients, because their health is not being taken care of and they are simply being deterred from seeking healthcare, even if their condition worsens.
Disordered eating can be linked to BMI in certain cases. For instance, if someone’s BMI indicates that they are overweight, that could lead to restrictive dieting in that person. In another case, if someone loses a lot of weight in an unhealthy manner, they may be praised for losing that weight. Thus, rather than getting the help they need to treat their eating habits, this individual may continue that destructive pattern of eating (CCTC Staff Writer 2022). In addition, a person may have a BMI that puts them in the “healthy” category, even if they are suffering from eating disorders (Bothwell 2021). Therefore, using the BMI to diagnose a person with disordered eating or putting a number value before a person is one of the many negative aspects of the BMI.
There are a few better ways to assess health in a numerical manner other than the BMI, and these include waist circumference measurements and body composition scales. A BMC Sports Science, Medication and Rehabilitation report stated that “fat stored in the belly is thought to be unhealthier than fat stored on other parts of the body” (Basile 2020), so measuring the waist can help medical professionals get an understanding of a person’s health in that way. The body composition scale takes into account muscle, fat, bone, and water in the body and how they each contribute to weight (Basile 2020). Despite having these other numerical scales, though, the most comprehensive health analysis comes from a combination of lab tests and health screenings that work together to show a physician where a person’s health stands.
Overall, the Body Mass Index (BMI) is not an accurate or holistic way of assessing an individual’s health, nor was it meant to be used in such a way. Although extreme BMI values should be cause for concern, the general scale does not take into consideration the several ways in which every person is different from another, including genetics, age, lifestyle, gender, muscle mass, and much more. This is why it is critical for healthcare professionals to treat a person’s health in order to improve well-being, rather than analyze numbers. It is also vital that we advocate for ourselves, especially when it comes to focusing on our health and comfort.
References
About BMI and Eating Disorders [Internet]. [Date of Publication unknown]. [Place of Publication unknown]: Eating Disorder Hope, Treatment Resources & Information on Eating Disorders; [updated 2021 Sept 17; cited 2023 Feb 25]. Available from:
https://www.eatingdisorderhope.com/information/eating-disorder/bmi
Is body mass index (BMI) still the best measure of body fat? [Internet]. 2016. Boston (MA): Harvard Women’s Health Watch; [date updated unknown; cited 2023 Feb 10]. Available from: https://www.health.harvard.edu/womens-health/is-body-mass-index-bmi-still-the-best-measure-o f-body-fat
The Problem with BMI [Internet]. 2020. [Place of Publication unknown]: EndocrineWeb; [updated 2021 May 7; cited 2023 Feb 10]. Available from: https://www.endocrineweb.com/news/problems-with-BMI
The Problem with BMI in Healthcare [Internet]. 2022. San Luis Obispo (CA): Central Coast Treatment Center; [date updated unknown; cited 2023 Feb 19]. Available from: https://www.centralcoasttreatmentcenter.com/blog-1/the-problem-with-bmi
Top 10 Reasons Why the BMI is Bogus [Internet]. 2009. [Place of Publication unknown]: npr; [date updated unknown; cited 2023 Feb 12]. Available from: https://www.npr.org/templates/story/story.php?storyId=106268439
Race, ethnicity, and gender are three factors that are not considered by the BMI, and thus result in an incomplete analysis of a person’s health. When the BMI was created, it was done so with white men in mind, specifically those from the 1800s. However, there are several differences, such as genetic, lifestyle, and body type, between white men and the several other races, ethnicities, and genders that the BMI is being applied to. In the words of Sabrina Strings, an assistant professor at the University of California, Irvine (UCI), “‘It is racist, and also sexist, to use mostly white men within your study population and then try to extrapolate that and create norms and expectations for women and people of color’” (Basile 2020). In addition, during the time that the BMI was created, the “normal” body weight for women, who were much shorter and had less muscle than women today, was considered. Thus, the BMI scale and what is considered overweight and underweight cannot be accurately applied to women who are more athletic, taller, and have more muscle than women from the 1800s. This inherently makes the BMI scale inapplicable for a large portion of women today. For instance, for athletes with higher muscle mass, the BMI scale may label them as overweight, when in fact, they are not. This lack of comprehensive consideration makes the BMI unreliable and problematic.
One of the most commonly believed notions of the BMI is that it measures fat. It, however, does not. For instance, the body has muscles, bones, and different types of fat, and the muscle and bone are both more dense than fat. So, in an athlete with a high density of muscle mass and bones, the BMI will assess that they have a high amount of body fat, and thus a high BMI, when in actuality they do not (Ricciotti and Hur 2016). Thus, the BMI is not accurate for those who are “lean, fit, and healthy” (Devlin 2009), because it was created around those who lead a mainly inactive lifestyle, not athletes and health-conscious people. Age is also a factor in the inaccuracy of the BMI because elderly people typically have lower bone density and muscle mass, so the BMI would assume a low body fat amount, and thereby give them a low BMI (Ricciotti and Hur 2016). Therefore, both the athlete and elderly person would be given a BMI that labels them as unhealthy, even if they are not. This is why age, lifestyle, muscle mass, and bone density are factors that cause the BMI to not be the most efficient or accurate tool to assess health in an individual.
When the BMI is used as a point of disregard for others’ health, it becomes an even more dangerous system. Weight bias is what results when healthcare professionals do not provide quality care to their patients because of their weight. For instance, if a person whose BMI labels them as overweight or obese seeks medical guidance, their weight may be cited as the cause for all of the symptoms or problems they are facing, even if it is a simple cold (CCTC Staff Writer 2022). Instead of their health being assessed and proper care and treatment being provided, they are told to lose weight. This causes a lot of issues for the patients, because their health is not being taken care of and they are simply being deterred from seeking healthcare, even if their condition worsens.
Disordered eating can be linked to BMI in certain cases. For instance, if someone’s BMI indicates that they are overweight, that could lead to restrictive dieting in that person. In another case, if someone loses a lot of weight in an unhealthy manner, they may be praised for losing that weight. Thus, rather than getting the help they need to treat their eating habits, this individual may continue that destructive pattern of eating (CCTC Staff Writer 2022). In addition, a person may have a BMI that puts them in the “healthy” category, even if they are suffering from eating disorders (Bothwell 2021). Therefore, using the BMI to diagnose a person with disordered eating or putting a number value before a person is one of the many negative aspects of the BMI.
There are a few better ways to assess health in a numerical manner other than the BMI, and these include waist circumference measurements and body composition scales. A BMC Sports Science, Medication and Rehabilitation report stated that “fat stored in the belly is thought to be unhealthier than fat stored on other parts of the body” (Basile 2020), so measuring the waist can help medical professionals get an understanding of a person’s health in that way. The body composition scale takes into account muscle, fat, bone, and water in the body and how they each contribute to weight (Basile 2020). Despite having these other numerical scales, though, the most comprehensive health analysis comes from a combination of lab tests and health screenings that work together to show a physician where a person’s health stands.
Overall, the Body Mass Index (BMI) is not an accurate or holistic way of assessing an individual’s health, nor was it meant to be used in such a way. Although extreme BMI values should be cause for concern, the general scale does not take into consideration the several ways in which every person is different from another, including genetics, age, lifestyle, gender, muscle mass, and much more. This is why it is critical for healthcare professionals to treat a person’s health in order to improve well-being, rather than analyze numbers. It is also vital that we advocate for ourselves, especially when it comes to focusing on our health and comfort.
References
About BMI and Eating Disorders [Internet]. [Date of Publication unknown]. [Place of Publication unknown]: Eating Disorder Hope, Treatment Resources & Information on Eating Disorders; [updated 2021 Sept 17; cited 2023 Feb 25]. Available from:
https://www.eatingdisorderhope.com/information/eating-disorder/bmi
Is body mass index (BMI) still the best measure of body fat? [Internet]. 2016. Boston (MA): Harvard Women’s Health Watch; [date updated unknown; cited 2023 Feb 10]. Available from: https://www.health.harvard.edu/womens-health/is-body-mass-index-bmi-still-the-best-measure-o f-body-fat
The Problem with BMI [Internet]. 2020. [Place of Publication unknown]: EndocrineWeb; [updated 2021 May 7; cited 2023 Feb 10]. Available from: https://www.endocrineweb.com/news/problems-with-BMI
The Problem with BMI in Healthcare [Internet]. 2022. San Luis Obispo (CA): Central Coast Treatment Center; [date updated unknown; cited 2023 Feb 19]. Available from: https://www.centralcoasttreatmentcenter.com/blog-1/the-problem-with-bmi
Top 10 Reasons Why the BMI is Bogus [Internet]. 2009. [Place of Publication unknown]: npr; [date updated unknown; cited 2023 Feb 12]. Available from: https://www.npr.org/templates/story/story.php?storyId=106268439
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