BM(L)I(ES)
Let’s talk BMI. To get started, a brief history lesson ☝
In the 1930s, Belgian mathematician, statistician, and sociologist, Adolphe Quetelet, created an equation to look at trends in body size across large populations. He named this tool the Quetelet index. In1972, Ancel Keys renamed this index the BMI (Body Mass Index). This index was never intended to be used to measure an individual, and it most certainly was NEVER INTENDED TO BE A MEASURE OF HEALTH. But here we are.
The BMI entered the medical community in the 1980s. In the 1990s, the government incorporated the BMI into health initiatives. It appears the medical community started utilizing the BMI in response to insurance companies demands. Insurance companies sought a simplistic way to determine life expectancy and equated life expectancy with…you guessed it…weight. Medical researchers at the time sought to identify a connection between fatness, disease, and life expectancy. Apparently, due to other measures being more costly and time intensive, medical doctors adopted the BMI as a means of “quickly” measuring patients “body fat”. OF NOTE, BMI DOES NOT MEASURE BODY FAT. Quetelet emphasized this point. It was Keys who associated this measure with “fatness.” I did a little dive into Ancel Keys’ research and soon learned that he studied MEN. He did not study children, women, or the elderly, yet the BMI is applied to these populations (Blackburn et al, 2014). Also, blaringly evident upon reading his work is his FAT PHOBIA. He described fat as “ugly” while noting fat NOT being the cause of chronic health conditions. In his defense, he DID CLARIFY that BMI was not intended to be used for “individual diagnoses” and he knew that the measure did not accurately account for gender and age. Furthermore, nothing about the BMI distinguishes between muscle, bone, and fat. Physiologically, this equation is nonsensical.
In 2016 it was as though the clouds parted and the sun emerged upon the publication of this research: https://www.ncbi.nlm.nih.gov/pubmed/26841729. Per this study, 54 MILLION PEOPLE WERE MISDIAGNOSED AS BEING UNHEALTHY OR OBESE when their cardiometabolic measurements indicated that they were healthy (Side note: cardiometabolic measurements include blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data) (Side side note: C-reactive protein data shows amounts of inflammation in the body). Another 21 MILLION individuals deemed at “normal BMIs” were NOT HEALTHY. REPEAT AFTER ME: WEIGHT AND SIZE ARE NOT INDICATORS OF HEALTH. Upon release of this study, Janet Tomiyama, the study’s lead author, stated in a press release, “Many people see obesity as a death sentence. But the data show there are tens of millions of people who are overweight and obese and are perfectly healthy." Mic drop.
SO WHY ON EARTH DO WE USE THIS CALCULATION?? I’m sorry to yell, but we know that HEALTHY BODIES COME IN ALL SHAPES AND SIZES and HEALTH CANNOT BE DETERMINED BY BODY SIZE OR SHAPE. It concerns me that this index continues to be utilized in the medical community whether that be due to implying someone who is “healthy” is NOT or due to telling someone they are healthy when they are NOT. It further perpetuates the misguided belief that weight/body size is a determinant of health. While its clear the measurement is severely flawed in and of itself, continuing to focus on a MEASUREMENT is my highest point of contention. I’ve gotten to the point professionally that when individual clients or colleagues inform me “My BMI is…” or “His/her BMI is…”, my response has become, “That tells me nothing” or “That means nothing to me.” So, while I apologize for being sassy, I do not apologize for discrediting this inaccurate, meaningless measurement.
DO NOT LET YOUR BMI INFLUENCE YOUR SELF PERCEPTION. It is a BM(L)I(E).
Additional resources:
https://www.thereallife-rd.com/2016/01/bmi-means-nothing/
https://tabithafarrar.com/2017/12/why-bmi-is-bullshit/
https://www.sizediversityandhealth.org/content.asp?id=161
Henry Blackburn, David Jacobs; Commentary: Origins and evolution of body mass index (BMI): continuing saga, International Journal of Epidemiology, Volume 43, Issue 3, 1 June 2014, Pages 665–669, https://doi.org/10.1093/ije/dyu061