Is BMI Flawed as a Measure of Overall Health?

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Is BMI Flawed as a Measure of Overall Health?

Body mass index has been around since the early 19th century, but it was the mid-1980s when doctors began using it to define obesity in the United States. It has stuck around for decades, even though many members of the medical community consider it flawed — a patient like Collard demonstrates why.

A new study from Rutgers University is shedding some light on the accuracy of BMI as a sign of increased mortality risk. The results? When classified as obese by BMI alone, the measurement largely gets it wrong.

“The literature on BMI has been inconsistent, and so we wanted to address the limitations of prior studies,” said study co-author Aayush Visaria, MD, an internal medicine resident doctor at Rutgers New Jersey Medical School. “The population makeup in the United States has shifted, so it was also time to redo the research on today’s population.”

To conduct the research, Visaria and his team analyzed data from more than 500,000 U.S. adults from the 1999-2018 National Health Interview Survey and the 2019 U.S. National Death Index. BMI in these cases was calculated from self-reported height and weight. They included data on demographics, socio-behavioral factors, comorbidities, and health care access. They divided the group into nine BMI categories.

The makeup was on average 46 years old, 50% female, and 69% non-Hispanic white. Of those people, 35% had a BMI between 25 and 30, which is defined as overweight, and 27.2% had a BMI above or equal to 30, which classifies them as obese. Visaria and his team then followed up at a median of 9 years, with a maximum of 20 years, which showed 75,807 participants had died. When breaking the data down into racial categories, the team did find increased risk of mortality among Hispanic participants who were overweight, but not among Black or White participants. In general, once a BMI hit 30 and above, however, mortality did go up.

The Rutgers group concluded that additional studies are needed to better incorporate weight history, body composition, and causes of death. They also determined that BMI alone should not drive clinical decisions.

In a press release, the association had this to say: “The AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations.”

Because of those limitations, the association said, it “suggests that it be used along with other “valid measures” of risk, including what’s known as visceral fat, which is fat hidden deep in the body, estimated body fat, waist circumference and genetic/metabolic factors,” among other things.

Sources:

Eric Collard, Ottawa, Canada.

PLOS ONE: “Body mass index and all-cause mortality in a 21st century U.S. population: A National Health Interview Survey analysis.”

Aayush Visaria, MD, internal medicine resident, Rutgers New Jersey Medical School, New Brunswick, NJ.

Matthew Davis, MD, bariatric surgeon, Methodist Medical Group, Memphis.

American Medical Association: “AMA adopts new policy clarifying role of BMI as a measure in medicine.”

Wendy Schofer, MD, founder, Family in Focus.

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Is BMI Flawed as a Measure of Overall Health?

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