Our culture seems to be obsessed with body weight and outward appearances. Just look at the significant attention into drugs like Ozempic, Wegovy, Tirzepatide and others that are riding the wave of weight loss products which began with movie entertainers, celebrities and media stars. It has now become a household conversation. Whether you like the premise of large body size as a “disease” and a modifiable risk factor or feel that body size is more of a determinant of health inequality and a social problem..its time to find out where this old outdated measurement of body mass index (BMI) came from. It is time to go beyond BMI and towards weight inclusion. Get ready…because this will blow your mind!
…BMI can be traced back to a famous Belgian mathematician, astronomer and socialist by the name of Adolphe Quetelet and his interest in statistics in the mid 1830’s.
The BMI can be traced back to a famous Belgian mathematician, astronomer and socialist by the name of Adolphe Quetelet and his interest in statistics in the mid 1830’s. He decided to develop an equation in defining the “ideal man”. He measured male military recruits whom were young, white and northern European. He searched for an equation that matched body size with normal curve and that was the BMI. This was his definition of the “ideal person” and the wrong people were defined as “deviant”. What’s wrong with this picture…Everything!!
This tool that defines ideal body weight was and still is a mathematical equation that never took into consideration other populations such as women, ethnic groups, race, etc. According to this BMI (did I mention it was founded in the 1800’s) a healthy BMI is between 18-24. If this is true then 2/3 of the population is overweight. This BMI is racist and sexist and even the American Medical Association suggests we move away from it. These numbers were not based on morbidity or mortality or science at all. BMI was also adopted by insurance companies to charge higher rates to overweight people, but the science was never there.
According to research looking at body weight in relationship to death…the lowest risk for death is actually in the overweight category with a BMI of 27-28. Also the lowest mortality occurs for older people, people of color and women when a BMI of 27-28 is used. Interestingly, a BMI of 21-22, considered normal, has a similar risk of death as someone with a BMI of 37, considered class 2 obesity. And a BMI of 18.5 (low normal) has a similar mortality as someone with a BMI of 45!
You can see how inaccurate a measurement of fatness the BMI is. If we use this category as the main indicator of health, then 74,936,678 U.S adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. So lets get away from using this measurement to determine how healthy one is and actually look at individual markers such as HgbA1C, glucose, inflammatory markers, lipid levels and symptoms. We need to update this century old tool and use science as our bases.
Reference: PESI Women’s Health Conference, 2024. “The Case of Weight Inclusion in Women’s Healthcare”. Dr. Lisa Erlanger