Doctors are being advised to look beyond BMI alone as a health indicator.

Criticism mounts against the Body Mass Index (BMI) due to its limitations and potential bias when assessing individual health. Roughly two centuries ago, a Belgian mathematician named Adolphe Quetelet observed the relationship between adult body weight and height, leading to the development of the Quetelet index, later known as BMI.

However, it wasn’t until 1972 that it gained recognition as a measure of body fat proposed by Dr. Ancel Keys. Today, BMI is widely used as a screening tool for obesity, but it has gained outsized significance and sometimes even labeled as a “scarlet letter.” BMI influences various aspects of individuals’ lives, including medical records, life insurance eligibility, access to treatments, and employment wellness programs. However, a movement to move away from relying solely on BMI for individual health risk assessment is gaining momentum.

The American Medical Association (AMA) recently adopted a new policy acknowledging the limitations associated with widespread BMI use in clinical settings, highlighting its historical harm and potential for racist exclusion. The AMA states that BMI is primarily based on data from non-Hispanic white populations and loses predictability when applied at the individual level. Clinicians recognize the need to consider more than BMI alone when assessing individual health, emphasizing the complexity of obesity and the importance of personalized approaches

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. The limitations of BMI include its inability to differentiate between lean and fat body mass, failure to account for racial and ethnic differences, and its disregard for fat distribution patterns, which can impact health risks. Different racial and ethnic groups tend to carry fat differently, and relying on BMI alone can disadvantage certain groups by inaccurately assessing their health risks.

The AMA suggests incorporating other measurements such as waist circumference, visceral fat measurements, body composition analysis, and genetic and metabolic factors to complement BMI in assessing health risks. While the limitations of BMI are well-understood, completely replacing it remains challenging due to the ease and cost-effectiveness of its calculation. However, healthcare professionals acknowledge the need to move away from BMI as the sole determinant for weight-loss treatment eligibility and emphasize the importance of considering additional risk factors such as waist circumference and metabolic markers.

Individuals are cautioned against disregarding BMI entirely, especially individuals of color, as the goal is to personalize its usage and move away from blanket generalizations that may lead to stigma and bias.