BMI standards are ‘racist’: American Medical Association

Weight, what? 

The American Medical Association, the largest council of doctors in the US, is ready to say goodbye to determining if someone is a healthy weight solely by the body mass index, owing to the measurement’s “racist” roots. 

BMI — which physicians have used to measure body fatness and predict obesity-related health risks for 200 years — is “indirect and imperfect” due to its historically harmful use for “racist exclusion,” per a newly issued policy from the AMA’s Council on Science & Public Health. 

The report found that “BMI does not appropriately represent racial and ethnic minorities” because it’s based on “the imagined ideal Caucasian” of the 19th century, without considering a person’s gender or ethnicity. 

In the late 1800s, the metric’s originator, Belgian mathematician Lambert Adolphe Jacques Quetelet, determined that the body weight of a “normal man” was proportional to his height. Quetelet’s study sample was composed of only white European men. 

Then in 1972, American physiologist Ancel Keys used Quetelet’s findings as the basis for a calculation to estimate body fat.

He proposed looking at the ratio between a person’s weight (in pounds) and their height (in inches). The higher the ratio, the more the person is considered unhealthy.

In the US, BMI is determined by dividing a person’s weight in pounds by the person’s height in inches, then multiplying that number by 703.

Adults with a BMI of less than 18.5 are regarded as “underweight,” per the CDC. Those with totals between 18.5 to 24.9 are categorized as “healthy weight.” Folks boasting a BMI from 25.0 to 29.9 are labeled “overweight,” and anyone with a 30 or more is marked “obese.” 

For children between ages 2 and 19, the average BMI “doubled” during the pandemic.

Men and women with high BMIs have long been considered at grave risk for disorders such as heart disease, high blood pressure, Type 2 diabetes and certain cancers, according to the National Heart, Lung, and Blood Institute.

However, the AMA found that BMI, while useful in forecasting the well-being of a general population, is mostly inaccurate in predicting an individual’s long-term wellness. 

In fact, the researchers found that BMI sorely falls short as a health indicator due to the scale’s disregard for how fat is stored in different body types across racial and ethnic groups, sexes, genders and ages. 

The report noted that “healthy” Asian women are at double the risk of developing Type 2 diabetes than white women with the same BMI. Hispanic and black women are also at higher risk of developing diabetes than whites with the same BMI, but to a lesser degree than Asian women, per the study. 

“South Asians, in particular, have especially high levels of body fat and are more prone to developing abdominal obesity [than whites], which may account for their very high risk of Type 2 diabetes and cardiovascular disease,” wrote the AMA. 

“In contrast,” the policy write-up continued, “some studies have found that blacks have lower body fat and higher lean muscle mass than whites at the same BMI, and therefore, may be at lower risk of obesity-related diseases.” 

The AMA went on to emphasize the severe impact of visceral fat — excess weight that develops over time around the center of the body — on one’s health. 

Clinicians determined that people with “apple-shaped” bodies — typically white women, who carry more weight around the waist — are in more danger of being diagnosed with chronic disease than those with “pear-shaped” bodies — commonly black women, who carry more weight around the hips. 

“Visceral fat accumulation and an expanded girth have been associated with development of insulin resistance, diabetes, and risk for coronary heart disease and hypertension,” reads the analysis. 

It then highlighted a study that concluded that using measuring tape to determine one’s visceral fat accumulation via waist-to-hip ratio — dividing waist circumference at its narrowest point by hip circumference at the widest point — is a better predictor of heart attacks than BMI. 

Per the report, “Abdominal obesity is defined by the World Health Organization as having a waist-to-hip ratio of 0.90 for males and above 0.85 for females.” 

And a recent study from the Uppsala University in Sweden, agreed, saying, “An important aspect of obesity-associated disease risk is the distribution of fat in different compartments of the body,” adding, “Fat stored in the abdomen is considered more pathogenic [disease-causing] compared to subcutaneous [below-the-skin] fat.”

Rather than exclusively revering BMI as the determining factor in a person’s health, the AMA suggests the calculation be in conjunction with other valid measures of risk such as visceral fat, body composition and waist circumference, as well as genetic and metabolic factors.

“Numerous co-morbidities, lifestyle issues, gender, ethnicities, medically significant familial-determined mortality effectors, duration of time one spends in certain BMI categories and the expected accumulation of fat with aging are likely to significantly affect interpretation of BMI data, particularly in regard to morbidity and mortality rates,” said the AMA. 

“Such confounders … need to be considered before [instituting] public health policies that are designed to apply to the general population and are based on BMI data.”