Beyond Body Mass Index (BMI)

Posted: Jun 17 in Health And Wellness by Dr. Lazarus

I had the pleasure of serving as a delegate at the American Medical Association’s (AMA) 2023 Annual Meeting in June. It was exactly 10 years ago that obesity was recognized by the AMA as a disease, at my first meeting serving as a delegate.

I wrote policy which passed at the interim meeting calling on the AMA to elevate its work on obesity, and hosted a caucus at this meeting which was attended by over 50 people including 2 AMA Board Members, 5 AMA Staff, and delegates from many states and specialties. We met to discuss strategies to curb the obesity epidemic which is expected to affect more than ½ of American adults by 2030.

One interesting report which was filed at this meeting had to do with Body Mass Index (BMI). BMI was invented by a Belgian astrologer, Adolpho Quetelet in the 1830s. It was popularized by Ancel Keys in the United States in the 1970s (who also popularized the low-fat diet trend), and began to be used by health and life insurance companies (often as a tool to raise rates!) Unfortunately, the current cut-points that have been used to define overweight (BMI ≥ 25) and obesity (BMI ≥ 30), while helpful to look at population-level trends, are crude, and not very applicable on an individualized basis. We use the same definitions for all races, genders, and ages.

We know for example, that men will have a higher BMI than women. Black and Latino populations have different BMI than Caucasian populations. And a BMI of 30 in a 20 year-old male weight lifter may be healthy, but that same BMI in a 60 year-old menopausal female may have a high health risk for diabetes, cancer and heart disease. Further, in some Asian ethnicities, BMI above 25 is already considered high-risk.

The AMA therefore has adopted policy calling on expanding the use of other assessment tools in addition to BMI. This includes health risk from body fat (metabolic syndrome, insulin resistance), and other more individualized measures including medical body composition analysis.

At CNC we have long been advocates of utilizing tools beyond BMI in our assessment. In the old days, we used to estimate body composition with calipers. These days, we measure neck circumference, abdominal  circumference, comprehensive lab, and medical body composition using what many consider to be the best device on the market, a SECA mBCA. This has been invaluable in helping us understand a person’s visceral (organ) fat, lean, and muscle distribution. It helps us make sure that when weight is lost, it is mostly fat weight. And, it helps us make individualized physical activity recommendations when we know how much muscle a person has and where it is distributed.

We applaud the AMA for taking this important step which will allow a more individualized assessment of a person’s health risk. If you haven’t had a body composition analysis in a while, feel free to request one next time you are in the office. We look forward to seeing you soon!