Why You Should Forget About Your BMI

Tom Brady can be considered one of the American icons of perfect health.  He is at the top of his game, and he is married to a super model, Gisele Bundchen.  Something that many meat-eating, beer-drinking football fans do not realize is that he and his wife maintain their highly-sought-after physiques by following a plant-based diet.  That’s right, he does not need to consume protein in the form of gigantic steaks to be able to perform at his athletic best!  What you also may not realize is that his Body Mass Index, the same number that your doctor uses to determine if you are healthy, is in the obese range.  Obviously, you would not think of him as an unhealthy individual, but our medical system would.  

 In fact, several studies have been done on many female athletes to determine the ideal BMI for them to maintain their power and athleticism.  It has been determined that the ideal BMI for a female athlete is …. 27.7.  This is considered overweight, and would certainly prompt a lecture from a physician.  Why does our medical system insist on using this as a measure of health?  You would be surprised to learn that it actually has nothing to do with measuring your longevity but instead is a construct of insurance companies and a way to dictate reimbursement.  This is why, in my opinion, you should stop putting so much emphasis on what your doctor says about your weight, and more emphasis on what he or she says about other markers such as cholesterol or blood pressure. 

 So where did this measurement come from? The BMI was invented over 200 years ago and for some reason is still being used today.  You will be shocked to find out that it was not a physician that came up with it, or anyone that has studied the human body at all for that matter.  It was a mathematician, that knew very little about human biology.  Alophe Quetelet (1796-1874) was a Belgian astronomer, mathematician, statistician, and sociologist who invented the BMI. He is also associated with developing some predictive models of health that have since been rejected (like determining your diagnosis based upon bumps in your skull).  He certainly did not intend for his model of the “average man” (or BMI) to be a measure of individual health.  He was interested in the then burgeoning field of “social physics”.  He wanted to understand the statical laws underlying variables such as crime rates, marriage rates, and suicide rates and to explain these things by social factors.  He wanted to paint a picture of the the “average man” that would use mean values following a normal distribution.  Given that human beings adapt and evolve to their environment, and our environment in the present day is certainly not what it was in the 1800s, I am sure that he would agree that his statistical calculations do not apply to modern humans.  They certainly do not measure health in an individual.  

 This system of measurement was then capitalized upon by the insurance industry as a way to determine who should be charged more for health insurance.  It has also been used by employers as a way to make certain employees pay more for their benefits.  These applications are based on a statistical measure and do not take into account an individual’s health status.  

 Physicians are also forced to use this system by insurance companies.  With the advent of the electronic medical record, the BMI is automatically calculated and will appear red on the screen of the physician who is seeing you.  The physician is then prompted to address this abnormal value with the patient.  If they inform you that you are fat and need to lose weight, they may be able to code at a higher billing rate to the insurance company.  The physician will never see this money, but the employer or clinic will.  What happens if the physician decides to ignore this number and not address it with the patient?  They will likely be harassed by special “coding specialists”  who insist that they insert documentation in the chart that they had this discussion with you so that the hospital system or clinic will make more money. 

The bottom line is: BMI is about money, reimbursement, and statistics.  It is not about your health.  

 What are better markers of actual health? You can be considered overweight and even obese and be healthy.  You can be thin by the BMI standard yet suffer from diabetes and all of your arteries are clogged with deadly plaque.  You should be more interested in what your physician says about your cholesterol, your blood pressure, your markers of inflammation, and maybe even your vitamin D level than about your BMI.  Also, BMI does not account for muscle mass as in the case of Tom Brady.  It also does not account for water retention, or hormonal fluctuations, or the distribution of fat on your body.  It is well-known that fat around the middle is more dangerous than fat stored on the hips and thighs.  BMI also does not account for the ratio of “sick fat” to normal fat.  This type of fat secretes hormones that makes diabetes and high blood pressure more likely in a person.  Some people are thin but they have copious amounts of this type of fat, resulting in life-shortening and disease-causing alterations in their body.  Many overweight and obese people do not have this type of fat especially if they exercise, as physical activity can alter the ratio of sick fat to regular fat.  Your blood work can tell you more about this than the scale can.  

 BMI may also not be consistent with life-expectancy.  Several studies, including one in Norway that studied 1.7 million people (very large sample size) found that the highest life expectancy is among individuals who are overweight by our current standards.  What was more interesting is that people who were in the ideal weight range had a lower life expectancy than some people who were obese.  I think this can be explained by the ratio of “sick fat” to normal fat.  Even the National Institute of Health Clinical Guidelines on Identification, Evaluation, and Treatment of Overweight and obesity has said that the lowest death rate is above a BMI of 25, the cut-off for “normal.”  

 If you have been following the BMI for a few years now you might remember that the normal range changed at one point.  This means that one night in 1998, 29 million Americans went to bed healthy and woke up overweight, according to Linda Bacon’s book, Health At Every Size.  More interestingly, the task force that came up with this standard was composed of several individuals who had ties and relationships with the pharmaceutical industry.  In other words, we can now market and prescribe weight loss medications to more people.  In my opinion, the risk may outweigh the benefit in this population of people as they are not at higher risk of death or chronic disease, but they are prescribed amphetamines and other medications with a very long list of side-effects.  

As usual, many of the “cut-offs” and “guidelines” used in medicine are influenced by both the pharmaceutical and insurance industries, and not by actual markers of health.  

 This should be a relief to you, because it means that you are not going to die early just because your doctor gave you a lecture about your weight.  It only means that your physician will get a naughty slip and a trip to the clinic managers office if they don’t.  It means that you should ask more questions about the true markers of health, and pay less attention to what the office scale says.  Several recent studies have also shown that exercise is more important to improving your lifespan than weight loss is.  This means that you should strive to do the activity that you enjoy, regardless of your size, and without focusing on the number on the scale.  In reality, you will probably build more muscle, which will artificially increase your BMI, but also will likely increase the number of years in your life.  

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 This information is for educational and informational purposes only and solely as a self-help tool for your own use. I am not providing medical, psychological, or nutrition therapy advice. You should not use this information to diagnose or treat any health problems or illnesses without consulting your own medical practitioner. Always seek the advice of your own medical practitioner and/or mental health provider about your specific health situation. For my full Disclaimer, please go to https://www.gingerlywell.com/disclaimer