There’s a big problem in our culture’s research on weight and health. This problem stems from a view that a “one size fits all” approach to weight and health will work for all, which is simply not true. In order to understand the perplexity of this problem we first need to focus on BMI.

BMI is used as a marker to measure someone’s risk for disease and overall weight status. However, muscle mass, bone density, overall body composition as well as race and gender all can dramatically change someone’s weight status and overall BMI.

How can a tool so regularly used to assess health neglect to consider the multiple and more complex factors that actually play into someone’s overall health?

Lets break down why this is truly a problem…
BMI allows eating disorders to fall through the cracks —
Many medical professionals use BMI as a tool to assess wellness, which leads to recommendations made for diet and exercise, insurance coverage and overall health assessments. More specifically, someone presenting with multiple factors of an eating disorder may be told they are not sick enough to have an eating disorder based off of weight and BMI. I first hand have witnessed this sad and true reality after working with many of my clients who’s eating disorders have gone untreated and behaviors have been exacerbated after visiting their primary care doctor and hearing they were not sick enough due to having a normal range BMI to qualify for an eating disorder. With more than 20 million females and 10 million males in America researched to have an eating disorder at some point in their lives it is clear that weight alone is not a sole factor for the development and existence of this illness. Further, it’s imperative for medical professionals to know that weight and health are not mutually exclusive, which is often confused due to the emphasis put on BMI and health status.

BMI ignores the obesity-mortality paradox —
There is a strong need for affordable and practical tools that can predict the risks of diseases and mortality for individuals and BMI is not that tool. Although obesity can increase the risk for heart diseases, diabetes, sleep apnea and other diseases and medical conditions obesity alone is not always an accurate predictor for risk. Obesity is measured and categorized from BMI (a BMI of 30 or more identifies an individual as “obese”). Although there has been much research supporting obesity and health risk there is a controversial paradox that has been researched as well and, unfortunately, is not as well known. A number of studies have shown that some obese individuals have lower risk for heart diseases and an improved metabolic profile compared to normal BMI individuals. Research from University of Virginia, Charlottesville has noted that individuals with lower BMIs (BMI of 23.1 or less) were twice as likely to die than those with higher BMIs (BMI of 35.3 or more). This paradox suggests that research based off of BMI and health does not account for why someone has gained or lost weight and more accurate research would focus more directly on the intentionality of weight gains or losses for individuals (which BMI cannot report on). This is another good example that weight and health cannot be determined by size alone but more by the individual and behaviors that shape someone’s overall size!

BMI is not a superior predictor for diabetes and other co-morbidities —
Not only does BMI exaggerate thinness in shorter people and fatness in taller people it also does not measure body shape. Waist to hip ratio has been shown by researchers from the Medical Research Council Epidemiology Unit in the UK to be strongly and independently associated with the risk for development of type two diabetes. This suggests that regardless of weight and BMI there can be an increased risk for type two diabetes. Not only is there information that can better assess and hopefully move into preventative medicine - it is also information that is often times looked over based off of BMI, which means many individuals at risk for type two diabetes are not aware of possible risk if the BMI falls within normal ranges. With so much focus on BMI and weight our standards for medicine and research have been skewed. Misinformation is thus provided and serious and life threatening conditions, like eating disorders and type two diabetes, can go overlooked when someone presents with a normal BMI. This restricts healing and help provided and perpetuates our culture’s tendency to weight shame. As individuals we can think about health more based off of action and mindset and not weight. How we take care of our bodies matters, but this does not have to be driven by weight. Often times a weight focus can lead to crash or yo-yo dieting and unhealthy mindsets about food and our bodies. Instead, focusing on health by moving away from body neglecting diets that restrict and starve to get weight down allows an individual to practice more loving approach to food and movement to reduce the risk of disease as well as allow for greater body acceptance. This can allow for true health, which encompasses the bigger picture of wellness that includes mental and emotional health paired with physical health.