A prominent medical organization in the United States is calling for a reevaluation of the use of body mass index (BMI) as the primary measurement for determining a healthy body weight due to its problematic origins. The American Medical Association (AMA), the largest organization of doctors in the US, argues that the use of BMI has perpetuated racist exclusion and fails to account for the variations in body composition among different races and sexes.
BMI, originally developed by a white man for white bodies, calculates an individual’s weight in relation to their height. While it has been widely adopted in the medical field as a measure of population health, it overlooks important factors such as body shape and fat distribution. For example, Asians within the “healthy” BMI range are still at a higher risk of diabetes. Similarly, black women tend to store fat around their hips and legs, which poses different health risks compared to white women who store fat around their midsection.
The AMA recently voted to recommend that doctors consider multiple factors beyond BMI when assessing an individual’s health. These factors include measuring visceral fat (fat around the organs, considered the riskiest type), assessing the percentage of fat, bone, and muscle in the body, and taking into account genetic and metabolic factors like abnormal blood sugar levels.
The AMA acknowledges the problematic history of BMI, which was devised by a Belgian mathematician and based on a sample of white, European men, not by a healthcare professional. While BMI can provide a macro-level view of population health, it cannot accurately predict disease risk on an individual level, especially across different racial and ethnic groups.
For instance, it has been recommended to screen individuals with a BMI of 25 or higher for type 2 diabetes. However, recent evidence shows that people of Asian descent are equally susceptible to the condition at a lower BMI of around 20, which is considered “normal.” Moreover, diabetes disproportionately affects black, Hispanic, and Asian Americans, resulting in under-diagnosis when using BMI cutoffs based on non-Hispanic white bodies.
The AMA suggests that medical professionals consider additional measurements such as waist circumference and waist-to-hip ratio alongside weight and height. These measurements help identify the presence of visceral fat, which poses significant health risks. A waist-to-hip ratio of 0.85 or higher in women and 0.9 or greater in men indicates a high risk of visceral fat accumulation.
The use of BMI and obesity discussions have evolved in recent years. In 2013, the AMA officially recognized obesity as a disease, leading to the development of medications such as fat-loss injections. The organization’s examination of BMI’s biases is part of a larger shift within the medical field towards more inclusive and comprehensive healthcare practices.
The AMA’s recommendations align with broader changes in the medical community, including the call for expanded access to transition-related healthcare services for transgender minors. Organizations like the American Academy of Pediatrics advocate for gender-affirming care, highlighting the importance of addressing different healthcare needs across diverse populations.
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