Vishal Gentle isn’t the avid gym goer he was before his daughter was born a few months ago.
But the new dad said he does what he can to stay active: carrying baby up and down the stairs to get some exercise, walking a lot and using a standing desk.
Gentle said she feels healthy, but based on her body mass index, or BMI, she’s overweight.
“Honestly, I don’t feel overweight. I mean, except a little bit around my waist. But I’m fully active. I can do anything and everything,” he said during an interview at his Toronto home.
Gentle isn’t alone when it comes to questioning whether your BMI is an accurate measure of health. The BMI is under increasing scrutiny, both for its usefulness as a measure of health and for its problematic origins.
The BMI is calculated by dividing the weight in kilograms by the height in meters squared. The result can be compared with the BMI table, easily found on the Internet, social networks and in doctors’ offices, which instantly informs the user if his result is underweight, normal, overweight or obese.
Last month, the American Medical Association (AMA) formally recognized the shortcomings of BMI and created a new policy that cautions when using it.
In a June news release, the AMA cautioned that BMI is an “imperfect way to measure body fat across multiple groups because it doesn’t account for differences between races/ethnicities, sexes, genders, and ages.”
He also points out that the BMI, which dates back to the 19th century, has a problematic foundation.
“Under the recently adopted policy, the AMA recognizes problems with the use of the BMI as a measure because of its historical harm, its use for racist exclusion, and because the BMI is primarily based on data collected from older generations of non-Hispanic white populations.” the press release states.
The AMA encouraged doctors to use other factors, such as waist circumference, fat distribution, and genetic factors, when evaluating a patient’s health.
The AMA’s position is the latest in growing criticism of BMI.
The inability to distinguish between the mass created by fat, muscle, and bone has been flagged as a deficiency by experts and health authorities, as has the failure to distinguish where fat is distributed in the body.
They note that belly fat may be a risk factor for conditions like diabetes and heart disease, while hip and thigh fat is less associated with health problems.
Dr. Sanjeev Sockalingam, chief scientific officer of Toronto-based Obesity Canada, said he hopes the AMA position will accelerate work to find better ways to assess health, and specifically to assess obesity as a medical condition.
“I hope this also sparks a bit more research in this area, which I think is much needed given all the challenges and issues we’ve identified with BMI,” he said.
Obesity Canada’s most recent practice guidelines leave BMI out of the definition of obesity, instead describing it as a chronic medical condition that results in disability and impairment.
Why has the BMI been maintained?
Health Canada promotes the use of BMI and has the chart on its website, but notes that the measure should not be used by people under the age of 18, or those who are pregnant or breastfeeding.
The agency has recommended using BMI along with measuring waist circumference since 2003, spokesman Nicholas Janveau said in an email.
“While BMI has some limitations, it still tends to be the preferred measure of excess body fat for population-level surveillance and epidemiological studies because of its simplicity and the ease with which it can be estimated,” Janveau said.
Despite all of Sockalingam’s misgivings about BMI, he said it cannot be abandoned yet because it is so deeply embedded in clinical trials and other aspects of health care.
“We don’t want to eliminate it right now with nothing to replace it because it’s been very difficult to get people to recognize obesity as a chronic medical condition and to think about patient-centered approaches and treatments that are now emerging for people living with obesity,” he said.
He advises people to think of BMI as a high-level screening tool, but not to rely on it to diagnose an individual.
What is the alternative?
Dr. Sonia Anand, a specialist in vascular medicine at McMaster University in Hamilton, Ontario, said she agrees that disentangling BMI from its place in clinical settings, research, and the weight-loss industry would be difficult.
He knows it won’t be going away anytime soon, but he said he’d like to see it replaced with waist circumference as the free, simple measurement.
“It’s ingrained in our thinking. But now is a reasonable, good time for different health professionals, agencies, researchers and individuals to start measuring waist circumference and using it in conjunction with body weight,” Anand said. .
Anand has investigated how South Asians experience metabolic changes, such as increases in blood sugar, blood pressure, and cholesterol at a lower cutoff than white Europeans.
He said continuing to rely on BMI for people with different backgrounds and lifestyles risks missing cues to assess metabolic changes, or could lead to someone with a lot of muscle mass and a high BMI being wrongly discouraged from losing weight. .
By itself, waist circumference is also not the gold standard for assessing health, Anand said, but added that it does a better job of assessing whether someone has excess body fat in a specific area that may increase the risk of health problems.
A holistic approach
When it comes to diagnosing and treating obesity, Sockalingam said he’d like to see a more holistic assessment.
“Ultimately, we want to see how obesity is affecting an individual in terms of their daily life, their functioning and their co-occurring conditions, whether it’s physical or mental health,” he said.
Anand and Sockalingam agree that even if discontent with BMI as a measure of health grows, it will take a long time for widespread change to occur. Sockalingam said she hopes that people who learn of BMI issues are empowered to ask their healthcare professionals for different types of assessments.
Vishal Gentle said he has had those discussions with his GP in Toronto, who told him he is not overweight.
He said it’s important for him to keep a close eye on his health because his father died at the age of 67 during cardiac arrest.
Gentle said his father carried weight on his belly, so his doctor’s advice to focus on eating right, exercising and watching his waist circumference makes sense to him.
“As long as I can feel good and go about my day, I have no problems,” he said.