Eric Collard has all the time been an athlete; he performed school soccer, obtained into triathlons in maturity, and now at age 44, frequently rides his bike, runs, lifts weights, performs golf, and extra. The Ottawa-based director of a nonprofit, Collard additionally takes his vitamin significantly. By virtually all measures — blood strain, ldl cholesterol, blood sugar — Collard is match and wholesome.
The one outlier amongst Collard’s well being markers is his physique mass index (BMI), which places him within the overweight class. “I’m an enormous man,” he says of his 6’4’’ peak and his 258-pound weight. “However I’m additionally wholesome, and BMI shouldn’t be the tip measurement of well being.”
Physique mass index has been round because the early nineteenth century, however it was the mid-Eighties when medical doctors started utilizing it to outline weight problems in america. It has caught round for many years, though many members of the medical group think about it flawed — a affected person like Collard demonstrates why.
Transferring Away From BMI
Visaria says that whereas BMI alone is a flawed measure of well being, he understands why it has been a well-liked methodology within the medical group. “It’s a easy calculation,” he stated, “and it’s trackable and scalable. Public well being nonetheless makes use of it for these causes.”
Matthew Davis, MD, a bariatric surgeon at Methodist Medical Group in Memphis, agreed with this evaluation. “Sadly, the identical elements that make it straightforward to make use of — it merely seems at an individual’s peak and weight, that are simply measurable, additionally make it topic to criticism,” he stated. “Its simplicity means it doesn’t keep in mind the myriad different elements that may contribute to elevated weight or poor well being, particularly social, environmental or genetic elements.”
These days, there’s been a shift away from the long-standing well being metric. In June on the annual assembly of the American Medical Affiliation, delegates adopted a brand new coverage aimed toward clarifying how BMI ought to be utilized in drugs.
In a press launch, the affiliation had this to say: “The AMA acknowledges points with utilizing BMI as a measurement attributable to its historic hurt, its use for racist exclusion, and since BMI is predicated totally on knowledge collected from earlier generations of non-Hispanic white populations.”
We make a ton of assumptions primarily based on these numbers.
Due to these limitations, the affiliation stated, it “means that it’s used together with different “legitimate measures” of danger, together with what’s often known as visceral fats, which is fats hidden deep within the physique, estimated physique fats, waist circumference and genetic/metabolic elements,” amongst different issues.
Wendy Schofer, MD, founding father of Household in Focus, is among the many medical doctors who’ve lengthy believed BMI is flawed. “Weight problems as outlined by BMI doesn’t say something in regards to the well being of a person at a sure BMI,” she stated. “We make a ton of assumptions primarily based on these numbers.”
As a substitute, Schofer urged, medical doctors want to higher perceive their sufferers and their life. “We have to perceive what’s vital to the person, what well being means to them, and find out how to develop and attain objectives which might be vital to them,” she stated. “I take away weight and BMI from the dialog. As a substitute, we discuss how we need to really feel, what we need to do, and the way we need to be.”
Collard stated his physician takes a extra holistic method to his visits, as nicely, one thing he appreciates. “My physician acknowledges that my BMI is irrelevant to my total well being,” he stated.
Visaria stated his newest examine is the first step in a crucial, ongoing collection on BMI. He just lately shared outcomes from a examine on bone density scans and BMI, which confirmed the constraints of each in visualizing the connection between lean mass and bone density. Future research will incorporate measurements of fatty tissue, heart problems, hypertension, and different metrics. “We need to look into the long-term implications on morbidity,” he stated. “Suppliers have to keep in mind all kinds of different measures past BMI.”
Eric Collard, Ottawa, Canada.
PLOS ONE: “Physique mass index and all-cause mortality in a twenty first century U.S. inhabitants: A Nationwide Well being Interview Survey evaluation.”
Aayush Visaria, MD, inner drugs resident, Rutgers New Jersey Medical College, New Brunswick, NJ.
Matthew Davis, MD, bariatric surgeon, Methodist Medical Group, Memphis.
American Medical Affiliation: “AMA adopts new coverage clarifying function of BMI as a measure in drugs.”
Wendy Schofer, MD, founder, Household in Focus.