We can do better than the BMI

The Body Mass Index (BMI) system is arbitrary and shouldn't assess overall health.

Brenden Rowan, DN Illustration
Brenden Rowan, DN Illustration

Daniel Kehn is a third-year journalism and telecommunications major and writes “A Kehn Perspective” for the Daily News. His views do not necessarily reflect those of the newspaper.

I have been athletic my entire life. First on the swim team, then baseball, then gymnastics and, most notably, almost a decade of soccer. At the present moment, I consider my diet to be healthy and reasonable with a natural amount of splurging.

I run upwards of 21 miles per week, and I recently ran my first half-marathon — I plan to complete a full marathon this fall.

I am 5-foot-8 and weigh 210 pounds. Despite my diet and activity, this margin classifies me as obese, according to the Centers for Disease Control and Prevention’s (CDC) Adult Body Mass Index (BMI) calculator.

For reference, the CDC lists any score over 30 as obese, between 25.0 and 29.9 as overweight, 18.5 and 25.9 as a healthy weight, and anything below 18.5 as underweight.

The organization notes that “BMI screens for weight categories that may lead to health problems, but it does not diagnose the body fatness or health of an individual.”

BMI doesn’t adjust based on gender, race or ethnicity. So why would we use this as a universal standard for weight and health if we aren’t going to adjust it universally as well?

Weight became a conversation in my life when I was in middle school. I wasn’t a thin kid, but I only really took note of that when other people started pointing it out. School uniform shopping quickly became my least favorite time of year because it ended with looking for pants and selecting my size with “Husky” as the classifier. 

As I grew up, I evened out, but there was still a major nag whenever I wanted to check my progress. That nag was an obese BMI score.

Since turning 18, I have yet to have a weight that isn’t considered obese or on the highest end of overweight according to the arbitrary standards of the BMI.

When I did “let myself go,” it was not strictly about weight — it was about a decrease in a health-conscious diet, exercise and mental health, which related to my overall health and wellbeing. When I began to take strides in the right direction and prioritize my physical and mental health, I felt the improvements — I had pride in my health again — but a BMI score on a chart wouldn’t say that.

That score doesn’t just impact how my health is viewed, but it impacts how I view myself. I have lost 50 pounds since June 2023, but every time I look in the mirror, I can only see the stretch marks and the chubby kid from middle school. 

Our viewpoint on physical health is so negative without enough focus on solutions or steps forward, and nowhere is this more prevalent than the Body Mass Index.

BMI only measures body mass without taking into account bone or muscle in overall weight. For example, a well-toned football player with an above-average muscle mass — which is twice as dense as fat — would see themselves in the BMI’s overweight or even obese category. 

The man who invented the original formula for BMI, Adolphe Quetelet — a statistician, mathematician and astronomer  — established the Quetelet Index. It was used to define what the “normal man” was, according to an article from the National Library of Medicine in November 2023 titled “The History and Faulys of the Body Mass Index and Where to Look Next: A Literature Review.”

Louis I. Dublin, a statistician, used Quetlet’s concept in the 1950s while he was vice president of Metropolitan Insurance Company (now MetLife, Inc.) to categorize “normal” weights. By categorizing normal weights, the company could get out of covering as much for obese people. 

Dublin utilized the formula to save money for his company by inflating coverage prices for overweight and obese policyholders. Most insurance companies are still using BMI in their assessments of policyholders and will charge higher premiums for those in the obese category.

The National Library of Medicine gives credit to Ancel Keys, a physiologist, for taking the Quetelet Index and creating the “Body Mass Index.” Keys analyzed 12 samples of 7,426 “healthy” men in 1972 which led to the creation of the BMI. In his study, Keys emphasized “the convenience and ease of using BMI in population studies to analyze data.”

The World Health Organization (WHO) formally recognized obesity as a global epidemic in 1997, according to the National Library of Medicine.

I’m not saying that obesity isn’t an issue. However, I would like to highlight that, of all three individuals who advanced the work of this widely-used medical measurement tool, none were medical professionals and doctors.

So, why are we still using this 200-year-old “hack” created by a mathematician and progressed by non-medical doctors? Convenience. 

It’s easier for us to plug in a formula and get a quick answer, but our health can’t be decided by decimal points at the end of the solution. 

According to the British Heart Foundation, there are several ways to measure body fat without using the BMI method — most notably the waist circumference method. 

Additionally, hydrostatic weighing (underwater weighing), air displacement (underwater weighing but uses air instead of water) and Dual Energy X-ray Absorptiometry (DEXA, measures bone mineral density using spectral imaging) are all effective methods of measuring body fat.

Of these methods, DEXA and hydrostatic weighing are the most accurate. However, they are also the most expensive. The waist circumference method is the most feasible for the average person, but it should be noted that this is not a general measurement of body composition — it’s only an indicator of excess body fat.

We shouldn’t be minimized to measurements — to numbers that don’t really measure individual health.

There is no “one size fits all” option in health, and adding mathematical formulas to the conversation doesn’t help anyone at all.

Contact Daniel Kehn with comments at daniel.kehn@bsu.edu or on X @daniel_kehn.


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