American Medical Association says BMI is ‘racist’

A leading US medical organization is urging doctors to scrap body mass index (BMI) as the primary measure of healthy body weight, citing its “racist” roots.

The American Medical Association, the largest body of physicians in the US, said the measure was used for “racist exclusion” and did not account for differences in body composition that vary based on race and gender.

Body mass index (BMI), coined by a white man who takes into account white bodies, is measured by dividing a person’s weight in kilograms or pounds by the square of height in meters or feet, and it is deeply rooted in the medical system as a way to measure the health of the population more broadly.

But on an individual level, BMI doesn’t take into account relative body shape and how fat is stored. For example, Asian people who fall within a “healthy” BMI range are still at high risk for diabetes.

Meanwhile, black women tend to store fat around their hips and legs, while white women tend to store it around their midriff, which is more dangerous to their health – even though they both have similar BMIs.

The medical body voted last week to recommend that doctors consider more than the ratio of a person’s height to their weight, instead measuring a person’s visceral fat (considered the riskiest type that accumulates around the organs). ), the percentage of fat, bone, and muscle in a person’s body, and genetic and metabolic factors such as abnormal blood sugar levels.

The AMA Council on Science and Public Health saidOur AMA acknowledges: The problems with using body mass index (BMI) as a measurement because: (a) the eugenics behind the history of BMI, (b) the use of BMI for racial exclusion, and (c) BMI cut-offs are based on the imagined ideal white person and do not take into account a person’s gender or ethnicity.’

The BMI was not invented by a doctor or any kind of health professional, but rather by a Belgian mathematician named Lambert Adolphe Jacques Quetelet, who tried to measure the height and weight of the “average” man based on a sample of white, European men.

While BMI can be a useful tool for researchers to gain a macro-level view of a population’s overall health, the AMA argues it cannot predict disease risk on an individual level, particularly across different racial and ethnic groups.

For example, it has long been recommended in the medical world to screen people with a BMI of 25 or higher for type 2 diabetes, the risk of which is greater in overweight and obese people.

But recent evidence suggests that people of Asian descent are just as susceptible to the condition with a lower BMI of around 20, which is considered ‘normal’. Similarly, diabetes is two to four times more common and deadly in black, Hispanic, and Asian Americans, and one-size-fits-all screening based on non-Hispanic white bodies will most likely result in an underdiagnosis of the disease.

The AMA committee said: ‘Numerous comorbidities, lifestyle issues, gender, ethnicities, medically significant familially determined mortality effectors, the length of time a person spends in certain BMI categories and the expected accumulation of fat with aging are likely to influence the interpretation of BMI data. significantly affect. , particularly with regard to morbidity and mortality rates.

“In addition, the use of BMI is problematic when used to diagnose and treat individuals with eating disorders because it does not encompass the full range of abnormal eating disorders.”

The AMA recommends that medical professionals consider a person’s weight and height, as well as waist circumference and waist-to-hip ratio.

This is because studies have shown that fat that accumulates in the abdomen and coats the heart, liver, kidneys and pancreas, also known as “visceral fat,” is more dangerous to a person’s health.

The waist-to-hip ratio is calculated by dividing the circumference of your waist by that of your hips. Women with a ratio of 0.85 or greater and men with a score of 0.9 or greater are considered to be at high risk for visceral fat

Rates of obesity have risen sharply in the US since the turn of the century. Two in five Americans are now obese (blue), up from just under 30 percent in 1999. However, the number of people considered healthy obese (gray) has doubled in that time

Visceral fat is believed to release harmful chemicals that increase inflammation in surrounding tissues and narrowing of blood vessels, increasing the risk of heart disease, type 2 diabetes, stroke and high blood pressure.

Typically in women, 35 inches or more is a sign of visceral fat, while in men it is 40 inches. But if you’re of Asian descent, the measure of visceral fat drops to 31.5 inches for women and 35.5 inches for men.

The ways doctors discuss BMI and obesity have changed dramatically in the past decade alone. It wasn’t until 2013 that the AMA officially recognized obesity as a disease, a move that heralded the advent of drugs to treat it, including the “miraculous” fat loss injections, including Mounjaro and Wegovy.

The AMA is the largest association of physicians in the country and its guidelines greatly influence the way medicine is practiced in the US.

The organization’s reckoning with BMI’s implicit biases comes amid a wave of policy and perspective changes in the mainstream medical field.

This is most notable in the battle for transition-related healthcare services, including hormone therapies and minor relocation surgeries.

The American Academy of Pediatrics is one of the most vocal professional organizations advocating for expanding access to this form of care for trans minors, also known as “gender-affirming care.”