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Doctors urged not to rely on BMI to assess health

The American Medical Association is no longer recommending the use of body mass index as a measure of weight, after years of controversy and criticism around the metric.

The scales are formally shifting on body mass index (BMI), a measurement that’s been the source of much scorn in recent years.

Invented in 1832 by Adolphe Quetelet, a Belgian astronomer and mathematician, it was adopted by governments around the world in the 80s as a way to determine the health of the population.

The calculation however (which takes someone’s weight in kilograms and divides it by the square of their height in metres to tell them if they’re ‘underweight,’ ‘healthy,’ or ‘obese’) was originally intended for the ‘average man’ and so used to define what was ‘normal’ in the 19th century – namely white European men.

This, of course, is heavily discriminatory and disregards the fact that a healthy weight changes depending on race, gender, and age.

BMI also doesn’t distinguish between fat, muscle, and bone density, which means that most professional athletes are classified as overweight.

It also doesn’t take into account where on the body the fat is carried – visceral fat around your organs is considered more dangerous than other areas of the body, for example around the hips.

In 2016, a study by UCLA concluded that tens of millions of people who had overweight and obese BMI scores were actually perfectly healthy. And that 30 percent of people with ‘healthy’ BMIs were, in fact, not healthy at all.

Noting this, the American Medical Association (AMA) has begun urging doctors to look beyond the almost 200-year-old screening tool.

Voting to adopt a new policy earlier this week, the AMA has officially recognised the ‘historical harm’ of BMI and admitted it has been used for ‘racist exclusion.’ Instead, it now recommends alternative measures for diagnosing obesity be used in clinical settings.

‘For the longest time, I’ve been in this emperor-has-no-clothes situation, where I just couldn’t understand why really smart physicians continue to rely on something that was so clearly flawed,’ psychology professor A. Janet Tomiyama told the New York Times.

The new policy also advises against the use of BMI in diagnosing eating disorders, saying it’s ‘problematic’ because ‘it does not capture the full range of abnormal eating disorders.’

The recommendations from the AMA are just suggestions, rather than strict regulations that doctors must comply with.

However, the association is influential in the medical community and the new policy indicates that accepted thinking around the metric and the way obesity is measured is finally changing and that the movement to shift away from BMI as a measure of individual health risk alone is gaining steam.

‘The goal is to personalize how BMI is used in medical decision-making and to move away from blanket generalizations that can lead to stigma and bias,’ says Dr. Jamy Ard, a professor of epidemiology and prevention at the Wake Forest University School of Medicine.

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