The Problem with BMI in Healthcare

Written by CCTC Staff Writer

You walk into a doctors office and sign in with the front desk for your appointment. You sit in the waiting room scrolling through your phone and hear your name called. Most people expect what comes next, a nurse will ask you to step on the scale and measure your height. That is then entered on the computer to calculate a number that unfortunately many healthcare professionals put way too much attention on: BMI.

BMI, which stands for body mass index, is one of the most commonly used tools for assessing a person’s health. Unfortunately, this widespread practice in healthcare is doing more harm than good. Read on to learn more about some issues with the use of BMI and why it is not an accurate measure of a person’s health.

Note/trigger warning: this blog contains the words obese and obesity, we know these are sensitive words. Central Coast Treatment Center uses them in this blog to discuss the accurate history and issues of using BMI. For more information on why these words are problematic read this article ‘What’s Wrong With Calling Obesity A Medical Problem?’

In this blog we will discuss:

What BMI is & why it is problematic
The racist roots of BMI
How BMI contributes to weight bias in healthcare
The role BMI plays in driving diet culture in our society
BMI in eating disorder treatment
How the Health at Every Size approach is beneficial for both patients and doctors
How to advocate for yourself

What is BMI? Why is it problematic?

BMI is a formula that takes someone's weight and height to formulate a number. These numbers then fall into different categories including underweight, healthy weight, overweight or obese. Unfortunately, many healthcare professionals rely on these numbers to assess whether someone is healthy or not. The problem with this quick assessment based on one calculation is quite endless.

One problem with BMI is that the number on the scale does not take into account the different things that contribute to our weight such as muscle mass, bone density, or fat composition, it is only a numerical reflection of our bodies relationship with gravity.

Beyond that, the more problematic issue of BMI is that it is only a number based on mostly pre-determined genetically physical attributes and it cannot tell you the issues or habits one engages in that may support, or not support, overall well-being mentally or physically.

These categories also feed into a toxic culture and the idea that healthy can only exist in one type of body.

While people of all sizes and levels of health deserve respect and adequate healthcare it is important to point out that one of the biggest problems BMI ignores is that someone in a ‘healthy’ weight range may be engaging in unhealthy behaviors and someone in the ‘overweight’ category, that will often experience weight bias as a result of their weight (more on that later), may be engaging in health promoting behaviors.

The racist roots of BMI

While the history of BMI is not widely known by the general public, it is important to highlight the racist roots of BMI. The creator of the BMI formula was a statistician from Belgium in the 1800s named Adolphe Quetelet. Yes, you read that right, a formula created in the 1800s is still being used today to determine health status.

Quetelet developed the formula as a way to measure obesity rates in different populations. This formula was never intended to be used as an evaluation tool for individuals, another issue with the use of BMI. He originally used data from British and French soldiers to develop the equation, not utilizing any data from other populations in his research. This is problematic as it is not accurate for everyone, only for these specific groups of people not taking into account age, gender, or ethnicity.

While Quetlet did warn that this should not be used, at the beginning of the twentieth century insurance companies began utilizing the BMI formula to categorize people in different weight categories. Without looking into correlation vs causation and based on limited research, these companies noticed a trend that those with higher BMIs had shorter lifespans and used that to their advantage.

How BMI contributes to weight bias in healthcare

Weight bias is a common issue facing those living in larger bodies. Studies have shown that healthcare professionals often judge their patients on their weight. This means that patients living in larger bodies, who may fall into overweight or obese BMI categories, may face poorer quality of care. Weight bias can also contribute to discrimination in access to proper healthcare including how pain medication may be prescribed, what procedures or surgeries may be performed, or what referrals may be made.

Despite all patients deserving to receive quality care regardless of their body size or weight, some doctors may focus on weight no matter the health issue a patient is facing. For example, someone in a larger body may go to a walk-in clinic for a standard cold hoping for relief and may leave feeling completely dismissed by a doctor who lectures them on weight loss.

Weight bias and eating disorder treatment

Unfortunately, BMI is frequently used in the treatment of eating disorders due to insurance companies requesting such information. This can often lead to those in need of help being cut early out of programming or being denied treatment completely.

Our team at Central Coast Treatment Center advocates for our patients to receive the proper care they need by advocating on behalf of our clients to insurance companies.

BMI and its role in diet culture

Using BMI as a way to determine someone's health status can both promote and encourage disordered eating habits. In a society where disordered eating habits are so normalized, this can be extremely dangerous for people of all sizes.

For example, if someone who has historically had a higher weight has lost weight due to the restriction and purging see their doctor to discuss related health issues, they may be met with a doctor who enthusiastically congratulates them on their weight loss. Rather than walking away with the referrals and information they need to get help for their disordered eating, they may continue on in these dangerous behaviors.

The benefits of Health at Every Size (HAES)

A Health at Every Size approach to health can allow both patients and healthcare professionals to focus on health rather than weight. When there is that shift there is room to focus on actual health promoting behaviors such as eating nutritious foods, moving your body in a way that feels good, and taking care of your mental health needs.

Advocating for yourself when seeking healthcare

Seeking help from doctors or health care professionals can feel difficult in a larger body. The fear that someone may dismiss your concerns or focus on your weight rather than your health can lead to avoidance of healthcare altogether. Some ways to advocate for yourself is preparing to request to not be weighed, to let them know you are in recovery from disordered eating if you are, seeking out providers who are size inclusive and weight neutral in their care, gently educating your healthcare professional that BMI is not a good indicator of health and that you’d like to focus on the reason you are in. Do not be afraid to stand up for yourself and your right to receive adequate healthcare.

If you or someone you love are struggling with an eating disorder or disordered eating, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer here at Central Coast Treatment Center.

Ai PonoSeptember 5, 2022