AMA suggests moving away from BMI

At its annual meeting in June, the American Medical Association (AMA) voted to adopt a new policy that moves away from using BMI alone when assessing whether a patient is at a healthy weight.

In a report, an AMA subcommittee wrote that BMI does not differentiate between fat and lean mass or account for where body fat is located. According to studies, fat that accumulates around the stomach may be more harmful than fat that accumulates in the thighs or legs.

In addition, BMI is primarily based on data from non-Hispanic white populations, which makes it difficult to apply to a broader population. For example, studies have shown that Asian, Hispanic, and Black patients have a higher risk of developing type 2 diabetes at lower BMIs compared to white patients.

According to AMA's Council on Science and Public Health, several factors, including "comorbidities, lifestyle issues, gender, ethnicities, medically significant familial-determined mortality effectors," and more, can significantly impact how physicians interpret BMI data, particularly when it comes to morbidity and mortality rates.

The council also noted that "the use of BMI is problematic when used to diagnose and treat individuals with eating disorders because it does not capture the full range of abnormal eating disorders."

Going forward, AMA recommends physicians use BMI in combination with several other factors when assessing patients' health and weight, such as visceral fat levels; body adiposity index; fat, bone, and muscle percentages; and genetic and metabolic factors. The organization also noted that BMI should not be used as a sole criterion for denying insurance reimbursement.

"There are numerous concerns with the way BMI has been used to measure body fat and diagnose obesity, yet some physicians find it to be a helpful measure in certain scenarios," said Jack Resneck, Jr., AMA's immediate past president. "It is important for physicians to understand the benefits and limitations of using BMI in clinical settings to determine the best care for their patients."

Some physicians are focusing on 'weight-neutral' care

Some physicians are currently looking beyond BMI and people's weight as they assess their health and recommend treatments.

"BMI is the simplest measure, beyond weight, to try to make an assessment of whether a specific individual's weight is potentially posing some harm to them," Scott Hagan, an assistant professor of medicine at the University of Washington School of Medicine, said in a statement. However, he noted that it is a poor predictor of health outcomes for individuals.

Rather than focusing on weight loss as a way to treat health issues, some providers are now taking a "weight-neutral" approach that avoids intentional weight loss.

According to patient testimonials, as well as recent research, focusing on a patient's weight has often led providers to misdiagnose, or sometimes completely miss, health problems they may be having. In addition, there is evidence that recommending intentional weight loss can harm patients' long-term cardiovascular health, potentially exacerbate eating disorders, and contribute to weight stigma.

Lisa Erlanger, a professor at UW Medicine, also noted that some patients' health problems may be further exacerbated by trying to lose weight since they are not getting enough food. "Sometimes things are blamed on being fat that are actually caused by dieting," she said. "For example, losing menstrual periods is often blamed on obesity. But, actually, dieting can cause a loss of menstrual periods."

Erlanger also noted that intentional weight loss often doesn't work, with over 95% of patients who try to lose weight regaining it within five to 10 years. Cycling between weights can also negatively impact your health, leading to higher blood pressure, increased heart rate, and more.

Tess Moore, a family medicine doctor in Seattle, tries to provide the best care to all her patients, regardless of size, and does not focus on their weight when assessing their needs.

"In most cases, the care you're providing should be the same no matter what the number on the scale is," Moore said. "... We don't recommend weight loss as a way of treating medical conditions. We recommend moving your body in a way that's sustainable, which hopefully is joyful, and eating food in a way that nourishes."

To help health professionals consider patients' needs beyond their weight, Erlanger teaches a seminar on weight stigma. The idea is to "get them thinking about how these ideas pervade every aspect of what we've been taught," she said, "and then troubleshooting together how we might serve, for example, a family with a larger bodied child who's getting bullied — not to help that child lose weight, but actually to support that child in a well-lived life." (Clarridge, Axios, 6/29; Berg, AMA, 6/14; O'Neill, KUOW, 6/22)

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