"Prevention" and "Good Housekeeping" Say Bye to BMI

Source: Art & photo courtesy of Denise Robertson

An article published on June 1, 2022, stated, “Prevention and our sister publication Good Housekeeping have decided to no longer use Body Mass Index (BMI) in our discussions of health. If we determine that we must mention it in the context of our reporting on related subjects, we will point out its limitations.” I remember a loud “Yes!” escaped my mouth as I read that.

Various professionals and organizations in the medical and mental health fields have been teaching about the misleading nature of BMI for years. Still, it's an uphill battle. Society, health literature, and scientific articles commonly refer to BMI in a way that gets misinterpreted (i.e., “I’m/you’re healthy or unhealthy.”).

Since I’m a mental health clinician, I can’t speak to medical information as a doctor can. So I reached out to Dr. Delia Aldridge, MD, FAPA, CEDS-S, and Medical Director, Eating Recovery Center, Chicago Suburbs, to ask her point of view on the BMI. She said this:

Relying on BMI alone to predict a person's risk of health problems can be misleading; for example, upper body fat around the midsection and visceral fat are more correlated to health complications such as cardiovascular disease than lower body fat around the thighs and butt regions. Also, many athletes and bodybuilders can be considered overweight according to BMI because of their greater muscle mass, despite being in peak athletic health. BMI cannot accurately predict the health of different demographics and races because it was created with data from only white European descent populations. In children and adolescents, body composition changes at different rates and at other times throughout youth, and varying growth rates may distort BMI measurements.

My previous post, “What Does the BMI Reveal? The Underweight, Overweight, Obese, and Healthy," provides additional examples of why BMI often offers only partial and even inaccurate information. Yet people still view it as supreme.

BMI shows up in my therapy office

I'm a Licensed Marriage and Family Therapist with 15 years in the eating and body image field. BMI commonly comes up in sessions (and social conversations, too, once people learn what I do professionally).

People striving to reach the “healthy” BMI zone

Whether they hit it or not, their attempts at better health per BMI can result—and have resulted—in the following:

• They start therapy because efforts to manage their health and weight have taken a negative toll on their psychological state.
• They experience hair loss, skin changes, sleep issues, moodiness, and increased relationship problems or isolation.
• They need to be medically monitored because sometimes commonly marketed diets and health crazes can lead to malnutrition. The consequences of malnutrition can become as severe as cardiac abnormalities and sudden death. (But hey, they got closer to or into the "healthy" zone per their BMI!)

For some, the body can be unable to lose much weight without near starvation and other harmful behaviors that no one would ethically recommend for improving health.

People reaching their peak physical and mental states of contentedness, wellness, and energy

These folks can also have good laboratory and physical test results, live healthy lifestyles, and engage in other factors considered “healthy.” Yet, the BMI measurement knocks them off their stride. Their category stigmatizes them because it indicates they’re failing at wellness—still branded as “unhealthy" by professionals and society because they have weight on them. But that’s not automatically true. Some studies indicate that people with “extra” weight may live longer than “healthy weight” and “underweight” people.

My BMI alone would mislead me

I’ll share something personal here to illustrate the potential deceptiveness of gauging health solely (or even mainly) on BMI. Technically, I’m in the “healthy” index category. To expand the concept of health one layer—there can be many layers—let’s add on laboratory work. There, I have at least one health marker that is consistently higher than it should be. A second is TBD at this moment. Many people in the "overweight," "obese," and "morbidly obese" categories have better health markers than “healthy"-BMI me.

If BMI isn’t the answer, then what is?

I contacted Dr. Aldridge again to help clarify what we might consider to assess our health risk better. She said, “lifestyle factors (such as smoking, physical activity, diet and stress levels), and blood pressure, waist circumference, blood sugar, triglycerides, and cholesterol levels should all be considered alongside BMI.“ So it's a combination. I'd also add social and psychological wellness to the mix since mind and body are connected.

For anyone curious, let's now return to my own wellness composite. I lead a healthful lifestyle (love veggies, enjoy exercising regularly, don't smoke, etc.). We already talked about my BMI. I won't pretend to evaluate myself psychologically, but I can say that I'm pretty contented and have relationships that add to my well-being. Despite all those positive factors, genetics or something else gave me disease risks to consider actively managing as I age. (A colleague reminded me that even factors such as the zip code I live in can impact my health outcomes for various reasons.) I'm glad I know not to give too much value to my BMI alone.

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Health is a complex concept that includes more than height and weight ratios. A research article from 2016 stated, "Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health.” Until those happen in obvious ways, it's up to practitioners, organizations, health educators, and (sadly) self-advocates to provide more balanced information regarding the BMI’s authority over any individual’s wellness.

This blog is for informational purposes and does not provide therapy or medical advice.