The way that doctors judge how overweight we are, a measure called body mass index or BMI, is unreliable and needs to change, according to a group of 58 experts. So what can and can’t BMI tell us about our health?
For over five decades, doctors have judged how overweight people are by their BMI, a measure of weight in proportion to height. It is calculated by dividing your weight in kilograms by the square of your height in metres.
But, while generally useful, BMI can fail to identify some people who are unhealthy due to their excess weight, and misclassify others as being unhealthy when they are not. This is the conclusion of an expert panel called the Commission on Clinical Obesity, just published in the medical journal, The Lancet Diabetes & Endocrinology.
If body fat is stored mainly in the belly and inside abdominal organs, this is linked with higher rates of conditions such as heart attacks and diabetes than if fat is stored more evenly around the body, including under the skin.
Health conditions
BMI also fails to consider if someone has health conditions caused or worsened by obesity, such as joint pain or breathlessness on exertion. “Some individuals with obesity can maintain normal organ function and overall health, whereas others display signs and symptoms of severe illness,” said Commission chair Professor Francesco Rubino, a weight loss surgeon at King’s College London.
People with clinical obesity should be prioritised for access to obesity treatments, like weight loss injections, said Professor Rubino.
“It can be misleading in the range of BMI between 25 and 34.9, said Professor Tom Sanders, a professor of nutrition and dietetics at King’s College London.
Real world
The Commission’s recommendations have been backed by many obesity experts globally. But it remains to be seen if they will be used in the real world, said Professor Simon Griffin, a professor of general practice at the University of Cambridge, who wasn’t a member of the Commission.
On the other hand, the arrival of weight loss injections has been a game changer for obesity treatments. Over the next few years the medicines are likely to be rolled out on the NHS to increasing numbers of people, in order of clinical priority. So a more accurate way of working out how much weight affects people’s health could be helpful.
“Our reframing acknowledges the nuanced reality of obesity,” said Professor Rubino. “This will facilitate a prioritisation of treatment options.”
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