On-line photos that help to demonstrate the inappropriateness of the BMI

Previously on drbriffa.com I have written about the limitations of the body mass index (BMI) as a marker of health. This measurement (calculated by dividing weight in Kg by the square of one’s height in metres) takes no account of body composition, nor where any addition fat is aggregated in the body. Nevertheless, we are told that BMIs of 18.5 ” 24.9 are ‘healthy’, that those of 25.0-29.9 are ‘overweight’ and that those 30 and above mean someone is ‘obese’. This, despite the fact that there are several studies that show that those in the ‘overweight’ category tend to have health status that is generally at least as good (if not better) as those in the ‘healthy category’.

In the previously published piece I have pasted below, I end by lamenting the fact that in practice I quite often see individuals in practice who, say, are in the overweight category, who don’t actually appear like they have any real weight to lose and are genuinely comfortable with their size and shape. Nevertheless, they have often been urged to lose weight by a health professional because they do not conform to BMI-dictated ‘norm’. Naturally, I am opposed to the idea of individuals feeling compelled to lose weight when there is neither medical nor personal reason for doing so.

Last week, I came across a collection of on-line photographs which, I think, demonstrate quite graphically the wrong-headedness of the BMI. The collection has been amassed by the blogger Kate Harding whose special area of interest is fat-acceptance issues. Take a look at these photos and you may find yourself eyeballing individuals who look (and may in fact be) perfectly healthy, despite being labelled as ‘overweight’ or worse.

Kate Harding advocates the concept of ‘Health At Every Size’, which concentrates on wellness through healthy eating and activity, not thinness per se. She is reported as saying: “A lot of people are just freaking out over absolutely nothing,’ and individuals can be: healthier than they think they are.”

In a World where there is a growing sense of health neurosis (I realise I may have contributed to this myself), I do think it’s a good thing of individuals to be made aware of factors that we may have been encouraged to concern ourselves with (such as BMI) that may not have the bearing on health we have been led to believe they do. Kate Harding’s photo collection, I think, helps to demonstrate visually to us the limitations of the BMI that have been amply demonstrated in the scientific literature.

Recent evidence suggests that bigger is better – 13 December 2006

I make no secret of the fact that I think a lot of health information and advice that comes at us is not just unsupported by the science, but also seems to have been contrived with profit in mind. For example, despite the fact that taking dietary steps to reduce cholesterol have not been shown to save lives, there remains considerable appetite for supposedly cholesterol-quelling foods including specially formulated margarines and yoghurt drinks. And the dental profession continue to trumpet the tooth-preserving ‘benefits’ of water fluoridation, despite the fact that the biggest review of the evidence ever conducted concluded that this practice only helps one in six people, but causes dental disease (in the form of something known as ‘dental fluorosis’) in almost one in two. I could go on�

Another major myth that some seem keen to propagate is that having a body mass index (calculated by dividing weight in kg by the square of one’s height in metres) of 25 or more is putting us in some sort of mortal danger. However, as I’ve written before, the BMI seems to be virtually useless for adjudging an individuals health status. In a previous post, I outlined the evidence which suggests that BMI has practically no relationship to disease risk, but what seems to be far more important is any fatty accumulation around the midriff (formally known as ‘abdominal obesity’). Abdominal obesity is often assessed by comparing the waist circumference with the hip circumference. Basically, the lower your ‘waist-to-hip ratio’, the better with regard to risk of conditions like diabetes and heart disease.

The reason that I’m writing about this now is because this week a study which assessed the relationship between BMI, waist-to-hip-ratio and mortality in middle-aged women [1]. One reason that I was drawn to this particular piece of research, published in the Archives of Internal Medicine, is because it focused on mortality (overall risk of death). Assessing the effect of a factor on this allows us to make much more useful judgements about the possible health effects of some factor than looking at homing in on cancer of the gallbladder or some such rarity.

In this study, about 18,000 women were followed for some 9 years. In keeping with previous research higher waist-to-hip ratio was associated with an increased risk of death. Compared to women with the lowest waist-to-hip ratios, those with the highest were some 30 per cent more likely to die.

However, also in keeping with previous research, an elevated BMI was not associated with an increased risk of death. Not only that, but this study found that, if anything, having a raised BMI might be a bit of a life-saver: compared to women with a BMI of 18.5 ” 25, those with a BMI of 35 or more were 30 per cent less likely to die. Bear in mind now that according to official tables, a BMI of 18.5-25 is labelled as ‘healthy’, while individuals with a BMI in excess of 30 are branded ‘obese’.

In the light of this and other existing evidence, the BMI is looking increasingly obsolete as a useful body measure. My guess, though, is that certain factions will continue to cling to and promote the BMI. Why? Because using the BMI, rather than the waist-to-hip ratio, will ensure that more people will be under the impression that they need to lose weight for the sake of their health. And that means good business for the diet, food and pharmaceutical industries.

Not uncommonly in practice I see individuals who are genuinely comfortable with their weight, but have nonetheless been advised to lose weight on the basis of their BMI. If this sounds like you, then you can almost certainly ignore this advice knowing that the weight of evidence is on your side.

References:

1. Tice JA, et al. Risk factors for mortality in middle-aged women. Archives of Internal Medicine 2006;166(22):2469-2477

Related posts:

Pot bellies again found to be a marker for cardiovascular disease

Study suggests that obesity might be healthy after all

Why the body mass index is virtually useless for assessing health

More evidence that obesity is not the spectre it’s so often made out to be

The body mass index and waist-to-hip-ratio as markers for health

7 Responses to On-line photos that help to demonstrate the inappropriateness of the BMI

  1. Neil 22 October 2007 at 8:10 pm #

    Does anyone know if there’s any real science behind the BMI or is it another arbitrary ‘guess’ on the lines of 14 and 21 units of alcohol per week for men and women, or ’5 a day’?

  2. Max 26 October 2007 at 3:21 pm #

    I looked at the pictures and was unable to see the blogger’s point. Nearly all of the women labeled as morbidly obese are at the very least very overweight and pretty divergent from what you would expect to see in any animal in the wild save man in civilization. Nearly all of the women who were more than a couple basis points away from normal on the underweight sized looked skinny to emaciated. And pretty much every woman in the overweight category seemed to have some excess fat accumulation. On the first page, the woman who is a few pounds short of overweight seemed to have a large belly roll, which could not possibly be healthy.

    I agree with you that BMI is not the be all and end all of health risk, beauty or fitness. But I think the blogger’s site you pointed to doesn’t make the case at all.

    Last: In the Journal of Occupational and Environmental Medicine, I had seen a study suggesting a link between high BMI and productivity, with the cut line the researchers used/found to be around 27. I think above that, the folks under study blew an average of 5 hours a week over the course of the study. Now, I’m not suggesting this is a health issue, but if you’re at a company, it might look like discrimination but it might make very good sense to hire the slim and cashier the obese.

  3. rm 27 October 2007 at 7:45 am #

    Is the waist to hip ratio waist divided by hip or the inverse?

  4. rm 27 October 2007 at 7:52 am #

    The photos included with your comments show various BMI’s, but tell us nothing of the health of the pictured people. I don’t see that they add anything to your point of view.
    thanks for the interesting information.

  5. helen 28 October 2007 at 9:37 pm #

    BMI is just a way to calculate the amount of fat in the body it has absolutely nothing to do with calculating health! being over weight is not a sign of being unhealthy being morbidly obese is another thing altogether. Currently in this country the public hospitals are using the BMI to deny surgery to individuals they are saying it is too risky to operate even if you are not obsese an operation is not risk free. However I wonder how many of these obese people are turned away from “dangerous” surgery if they want their stomaches stapled??

  6. Sylvia Wainhouse 30 October 2007 at 4:58 pm #

    The article posted on 22 October 2007, obtained through your e-newsletter dated 26 October 2007 refers to a lower ‘waist to hip ratio’ being better. I have misunderstood?

  7. Neil 1 November 2007 at 7:22 pm #

    The ‘best’ would probably be ‘percentage of body fat’ (assuming you put a lot of store by any of these measurements)

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