Rethinking the overreliance on BMI is long overdue, not least because of how it has been misused to reduce conversations about health to mere numbers on a scale. (File Photo)
Jan 15, 2025 19:21 IST First published on: Jan 15, 2025 at 19:15 IST
Ease is the name of the game. Just as one can easily shed kilos now, thanks to “miracle” drugs like Ozempic, Zepbound and Saxenda, one can determine whether said kilos need shedding at all, thanks to the easy-peasy method of calculating Body Mass Index (BMI). From .gov websites to neighbourhood gyms, calculating one’s BMI is presented as the first step towards better health. The higher the BMI, the greater the obesity and the more the need for interventions like exercise and diet control — maybe even drugs and surgery. Simple. But also, as it turns out, not so simple.
A report published in the Lancet Diabetes and Endocrinology journal has called for an overhaul of our understanding of obesity, citing an over-reliance on BMI, which has had the peculiar effect of leading to both underdiagnosis and overdiagnosis of the condition. This is because BMI does not provide a reliable picture of health: Neither is it a direct measure of fat, nor does it give accurate information about how fat is distributed in an individual’s body. It frequently fails to capture the true state of health of a person who may have excess body fat, while having “healthy” BMI. And just as frequently, it overlooks the fact that while a person’s BMI may indicate they’re “obese”, their organs and bodily function may be normal, with no signs or symptoms of an illness.
Rethinking the overreliance on BMI is long overdue, not least because of how it has been misused to reduce conversations about health to mere numbers on a scale. It has played a role in perpetuating myths about what a healthy or fit person looks like (thin) as against one who is not (overweight), with associated sub-myths that attach subjective values like beauty, worth and efficiency to an individual’s appearance.
What the Lancet report underlines, in fact, is how little we understand about the combination of bones, flesh and blood that is the mortal coil — and by extension, how limited our understanding is about the actual state of our bodies. Space may be the final frontier, but the original, unconquered frontier remains the human body. It is a fact that medical practitioners, the ones who rely on a combination of scientific evidence, experience, patient history and gut feeling — their clinical judgement, in other words — understand and acknowledge.
The problem is that this acknowledgement of the gaps in medicine — that the right diagnosis, the best cure, the fullest understanding is still in the future — fails to trickle down into the wider culture, even as medical jargon/tools become more and more widely-used by laypersons to self-(mis)diagnose. This is not something that began during the Covid-19 pandemic, but it was certainly not impeded by it. Our larger anxieties about our bodies — are we getting enough sleep/water/protein? Is it gas/ IBS/ lymphosarcoma of the intestine?— have always existed. After all, the great joke that kicked off Jerome K Jerome’s Three Men in a Boat is not that the narrator used a medical book to conclude that he suffered from “every malady but housemaid’s knee”, but that every one of us has, at some point, arrived at exactly that conclusion. In the digital age, these anxieties seem to have entered some sort of hyper-speed mode thanks to the vast amounts of information that the right (wrong?) device and an internet connection can pull up. BMI is but one of the many widely-misunderstood and abused tools that, in medically uneducated hands, can trigger panic and overreaction: Over the past decade, obsessive tracking of indicators like sleep quality, calories, macronutrients, heart rate and fertility has been linked to conditions like clinical anxiety and eating disorders.
Every individual is a unique constellation — not only of genes and other biological variables, but also socio-economic conditions, habits and that most unreliable factor known as luck. One diagnosis does not fit all, a fact that must be underlined, especially at a time when “miracle” drugs used to treat conditions like diabetes are being widely used/abused as a weight-loss measure. Can the Lancet report’s call for a nuanced approach to identifying obesity — endorsed by over 75 medical organisations from around the globe — help dispel some of the myths we cling to, including the reliability of mere numbers?
pooja.pillai@expressindia.com
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