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BMI Is Not an Accurate Tool for Identifying Obesity-Related Complications

By Elizabeth Wassenaar, MS, MD, CEDS

The use of BMI and weight as a way of assuming health has a long history of being problematic and reductionistic, in addition to being racist, sexist and stigmatizing.

Arbitrary "healthy," "overweight" and "obese" weight ranges have been associated with stigmatized and biased assumptions about an individual leading to discrimination, less access to effective and inclusive care, and increased morbidity and death.

In the Canadian Medical Journal last week, an important step was taken toward separating body size and health. New guidelines published by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons were based on the assessment of over 500,000 published, peer-reviewed articles and were built on expert consensus.

These new guidelines recognized far-reaching recommendations for the understanding of "obesity." Obesity should be understood to be a complex chronic disease of dysfunctional adipose or fat tissue that impairs health and increases morbidity and mortality.

It separates the idea that all excessive weight is unhealthy and refines the idea that adipose tissue, like any organ of the body, can become dysfunctional and become associated with health concerns. The guidelines are very specific, identifying that the disease of obesity is reflective of several factors including an individual’s genetics, metabolism and environment.

The new guidelines also represent a shift to focus on improving an individual’s health rather than on weight loss and emphasize the need to address weight bias and discrimination and the trauma it can cause people. Furthermore, it calls for more research into weight-neutral interventions and acknowledges the research bias towards weight-loss interventions.

This new set of guidelines from Canada is in line with growing evidence that shifting the focus to weight-neutral health outcomes instead of weight-loss based outcomes (in line with the Health at Every Size, or HAES, movement) is more effective for improving measures like blood pressure and cholesterol, health-promoting or health-maintenance behaviors and psychosocial measures like depression, self-esteem and body image.

While we still have a long way to go in shifting the health care and societal paradigm about weight and body size and shape, this new set of guidelines from Canada is a step in the right direction.


References 

Byrne, Christine. “The BMI Is Racist and Useless. Here's How to Measure Health Instead.” HuffPost (July 20, 2020).

Leung, Wendy. “Obesity not defined by one’s weight or size, new guidelines say.” The Globe and Mail, Canada. (August 3, 2020).

Wharton, Sean, David C.W. Lau, Michael Vallis, Arya M. Sharma, Laurent Biertho, Denise Campbell-Scherer, Kristi Adamo, et al. “Obesity in Adults: A Clinical Practice Guideline.” Canadian Medical Association Journal 192, no. 31 (August 4, 2020): E875–91.

Written by

Elizabeth Wassenaar, MS, MD, CEDS

Dr. Elizabeth Wassenaar comes to Pathlight following her role as Medical Director at Eating Recovery Center (ERC), Denver. Prior to joining ERC, Dr. Wassenaar served as a staff psychiatri...

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