The Truth Behind The BMI, the Body Mass Index.
The Truth Behind the BMI or the Body Mass Index is That it is OLD.
How many times have you had your BMI measurement taken?
Have you had warnings about your health, based on your BMI alone?
If you are in a larger, aging, body, this is an uncomfy topic.
This should not be your primary measure of health in menopause.
Trigger warning: this blog post talks of being measured, specifically with the BMI. It does not talk of specific numbers or categories in the BMI.
Skip this if it is triggering for you
Before I talk about the truth behind the BMI, let’s take a look at what the Body Mass Index actually IS.
The BMI is a value is determined by your height, and weight. Your weight in kgs is divided by the square root of your height. It’s then multiplied by 703. It’s expressed in unit of kg/m2. This comes from mass in kgs, and height in metres.
Yeah, I’m confused too.
That’s why there are BMI tables for clinicians to use, because who wants to throw that into a calculator? Read on:)
The Truth Behind The BMI and Who invented it.
Adolphe Quetelet created this calculation in 1830. He wanted to characterize, and quantify, the average man. He measured typical weights of French and Scottish MEN.
I wonder how this applies to women?
His interest was promoting the sciences of statistics and anthropometry.
Anthropometry is the scientific study of the measurements and proportions of the human body. He was a statistician, mathematician, but he was not a doctor. He also analyzed national crime statistics in the 1800’s (1).
The BMI was never developed around women.
Sigmund Freud’s quote here gives us a great view of how women were seen in that era. He noted that femininity was something to worry about, if you were male, because if you were a woman, well “you are yourselves the problem” (2).
Ancel Keys, who studied body mass, body composition, and its relation to disease and health, named this calculation the Body Mass Index. This guy is famous for The Minnesota Starvation Experiment, looking at the effects on the body and mind, with food deprivation.
The book, Body Respect, by Lindo Bacon and Lucy Aphramor, names
SEVEN myths about weight, one of them being:
BMI is a valuable and accurate resource
In the book, Lindo shares that she went to one of the committee members behind the framework of the BMI, asking why they set the numbers the way they did. The data that was available to the committee showed that health detriment did not occur until a BMI of 40. But the US committee set the standard of “overweight” at 25, and “obesity” at 30 because “they got a lot of pressure to conform to international standards.”
Lindo further highlights that the international standards were set by the WHO (World Health Organization) relied on a specific task force, the IOTF (International Obesity Task Force) to make the recommendations.
Who was behind this task force?
Two large pharmaceutical companies, who at the time had the only weight loss drugs on the market. (3)
If this is the truth behind the BMI, how do you see it in relation to menopause weight gain now?
Would information like this change your opinion about the BMI and what it means for uou?
And, with all the tech out there, why ARE we still using this? Well here are a few thoughts:
Doctor’s are tightly regulated.
Licensed health care providers have many rules to follow, that fall under the standard of care of their regulatory bodies. These bodies allow a care provider a licence to practice, if they follow the guidelines. This is to protect the public, and is tied to government legislation, at least in Canada. There needs to be frameworks in place to deliver healthcare.It’s cheap and easy.
According to the CDC: “BMI is an inexpensive and easy screening method for weight category—underweight, healthy weight, overweight, and obesity.”Just before 1900’s, the medical based issue of “body build” increased in popularity. Data, accumulated by life insurance companies had seen that weight, adjusted for height, was a determinant of life expectancy. The late fifties saw a major life insurance company publish tables of average body weights, coordinated with height, gender and age.
Companies can base premiums on the BMI, and charge more for a person who falls into an overweight or obese category.
This is based on data that takes that old equation which may influencethe decisions for insurance premiums.
Insurance audits or reviews of eating disorder claims may look upon the BMI as an indicator of the need for mental health help.
Meaning that if the BMI is too high, the person will be denied for any eating disorder claim.
The bias within this is undeniable.It’s less invasive as a tape measure.
If used as just one tool as part of a health screening, it has its use as a screening tool. It’s better than a tape measure, although those are used for waist ratios, as well, in screening for metabolic syndrome.I did fitness appraisals, and taught fitness as I was going through dental hygiene school. I can tell you that I did not like the shame based practice of measuring waist, hips, biceps etc, as much as people felt awful when I was doing it. Even if they signed up for the assessment!
There is also an assumption that larger bodies could not possibly experience an eating disorder. Which is so harmful.
Bias exists within the medical community.
It also exists within ourselves, as larger bodied people are seen as having a weight problem, not an eating disorder problem.
And how many conditions are meant to be “fixed” by addressing weight, either first or as an ONLY intervention.
The biggest problem with the BMI, isn’t the BMI itself.
It’s with the way it positions people in larger bodies.
Too tired in midlife to even contemplate the truth behind the BMI? I feel you!
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The Truth Behind the BMI is That it May Be Harmful.
We have societal attitudes about larger bodies, that may put people’s health at risk, and these attitudes have permeated the healthcare and wellness world.
There is heavy social framing around the BMI as a measure of health (4).
And an assumption is made that larger bodies could not possibly experience an eating disorder.
This bias exists within the medical community, as larger bodied people are seen as having a weight problem, not an eating disorder problem. And how many conditions are meant to be “fixed” by addressing weight, either first, or as an ONLY intervention.
Keys, the starvation study guy, always said that “overweight” did not mean “overfat”. That leads us to the next section.
With the truth behind the BMI, What are the positives?
It’s still applicable in research, in epidemiology, and public health.
Easy low cost collection of data.
Links some health outcomes through large populations.
What the BMI doesn’t account for:
Sex
Race
Bone Density
Nutrition Status
Age
Muscle Mass**
Body shape
Genetics
Alcohol and recreational drug use
The Social Determinants of Health
Ability to change/Barriers to change
SRH, or Self Reported Health
What does this have to do with Menopause?
As we age, our bodies lose muscle and gain more fat (5). The natural decline in estrogen increases visceral fat mass (that’s the stuff wrapping around your organs, not necessarily your belly), decreases bone mass density, muscle mass, and strength.
So while the BMI may be ONE limited screening tool for “health”, is it assessing:
protein intake?
physical activity including strength training?
hormone levels?
mental health?
The BMI reduces us as humans to numbers, much like the scale does.
We are more than numbers. Menopause is more than hormones.
That’s why I love the Non Diet Approach to Menopause Health.
Learn more here.
There are so many things we are coming to terms with in our 50’s including:
changing bodies
loss of loved ones
increased stress, financially and emotionally
Yet the categorization of our bodies and health based solely on an outdated method continues.
And the diet industry thrives on it.
For me, the BMI created more stress about my health.
Now that I know the truth about the BMI, I can take it or leave it and
KNOW I can STILL work on my health.
What about you?
Sources:
https://www.britannica.com/science/body-mass-index
Alexander, Sally. “Women, Class and Sexual Differences in the 1830s and 1840s: Some Reflections on the Writing of a Feminist History.” History Workshop, no. 17, 1984, pp. 125–149. JSTOR, www.jstor.org/stable/4288549. Accessed 22 May 2021.
Bacon, L., Aphramor, L., Body Respect, 2014
Nuttall, Frank Q. “Body Mass Index: Obesity, BMI, and Health: A Critical Review.” Nutrition today vol. 50,3 (2015): 117-128. doi:10.1097/NT.0000000000000092
Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009 Oct-Dec;9(4):186-97. PMID: 19949277.