In today’s post, I will talk about BMI (body mass index) and give you 8 reasons why BMI doesn’t reflect health.
Too many people get caught up in numbers in eating disorder recovery – how many calories to eat? What is my healthy weight?
But at the end of the day – only your body knows and decides these things. Eventually, you must let go of relying on numbers and let your body recover because it knows the best what it is doing. We can’t assign a number to our recovery and decide exactly how much food your body needs and exactly how much it should weigh. These things are out of our control. And trying to control these things will lead to staying stuck in quasi-recovery.
Getting caught up in weight and BMI numbers is another thing we must get rid of. BMI is NOT an accurate measure of your true set point weight or a measure of health. Relying on BMI to tell you whether you are healthy or recovered is very narrow-minded as there is so much MORE to our health than the ratio between your weight and height.
So let’s dive in!
What is BMI?
BMI is a body mass index that shows the ratio between your height and weight and this supposedly puts you in categories of “underweight”, “normal weight”, “overweight” or “obese” and this, supposedly, is some kind of marker of health.
But it isn’t. Actually BMI is complete BS. Or as they say “bullshit measurement indicator”.
The ratio between your height and weight cannot paint a picture of your health. Our health is not so simplistic like that and there are SO many different factors that indicate health.
“It’s important to recognize that BMI itself is not measuring “health” or a physiological state (such as resting blood pressure) that indicates the presence (or absence) of disease. It is simply a measure of your size. Plenty of people have a high or low BMI and are healthy and, conversely, plenty of folks with a normal BMI are unhealthy.” – Robert H. Shmerling, a doctor and editor at Harvard Health Publishing. (source)
Thankfully many doctors are starting to move away from relying on BMI.
But of course, there are many who still use this tool to measure a person’s health.
So who is responsible for starting this mess?
In the 19th century, there was this Belgian guy named Adolphe Quetelet who was a mathematician, astronomer, statistician, and sociologist. Clearly, he wasn’t a physician and had not studied medicine. So he wasn’t an expert of the human body.
Back then the BMI was known as the “Quetelet’s Index” and his only aim by creating this was to determine the characteristics of an “average man”. It was never intended to be used as a measure of an individual’s body fat, build, or health. The Quetelet index was not created for use as a health indicator but rather for gathering population data.
Quetelet derived the formula based solely on the size and measurements of French and Scottish participants. So it was devised exclusively by and for white Western Europeans.
Then fast forward in 1972 Dr. Ancel Keys (yes the same one who is responsible for creating the famous Minnesota Starvation Experiment) first coined the term BMI or the Body Mass Index in one of his studies. He used BMI calculation for his population studies, not for individual diagnosis.
“Ancel Keys also warned that the BMI should not be used for individual diagnosis due to complex effects of age and sex in the mathematical determination of the value of BMI and the poor precision of that value to predict health problems of an individual.” – “The BMI Myth” by Akshay Chopra
But of course, at some point all of the warnings against BMI were ignored and somehow BMI has now become a measure of an individuals health.
How BMI threshold was lowered in 1998.
Right now the threshold of “overweight” is BMI 25, but before it was 27.8.
“In 1998, the National Institutes of Health lowered the overweight threshold from 27.8 to 25—branding roughly 29 million Americans as fat overnight“
“But critics noted that those guidelines were drafted in part by the International Obesity Task Force, whose two principal funders were companies making weight loss drugs.” (source)
So the organization behind the guidelines is the International Obesity Task Force, whose funders are weight-loss drug manufacturers.
How can 29 million Americans become too fat overnight by not gaining a pound?
The answer is there is a lot of money to be made by telling people their bodies are the problem and they need to lose weight.
There is a lot of money to be made by telling people their bodies are the problem and they need to lose weight.
And this is exactly what the weight loss companies did as they were responsible for making this decision of lowering the BMI threshold and by this one step the diet industry got 29 million potential new customers.
And actually the optimal BMI is not between 18.5 and 25. But it actually sits around BMI 27. (source)
Why BMI is not a measure of health?
1. BMI doesn’t differentiate between bone, muscle, and fat. People who have more muscle and high bone density are categorized as “overweight” or “obese” according to BMI with not actually having problems with excess fat. Also, BMI doesn’t measure where the fat is distributed in the body, but this also makes a difference health-wise.
2. BMI doesn’t take into account your genetic makeup. As we said before the index was originally devised from white Europeans so therefore it doesn’t take into account the genetic body shape differences in various races.
3. BMI doesn’t measure health parameters. BMI doesn’t measure things like blood pressure, cholesterol, triglycerides, blood sugar and other markers that are a more accurate way to measure health.
“Use markers that researchers argue are a more accurate marker of health than BMI, such as physical activity and cardiorespiratory [cardiorespriatory] fitness, waist circumference, or body fat percentage, or their combination. Blood pressure, triglyceride, cholesterol, glucose, insulin resistance, and C-reactive protein data are more accurate measures of health than BMI.” – “The BMI Myth” by Akshay Chopra
4. BMI doesn’t measure your overall health habits and activity level. Our health is not simply a number. For example, a person with a BMI of 30 who has good health habits and activities may be way healthier than a person with BMI 22 who is drinking, smoking, has too much stress in their lives and doesn’t have good self-care habits.
“A person with a normal BMI who smokes and has a strong family history of cardiovascular disease may have a higher risk of early cardiovascular death than someone who has a high BMI but is a physically fit non-smoker.” (source)
Also, I would argue that if someone has a lower BMI but has got there by dieting and restriction that has sooo many physical and mental health side-effects and probably even accompanying disordered eating then they are way more unhealthy than a person who has a higher BMI but is a normal eater, has a healthy relationship with food, good mental health, and their body is not torn down by chronic restriction and yo-yo dieting.
If your BMI is maintained by restriction then it’s not making you healthy because we know the host of negative side-effects that come with that.
5. “Overweight” BMI has the lowest risk of mortality. Some studies have actually found that people in the “overweight” category live longest. And even people in the “obesity level 1 have no increased risk of mortality. Rather people in the “underweight” category have the highest risk of mortality. – “The BMI Myth” by Akshay Chopra
And if a physician is instructing a person to lose weight to “become healthy” it can actually increase the persons mortality risk.
“Individuals with an overweight or obese BMI are often instructed by their physicians to lose weight. If these individuals are otherwise healthy, however, intentional weight loss may actually increase risk for mortality.” – “The BMI Myth” by Akshay Chopra
6. Many people in “overweight” and “obese” category are metabolically healthy.
One study showed that nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were (and these are not limited to people who are bodybuilders or elite athletes) metabolically healthy. And over 30% of normal-weight individuals were cardiometabolically unhealthy. Using BMI categories as the main indicator of health, an estimated 75 million (74,936,678) US adults are cardiometabolically misclassified. (source)
7. BMI doesn’t take into account children’s natural BMI increase during puberty. While BMI takes into account someone’s age it’s still not an accurate health indicator. During and after puberty children, both males and females, go through various normal body changes. Their body develops from a child’s body into an adult body. Girls will see an increase in body fat to be able to get their first period and boys will also see gradual weight gain through those years. It is normal to see a BMI increase during those changes and it doesn’t indicate health issues.
8. BMI doesn’t take into account a wide variety of other health factors and indicators of well-being.
Our health is holistic that includes various aspects other than just physical health. Mental health is also such an important aspect of our overall health. And things like weight stigma can actually make our health worse and promote unhealthy behaviors and even weight gain.
“The latest science indicates that weight stigma can trigger physiological and behavioral changes linked to poor metabolic health and increased weight gain. In laboratory experiments, when study participants are manipulated to experience weight stigma, their eating increases, their self-regulation decreases, and their cortisol levels are higher relative to controls, particularly among those who are or perceive themselves to be overweight. Additionally, survey data reveals that experiences with weight stigma correlate with avoidance of exercise. The long-term consequences of weight stigma for weight gain, as this experimental and survey work suggests, have also been found in large longitudinal studies of adults and children, wherein self-reported experiences with weight stigma predict future weight gain and risk of having an ‘obese’ BMI, independent of baseline BMI.” (source)
Centers of Disease Control and Prevention reports that our day-to-day health behaviors, like diet and exercise, only account for less than a quarter of differences in health outcomes.
What matters the most is actually “social determinants of health”. Things like early childhood development, level of education, financial health, employment, food security, having social support and access to housing and healthcare. (source)
Most ill health is caused by how oppressed a person is. And we see plenty of oppression going on in the diet culture that promotes thinness and sees people in larges bodies as inferior.
Fat phobia, weight discrimination, and body shame are definitely not the way to promote health. If you truly care about someone’s health then stop criticizing their bodies or suggesting them to “lose weight for health” as this weight stigma can actually cause a decline in someone’s health.
Fat phobia, weight discrimination, and body shame are definitely not the way to promote health.
Also, I have talked so many times why diets don’t work and will actually cause more health issues and even more weight gain. There isn’t any long term study that proves losing weight improves health long-term. Not one. Actually the studies done on diets and its long term health effects prove the exact opposite.
If people are suggesting someone to diet to lose weight for their health I want to ask them “HOW exactly you suggest one do it without potentially messing up their physical and mental health?”. It so easy to suggest someone to diet and lose weight but its a whole another story to actually do it.
Because research shows that 99% of diets don’t work, they make you more unhealthy and make you actually gain more weight in the future. Plus, dieting is a huge risk factor for developing disordered eating and even eating disorders.
Dieting and losing weight is just the tip of the iceberg. The whole iceberg underneath that you don’t see is actually the never-ending rebound weight gain that happens to 99% of dieters, the constant food obsession, the never-ending urges to binge and overeat, the uncontrollable cravings, losing your period, not even talking about developing symptoms of an eating disorder, lowered self-esteem and body image, increased risk for anxiety and depression. Lowering your BMI number for all of that is NOT making you healthy one bit, quite the opposite.
The health risks of dieting are way WORSE than any supposed health benefits you get.
“Current guidelines recommend that “overweight” and “obese” individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change. This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging.” (source)
Set point weight
And even if you are still not convinced and want to lose weight “for health” then your body’s set point weight regulation system will literally start to fight against it.
Your body’s set point weight is the weight that is pre-determined by your genetic makeup and is what your body will naturally defend. Trying to go lower than your set point is literally the fight you will never win. Because you won’t win biology.
But if you will fight against it and you manage to lose weight below your set point then it can only be maintained by staying in a state of chronic undernourishment and you will forever fight with the negative symptoms and side-effects because of it.
But this already defeats the purpose of “losing weight for health” already, right?
Also, some people may still argue that “ok, yes, BMI is BS but what about excess fat, isn’t this a killer? We need some kind of way to measure that and get rid of that?”
And here again, it’s not so easy. Our body is biological, not mathematical.We can’t simply assign a diet and exercise program to someone and expect them to lose weight by sheer will power because the biology of our body and how self-imposed starvation aka dieting affects us will simply start to fight against it.
I also recommend you to watch my latest video about stress. So you can understand how dieting and weight loss is an instant stress response to your body and how it affects your physical and mental health.
Somewhere I saw a quote that went something like this: “We prescribe to people in larger bodies what we diagnose as eating disorders in people with thinner bodies” and I think this is so accurate. People think that if a person has more fat on their bodies then somehow self-induced starvation in a form of dieting doesn’t have negative side-effects to them. But of course, this is not true.
Better approaches to health than BMI
1. Health At Every Size (HAES)
A much better approach to health is to promote good health behaviors without the focus on weight. And this is promoted in “Health At Every Size” approach.
“A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures [example, like] (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence and rationale that justifies shifting the health care paradigm [paradaim] from a conventional weight focus to HAES.” (source)
2. Intuitive eating
Intuitive eating is a way better approach to promote long term normal eating patterns and healthy eating than controlling your eating by food and calorie restriction.
“Women with high Intuitive Eating Scale (IES) scores had significantly lower body mass index, which suggests that people who eat in response to hunger and satiety cues, have unconditional permission to eat, and cope with feelings without food, are less likely to engage in eating behaviors that lead to weight gain.” (study)
“Large study evaluated Intuitive Eating as a possible healthier, more effective, and more innate alternative to current strategies of weight management among 2,287 young adults from Project EAT-III. Intuitive eating practices were inversely associated with a number of harmful outcomes, including binge eating and eating disorder behaviors. Researchers concluded that clinicians should discuss the concept of intuitive eating with their young adult patients to promote healthier weight-related outcomes.” (study)
“Consistent with adult findings showing cross sectional relationships between intuitive eating practices and health markers, our findings suggest that intuitive eating can be safely used in obese adolescents without fear of sustained consumption of unhealthy foods. In other words, no sustained increases in calories, sugars or fats were seen despite the curriculum suggesting all foods are allowable, dieting is counterproductive, and portion size should be addressed using awareness of internal satiety and hunger signals rather than external rules.” (study)
“A 10-week intervention combining Intuitive Eating and mindfulness, is more effective than traditional weight-loss programs in improving individuals’ views of their bodies and decreasing problematic eating behaviors.” (study)
3. Full recovery from an eating disorder
You will not be healthy being thinner and with an eating disorder.
At the same time, you can be much more healthy being at higher weight and without an eating disorder and being fully recovered.
Recovery can improve your health markers. Recovery will increase your metabolism that has been suppressed by diets. You can have improved digestion, better sleep, healthy hormones, get back your period, more energy, mental clarity, and better mood. With recovery you achieve normal eating behaviors, no more binge eating or uncontrollable cravings. No more food obsession and anxiety over food. And also increased mental health and well-being.
And the BMI varies from person to person. We all have different natural weight set points that are the most healthiest for us.
If your natural BMI is 30 and you diet down to BMI 22, let’s say, then by BMI you are “normal weight” but does it mean you are healthy? No. It doesn’t.
At the same time, if in your eating disorder you were BMI 19 and with full recovery you gain to BMI 28 you will be much healthier now compared to lower BMI with an active eating disorder.
4. Our health is holistic and not always in our control
As we already talked about in this video our health is holistic and there are so many other ways to indicate health than with a BMI number and also to improve your health without weight loss.
Focus on other aspects of health like getting good sleep, enough rest and also lowering your stress levels. Include in good self-care practices and health behaviors like nourishing your body with enough food and healthy movement but also with a healthy mindset.
Also, know that our health is affected by so many factors and most of them are not in our control. And being healthy is not your moral value and doesn’t determine your worth.
You are good enough and valuable just as you are even with health issues. Losing the stigma around illness is also a very important aspect of our health as oppression and discrimination never made anybody healthy.
5. Make peace with your body to become healthier
Focusing on improving your relationship with yourself and your body helps you become healthier. As we talked about – mental health is also health.
Hating your body won’t help you become healthier. And also, loving and accepting your body won’t make you any less healthy. Quite the opposite. Making peace with your body can actually help you become healthier as you let go of your own body criticism and self-oppression that creates so much stress in your life.
Because shaming your body and self-objectifying yourself will only contribute to more stress and therefore more poor health.
Now you understand why the BMI number is BS and is not an accurate measure of health.
And you also know that trying to intentionally lose weight to lower the BMI number will also come with a host of negative side-effects as diets don’t work and will cause your body to fight against weigt loss.
And there are much better and scientifically proven more effective ways to become healthier, things like Health At Every Size Approach, intuitive eating, fully recovering from eating disorder and dieting, focusing on other aspects of health like getting enough sleep, reducing stress, developing good self-care habits, and also losing the weight stigma and becoming weight neutral and accepting your body to improve your mental health as this is also a huge part of your overall health.
If you start to focus on these things your health will improve without needing to focus on weight or lose weight. And this is a much better long term sustainable approach to health that weight loss dieting.
And if you want to know more about recovery and how to do it step by step then please read m book “BrainwashED”
If you wish to work with me one one one, then I offer 12-Week Recovery Coaching where I can help you go through your recovery step by step and offer support and accountability. Read more and apply HERE.