How did a simple search for the usefulness of BMI (Body Mass Index) as a diagnostic health tool turn into such a quagmire of misinformation, defensiveness and finger-pointing about body weight?
A single misstrike on the keyboard opened a social media wasteland, and whether you’re skinny or obese, male or female, there’s someone out there who abhors you. On top of that, they’re willing to use the most attention-grabbing vocabulary and images to drag you sufficiently far into their rabbit hole that some billionaire’s algorithm can take over feeding us their drivel—regardless of the serious negative consequences it may have for our health.
Body positivity—accepting our own body shape and size, and feeling good with ourselves—is being morphed into “normalizing” genuine obesity, confusing and hurting many of those most in need of support.
This was my first deep trip into social media’s misinformation morass, and it totally spun me out. How can hundreds of bloggers and influencers be promoting and endorsing obesity as a healthy lifestyle choice?
So here’s the thing. This column is called The Balanced Life, yet this BMI research has me seriously wondering if such a concept is disappearing. We don’t have to get into politics or Trumpism or whatever. As a population we’re just getting crazy, and there are obviously enough of us boarding this Titanic that it’s paying its own way.
Audrey Gordon, “yrfatfriend”, has 303,000 followers on Instagram alone. A search of her site yields legitimate complaints about healthcare systems that sometimes callously misdiagnose and stigmatize overweight people based, in part, on their BMI numbers. But how are we to respond when this surreptitiously morphs into obesity-promotion that claims there is no harm in being 100 pounds overweight? There’s a difference between being happy in your own body and promoting obesity, which the World Health Organization formally recognized as a global epidemic in 1997.
In 2018, concern began to be voiced in medical and social journals about how using Body Mass Index (a simple calculation based on body weight divided by height) as a first step to discovering the reasons for many health conditions and risks, was losing its relevancy. The reasons were essentially twofold—poor diagnosis often resulted because of BMI assumptions, and stigmatization and lack of trust in medical practitioners and the system created further health issues down the road.
Is this still an issue? Yes.
In June 2023 the American Medical Association issued the following statement: BMI is an imperfect way to measure body fat in multiple groups given that it does not account for differences across race/ethnic groups, sexes, and age-span.
They added that waist circumference, fat distribution and genetic factors should instead be used by clinicians. Increasingly, there is a feeling within the medical community that a non-comprehensive “lose weight” diagnosis based on BMI scores is generally unhelpful, and that a brusque “lose weight” recommendation, or calling a patient obese, can lead to mental health issues.
And just this week, The Lancet Diabetes & Endocrinology journal published the years-long study results of an international commission, which concluded that obesity should be split into two categories: "Pre-clinical obesity," and "Clinical obesity," sidestepping the traditional BMI approach. This excellent New York Times summary of the commission's findings and recommendations makes for a reassuring antidote to social media ignorance, as does this BBC report.
The reasons that BMI measurements, introduced in 1972, are no longer sufficient are many. Muscle is more dense than fat. If you regularly participate in aerobic and resistance exercise, you may have a healthy percentage of body fat and still be above the “normal” BMI range. Fat is more volumetric, and some varieties gravitate to our waists.
Not all fats are equally dangerous
Not all fats are equally dangerous. As we age, our hormones evolve, resulting in body shape changes. Some illnesses cause people to retain fluids, and post-pregnant women can store necessary weight for up to two years. Size is different for everyone, and your eating, smoking, and alcohol consumption, to mention a few things, can be a better predictor of health than BMI.
Many recent studies have proven treatment bias can be caused by over-reliance on BMI-based diagnosis, and is especially dangerous when researchers and doctors assume obesity is the problem rather than perhaps a symptom or unrelated circumstance.
Recent studies have found that some people avoid seeking medical care because of fear of being stigmatized, which can lead to emotionally-driven responses such as binge eating, restricted eating, bulimia nervosa, weight cycling and eating anxiety. According to a Yale School of Medicine study, stigma actually adds fuel to the obesity epidemic. More than half of those experiencing weight stigma have at least one psychiatric disorder. Weight stigma can also lead to stress, which in turn impacts blood pressure, cardiac health, insulin resistance and other related issues.
Recognizing that BMI is less useful than historically assumed is a good thing, as is body neutrality – the understanding that we don’t have to love our bodies unconditionally or obsess about them either positively or negatively.
Body positivity, the social movement that promotes a positive view of all bodies, male and female, regardless of shape, size, skin tone and physical abilities has its positives, with caveats.
When Lizzo shares in interviews and on social media, “I want to be body-normative, I want to normalize my body,” with her millions of fans, it’s difficult for me to accept this without an asterisk and footnote about the multitude of proven health issues obesity is related to. Her labelling such a comment as body positivity is dangerous misrepresentation.
A 2018 British Journal of General Practice paper titled “Childhood obesity: running from this crisis of ‘normalization’ won’t work,” claims that in broad terms, obesity in kids is being normalized, causing significant problems for healthcare providers. In Britain, the study found more than two thirds of parents with overweight seven-year-olds described the child as being of normal weight. The study concluded “This process of normalization is not benign; perceived necessity to resolve childhood obesity will wither if it vanishes into a “new normality.”
This is not unexpected, nor is the fact that so many are choosing sides rather than working collaboratively to improve health outcomes for everyone. Stigma and out-of-control body positivity are an equally toxic minefield.
The future of health care, both personal and systemic, depends on us understanding how subjects such as these exemplify the importance of facts, civil discourse and compassion.
