How important is BMI? A revelation about weight and health

Body mass index: BMI. A number on the scale, a line in the chart. What does it matter? And why does it matter so much?

I’ve found myself contemplating these questions and my BMI more often now that I’ve begun my training as a clinical ethicist. In this role I am constantly confronted by my own mortality and fragility.

One responsibility of ethics consultants in some hospitals is to attend medical review boards where surgeons, cardiologists, nurses, social workers, and others decide who may be listed for organ transplants.

Another responsibility is to round with an ICU team in the morning, keeping an eye out for situations where ethical issues could arise. In both of these settings, when a patient is overweight or obese, the team mentions the patient’s weight or BMI.

I can see why. Clearly something is medically wrong with this patient if they require being in the ICU or a new organ, and obesity can be a contributing factor to so many serious conditions. This got me thinking, “Wow, I should lose some weight so I don’t end up here someday.”

A recent Huffington Post article helped illuminate why this thinking may be misguided. In the piece, people around the country shared their life-long struggles with weight and body image, discussing the diets they’ve tried and the bullying they’ve experienced.

The author cites studies indicating that BMI and health are not perfectly correlated; one study found that BMI status exerted no influence on the risk for coronary artery disease, stroke, and mortality. The study showed that metabolic health status (measured by blood pressure, fasting blood glucose, and lipid profile) was a much more powerful indicator of risk for diabetes than BMI.

While these studies admit “healthy obese” is controversial, they show that the hyper focus on fat and obesity may be misplaced.

This article helped me shift the focus of my own goals from “lose weight” to “be healthier.” It also empowered me to challenge my patient’s clinicians if they attempt to reduce a patient to a number.

It’s funny, though. I felt inspired after researching this blog post that my goal should be health and not weight. But within just a few days, I was right back to thinking “oh, if only I were skinnier.” Clearly, the conflation of weight and self-worth will take much longer for me to untangle than it did for me to write and research this post. It will likely be a life-long struggle.

-By Jamie Crist, J.D., M.A. clinical ethics fellow in the Center for Medical Ethics and Health Policy at Baylor College of Medicine

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