AMA asking physicians to de-emphasize BMI use for health and obesity assessment

AMA asking physicians to de-emphasize BMI use for health and obesity assessment | Image Credit: © Keith Frith - © Keith Frith - stock.adobe.com.

The American Medical Association (AMA) House of Delegates is asking physicians to de-emphasize the use of the body mass index (BMI) measurement when evaluating health and obesity in patients, after voting to adopt a new policy at the 2023 annual meeting in Chicago, according to a recent STAT article.¹

The AMA Council on Science and Public Health contained the newly-adopted policy, "which evaluated the problematic history with BMI and explored alternatives," according to a press release from the association.²

According to STAT, the association recognized BMI has been used for “’racist exclusion’ and has caused ‘historical harm.’”¹ The association has further issues with BMI as a measurement because BMI is "based primarily on data collected from previous generations of non-Hispanic white populations."²

According to the Centers for Disease Control and Prevention (CDC), BMI is “a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet).” The CDC lists that BMI can point out high body fatness and that it “screens for weight categories that may lead to health problems, but it does not diagnose the body fatness or health of an individual.”³

"The AMA's move to de-emphasize the use of BMI is timely and necessary," said Whitney Linsenmeyer, PhD, RD, LD, assistant professor of nutrition and dietetics, Saint Louis University, spokesperson, Academy of Nutrition and Dietetics. "In addition to the rationale cited by the AMA (i.e. problematic history, preferred alternatives), this landmark move will catalyze a paradigm shift where health care physicians can focus on a patient's overall health, rather than body size alone."

The AMA suggests BMI be used in conjunction with other valid measures of risk such as, but not limited to "measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors." Further, according to the press release, "The AMA also recognizes that relative body shape and composition differences across race/ethnic groups, sexes, genders, and age-span is essential to consider when applying BMI as a measure of adiposity and that BMI should not be used as a sole criterion to deny appropriate insurance reimbursement."²

“There are numerous concerns with the way BMI has been used to measure body fat and diagnose obesity, yet some physicians find it to be a helpful measure in certain scenarios,” said Jack Resneck Jr., MD, Immediate Past President, AMA, in the press release. "It is important for physicians to understand the benefits and limitations of using BMI in clinical settings to determine the best care for their patients.”²

"BMI can be used in tandem with other measures of body composition and body shape, such as body fat percentage, waist circumference, and waist-to-hip ratio," said Linsenmeyer. "BMI may be used as an initial screening tool for further evaluation, such as patient with an underweight BMI who may require further evaluation for malnutrition."

An AMA subcommittee wrote in a report ahead of the vote that fat and lean mass are not differentiated by BMI and that the measurement does not take into consideration body fat location. Further, the subcommittee wrote that cutoffs do not represent racial group risks appropriately.¹

This article was published by our sister publication Contemporary Pediatrics.

References:

1. Trang B, Chen E. AMA asks doctors to de-emphasize use of BMI in gauging health and obesity. STAT. June 13, 2023. Accessed June 14, 2023.https://www.statnews.com/2023/06/13/bmi-obesity-ama-criticism/

2. AMA adopts new public health policies to improve health of nation. American Medical Association. June 14, 2023. Accessed June 14, 2023. https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-public-health-policies-improve-health-nation-6

3. Body mass index (BMI). Centers for Disease Control and Prevention. June 3, 2022. Accessed June 14, 2023. https://www.cdc.gov/healthyweight/assessing/bmi/index.html