
Wrestling with BMI in the Annals of Internal Medicine
It’s nice, really. People are paying attention to obesity, its definition, and the bias they bring to the subject. If you need evidence of this, look no further than a series of three new editorials in the Annals of Internal Medicine. They’re wrestling with BMI and the definition of obesity. The authors present a range of views that are thoughtful and complimentary.
Even though (or perhaps because) this is a subject people have mangled beyond recognition, these editorials are welcome.
Not So Fast
Adolfo Cuevas and Walter Willett suggest some of the wrestling with BMI has gone too far in the direction of nihilism:
“We contend that BMI, although not a perfect measure of adiposity, remains a useful population level and clinical tool for addressing adiposity, including within groups defined by race and ethnicity. Further, BMI can be useful for understanding the effects of structural racism on body weight and heath.”
They point out that, despite its flaws, it’s a pretty good marker for cardiovascular and mortality risk.
One Size Does Not Fit All
Simar Bajaj and colleagues make the point that without meticulous corrections for risk thresholds in Asian populations, BMI has issues. Long ago, the World Health Association identified the need for new BMI categories for many Asian populations. They lament that the U.S. has not adapted:
“Twenty years later the United States has not developed more granular BMI categories despite heterogeneity among Asian American ethnic groups. With recent pushes toward disaggregated data and personalized medicine, we believe that increasing granularity for Asian Americans can pave the way for similar efforts among all racial and ethnic groups, making BMI more accurate, tailored, and equitable.”
Diseases and Risks
Claiming the final word for herself, Christina Wee raises issues with framing obesity as a disease, rather than putting more effort into accurate risk stratification to properly stage obesity:
“Framing obesity exclusively as a disease rather than a broader, more inclusive construct may have unintended consequences—including reinforcing the weight bias this framing was in part intended to combat.”
We admit to growing tired of this argument about whether obesity is a disease or merely a risk factor for other diseases that people take seriously. It mainly serves as an excuse to delay and defer highly effective treatment. But people advance these arguments honestly as they wrestle with BMI and the disease of obesity.
Anyone who tells you they have the right answer is kidding themselves.
Click here for the commentary by Cuevas and Willett, here for Bajaj et al, and here for the Wee editorial. For further perspective from Medscape, click here.
The Wrestlers, painting by Thomas Eakins / WikiArt
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July 24, 2024