‘A problematic history’: BMI alone is not good enough, says new AMA report

Doctors need to look beyond a patient's body mass index when making a diagnosis or assessing risk of certain diseases because this "imperfect" measure of fat. That's the key takeaway from a new report released recently by the American Medical Association (AMA). The AMA now recommends using BMI in conjunction with other valid measures of risk, such as visceral fat, relative fat mass using a height-to-waist ratio, as well as waist circumference. Genetic factors, family history of diabetes and heart disease, as well as metabolic factors like high blood pressure and fasting blood sugar levels, should also be considered, according to a Live Science article. In its report, the AMA highlighted the critical limitations of BMI, in particular its failure to differentiate between body fat and lean body mass, and to account for the distribution of excess fat in different areas of the body. The latter is particularly important because greater upper body fat is linked to a higher risk of type 2 diabetes and coronary artery disease. Read: American Psychiatric Association new guidelines on eating disorders BMI also does not accurately measure body fat in various groups because it does not factor in differences in body shape and composition among people of different sexes, ages, races and ethnicities, according to a Live Science news report. The AMA pointed to the BMI's "problematic history," noting that the scale was primarily based on data collected from previous generations of non-Hispanic white populations, which means it may not accurately reflect the disease risk for all patients. For example, evidence suggests that at the same BMI, Black and Hispanic women have a slightly higher risk of developing type 2 diabetes compared to white women, while Asian women have double the risk of white women. The widespread use of BMI in medical research has skewed the understanding of disease and death risks associated with obesity, according to the AMA report. Many studies that find a correlation between high BMI and disease or death fail to account for other factors that may influence risk, such as smoking history, alcohol use, medication use or family history of disease. Read: Can imaginary eating help people eat less? These studies also often fail to consider the expected weight fluctuations with age or the amount of time spent in a specific BMI category, which can impact later disease risk. Relying solely on BMI can result in the underdiagnosis and undertreatment of eating disorders, added the report. That's because patients with "normal" or "above normal" BMIs may not be identified as needing treatment, leading to substandard care. There are also numerous concerns about the use of BMI as a measure of body fat and diagnosing obesity. Physicians need to understand the benefits and limitations of BMI in clinical settings to provide the best care for their patients, according to the AMA report. Read: New guidelines on type 2 diabetes remission

‘A problematic history’: BMI alone is not good enough, says new AMA report

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