Weâve all heard that thereâs an obesity epidemic in the U.S. And if youâre one of the many people who has been told that youâre âoverweight,â youâve probably had at least one talk with a doctor about your Body Mass Index (BMI).
So what is BMI? Supposedly, itâs an index that allows us to find the healthy weight for our height. You can even check your BMI by typing your height and weight into one of the many BMI calculators on the web. Weâve been told that if itâs 25 or above, weâd better cut the calories and hit the gym or weâre likely to pay for it with health problems later in life.
Now the risks of obesity are real. But can we rely on a single number to tell us if someone is overweight? How reliable is BMI really?
The answer is that BMI works reasonably well at what it was first designed for: looking at broad trends in the health of large groups â to see if thereâs an obesity epidemic. It was never designed to assess the âhealthy weightââ of an individual, so it really only sort-of works at that.
How can something work for a group of people but not for a person in that group? The answer is that as long as it works for most people (say 2/3 of the population), the errors will tend to cancel out so the trend will be valid. When BMI was first used to track obesity in groups, it was shown to work about as well as the more difficult process of calculating body fat percentage.
But the current BMI formula makes a very strange assumption. It assumes that the best way to guess how much fat you carry is to divide your weight by the square of your height (your height, multiplied by itself). This takes into account the fact that we need to get wider as we get taller, but it seems to miss the fact that we also need to get thicker, from back to front. In other words, the current BMI formula appears to assume that weâre all two dimensional, as though weâre cut out of cardboard.
How well does BMI work in practice? Well, if youâre between about 5â5â and 5â9â, itâs not bad. On the other hand, an NFL quarterback in top condition might be 6â2â, 220 pounds and so have a BMI of 28. His doctor might tell him heâs overweight, but this person doesnât carry a lot of fat. A standard BMI chart also shows us that a person who is 6â8â is considered âoverweightâ at 230 pounds and ânormalâ at 170 pounds. That canât be right.
At the other extreme, my daughter is 4â4â and 70 pounds Thatâs a very average height and weight for a 9-year-old girl. But pediatricians will say sheâs overweight because her BMI is 18. Huh?! What happened to 25? Well, BMI has to be adjusted for age in children and, the truth is my daughter is not 9 years old, sheâs only 6. A BMI of 18 is fine if youâre 9, but itâs too high for a 6-year-old (even if that 6-year-old is as tall as an average 9-year-old). How does any of that make any sense at all?
BMI is supposed to correct for height, but you can see that it doesnât unless youâre close to the average adult height. For everyone whoâs not, I have a solution: recalculate BMIs, only this time account for all three of our dimensions. Squaring our height is appropriate for two-dimensions, but for those of us here in the 3D world, we should multiply in our height one more time (to the third power). Itâs not perfect, but I think itâs far better than what weâve got now, because this formula doesnât assume that weâre cut out of cardboard.
Iâve created a chart (here) using the revised formula (weight/height3). Since the formula is different, all of the BMI numbers have changed. Using this chart, a person with a BMI of 9 is probably underweight at any height. A person with a BMI of 10 or 11 is definitely skinny, but probably OK if they have a small frame. A BMI of 12-13 is good for a person with an average build, and a large-framed person would still be healthy with a BMI of 14. Past that, unless youâre a super muscular athlete, you probably need to lose a few pounds.
Going by this chart you can see that someone who is 4â6â tall and weighs 74 pounds would have a BMI of 13. So would someone who is 5â even at 101 pounds, 5â6â at 135 pounds and 6â6â and 222 pounds. And for genuine athletes, a 6â8â NBA star who weighs about about 250 pounds would have a BMI thatâs between 13 and 14.
Now even this chart shouldnât be used as an absolute indicator of whether a personâs weight is ideal for their height. Other factors such as a personâs body habitus and how much muscle and fat they have should always be considered.
Still, BMI is being used to define an epidemic in a country. Also, insurance companies are relying more on BMIs to assess a patientâs health risk and doctors are now required to asses the BMI of every patient we see. If weâre going to rely on this index for so much it might help to at least bring it into the 3D world and finally start calculating it more sensibly.
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