The Truth About BMI: A Flawed Metric for Modern Health?
by Zubi Suleman, MD, Junaid Shahzad, M2, Sona Shahzad, M1
Body Mass Index( BMI) is widely used in clinical settings as an anthropometric index to assess various disease risks and to classify underweight and overweight status. It is also included in the diagnosis and monitoring of eating disorders( EDs). However, BMI is fundamentally limited as it fails to capture essential markers of body composition, such as body fat percentage and muscle mass, as well as behavioral severity and metabolic health. As a result, BMI can be misleading when used as a sole marker for ED diagnosis and treatment.
History
BMI was first conceptualized in 1832 by Adolphe Quetelet, who was a Belgian statistician, mathematician and astronomer. He was inspired by his passion for statistical analysis and bell-shaped curves to establish quantifiable characteristics of the“ normal man.” He developed the Quetelet Index: weight divided by height squared [ Adolphe Quetelet, 1796-1984 ]. This statistical index was designed for population-level anthropometric studies rather than individual diagnosis( Keys, Fidanza, Karvonen, Kimura, & Taylor, 1972). In the 1950s, Louis I. Dublin, a statistician and vice president of Metropolitan Life Insurance Company, established tables of normal weights for clients after the company noted that an increasing number of claims were coming from their policyholders with larger weights [ Adolphe Quetelet, 1796-1984 ]. Dublin’ s tables did not specify age, though they did place clients into three categories based on their frame:“ small,”“ medium” and“ large”( Adolphe Quetelet, 1796-1984, Keys et al). Further developing Adolphe Quetelet’ s Index, physiologist Ancel Keys established the‘ body mass index’( BMI) in 1972. The term BMI is frequently used today, particularly in discussions of how body mass and obesity relate to health and disease. Of note: Dublin’ s tables were established when over half of men and about a third of women were smokers.
16 LOUISVILLE MEDICINE