AMA: Use other measures in addition to BMI when diagnosing obesity
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Key takeaways:
- BMI does not differentiate body lean mass from body fat mass, nor does it represent all ethnic and racial groups.
- The AMA suggests using it in tandem with other valid measures.
The AMA House of Delegates adopted a policy encouraging physicians to use BMI in conjunction with other valid measures when assessing patients for overweight or obesity.
Under the policy, the AMA said it acknowledges that the use of BMI has led to “historical harm” and “racist exclusion,” and its use is based on data collection from earlier generations of non-Hispanic white populations.
In addition to BMI, the AMA said that physicians may use measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic or metabolic factors.
The policy is part of the AMA’s Council on Science and Public Health report, which explored the limitations and potential harms of widespread use of BMI as a diagnostic tool. According to the report, the BMI classification system is “misleading regarding the effects of body fat mass on mortality rates.” Although it is easy to use and inexpensive, “BMI does not differentiate between body lean mass and body fat mass,” the report stated. It also does not consider body fat location nor represent all racial and ethnic groups. For example, previous research has shown that individuals of Asian ancestry may develop adverse health conditions and outcomes at a lower BMI compared with other populations.
Other factors, including gender, age, lifestyle and the duration of time spent in certain BMI categories, may also “significantly affect interpretation of BMI data,” according to the report.
“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,” Jack Resneck Jr., MD, immediate past president of the AMA, said in the 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.”
References:
- AMA adopts new policy clarifying role of BMI as a measure in medicine. https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine. Published June 14, 2023. Accessed June 14, 2023.
- Report of the Board of Trustees. https://www.ama-assn.org/system/files/a23-handbook-refcom-d.pdf. Accessed June 14, 2023.
Perspective
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Fatima Cody Stanford, MD, MPH, MPA, MBA, MACP, FAAP, FAHA, FAMWA, FTOS
I am excited to see the AMA making efforts to recognize obesity as a chronic, multifactorial disease. I am pleased with their recognition that BMI is a screening tool, not a diagnostic one. This will help us recognize the heterogeneity of a person’s body, with a recognition of differences in minoritized individuals.
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