How useful is the body mass index (BMI)?

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

Do you know your BMI? Increasingly, people know theirs, just as they know their cholesterol.

If you don’t know your BMI, you can use a BMI calculator available online, including this one at Harvard Health Publications. All you need is your height and weight. Or, you can calculate it yourself, using this formula:

BMI = (Weight in Pounds x 703) / (Height in inches x Height in inches).

So, now that you know your BMI, is it worth knowing? What are you going to do with it?

What your BMI means

To understand what your BMI means, it’s useful to take a step back and understand what it’s measuring and why it’s measured.

BMI is a calculation of your size that takes into account your height and weight. A number of years ago, I remember using charts that asked you to find your height along the left side and then slide your finger to the right to see your “ideal weight” from choices listed under small, medium, or large “frame” sizes.

These charts came from “actuarial” statistics, calculations that life insurance companies use to determine your likelihood of reaching an advanced age based on data from thousands of people. These charts were cumbersome to use, and it was never clear how one was to decide a person’s “frame size.”

BMI does something similar — it expresses the relationship between your height and weight as a single number that is not dependent on “frame size.” Although the origin of the BMI is over 200 years old, it is fairly new as a measure of health.

What’s a normal BMI?

A normal BMI is between18.5 and 25; a person with a BMI between 25 and 30 is considered overweight; and a person with a BMI over 30 is considered obese. A person is considered underweight if the BMI is less than 18.5.

As with most measures of health, BMI is not a perfect test. For example, results can be thrown off by pregnancy or high muscle mass, and it may not be a good measure of health for children or the elderly.

So then, why does BMI matter?

In general, the higher your BMI, the higher the risk of developing a range of conditions linked with excess weight, including:

  • diabetes
  • arthritis
  • liver disease
  • several types of cancer (such as those of the breast, colon, and prostate)
  • high blood pressure (hypertension)
  • high cholesterol
  • sleep apnea.

Current estimates suggest that up to 365,000 excess deaths due to obesity occur each year in the U.S. In addition, independent of any particular disease, people with high BMIs often report feeling better, both physically and psychologically, once they lose excess weight.

And here’s why BMI may not matter

It’s important to recognize that BMI itself is not measuring “health” or a physiological state (such as resting blood pressure) that indicates the presence (or absence) of disease. It is simply a measure of your size. Plenty of people have a high or low BMI and are healthy and, conversely, plenty of folks with a normal BMI are unhealthy. In fact, a person with a normal BMI who smokes and has a strong family history of cardiovascular disease may have a higher riskof early cardiovascular death than someone who has a high BMI but is a physically fit non-smoker.

And then there is the “obesity paradox.” Some studies have found that despite the fact that the risk of certain diseases increases with rising BMI, people actually tend to live longer, on average, if their BMI is a bit on the higher side.

Should we stop giving so much “weight” to BMI?

That’s exactly what’s being asked in the discussion generated by a new study. For this study, researchers looked at how good the BMI was as a single measure of cardiovascular health and found that it wasn’t very good at all:

  • Nearly half of those considered overweight by BMI had a healthy “cardiometabolic profile,” including a normal blood pressure, cholesterol, and blood sugar.
  • About a third of people with normal BMI measures had an unhealthy cardiometabolic profile.

The authors bemoaned the “inaccuracy” of the BMI. They claim it translates into mislabeling millions of people as unhealthy and also overlooking millions of others who are actually unhealthy, but are considered “healthy” by BMI alone.

Actually, this should come as no surprise. BMI, as a single measure, would not be expected to identify cardiovascular health or illness; the same is true for cholesterol, blood sugar, or blood pressure as a single measure. And while cardiovascular health is important, it’s not the only measure of health! For example, this study did not consider conditions that might also be relevant to an individual with an elevated BMI, such as liver disease or arthritis.

Bottom line

As a single measure, BMI is clearly not a perfect measure of health. But it’s still a useful starting point for important conditions that become more likely when a person is overweight or obese. In my view, it’s a good idea to know your BMI. But it’s also important to recognize its limitations.

Comments:

  1. claire crawford

    of course healthy food are very helpful for heart health i think. both cholesterol and triglycerides are so important.

  2. Marcel

    bone, water, muscle and fat mass not measured therefor useless

  3. Dr Peddada Narasinga Rao

    As per the anthropological studies the nature had made the human bodies to exert to gather their food in around an area of 18.5 sq km. Whereas the modern man is not even exercising in an area of half the size. Instead of lean body mass, fatty bodies are favoured and even revered and ludicrously defend themselves. So much of attitudinal changes have taken place. Lifestyle modifications with judicious usage of everything that is available is the need of the hour

  4. ch.liaquat Ali

    Healthy food and life style make the life long.Vegetable,Fruit ,lean protein,Nuts and healthy fat, Gluten free whole grain ,Make the health perfect.it not increase BMI and remain away from fetal diseases.if increase the exercise it will made
    long the life.Some of bad habit like smoking excessively drinking and not adopting hygienic means carry toward early death.