Body mass index
The body mass index (BMI), or Quetelet index, is a measure for human body shape based on an individual’s weight and height. It was devised between 1830 and 1850 during the course of developing “social physics”. Body mass index is defined as the individual’s body mass divided by the square of their height. The formulae universally used in medicine produce a unit of measure of kg/m2. BMI can also be determined using a BMI chart, which displays BMI as a function of weight (horizontal axis) and height (vertical axis) using contour lines for different values of BMI or colors for different BMI categories.
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Usage
While the formula previously called the Quetelet Index for BMI dates to the 19th century, the new term “body mass index” for the ratio and its popularity date to a paper published in the July edition of 1972 in the Journal of Chronic Diseases by Ancel Keys, which found the BMI to be the best proxy for body fat percentage among ratios of weight and height; the interest in measuring body fat being due to obesity becoming a discernible issue in prosperous Western societies. BMI was explicitly cited by Keys as being appropriate for population studies, and inappropriate for individual diagnosis. Nevertheless, due to its simplicity, it came to be widely used for individual diagnosis, despite its inappropriateness.
BMI provided a simple numeric measure of a person’s thickness or thinness, allowing health professionals to discuss overweight and underweight problems more objectively with their patients. However, BMI has become controversial because many people, including physicians, have come to rely on its apparent numerical authority for medical diagnosis, but that was never the BMI’s purpose; it is meant to be used as a simple means of classifying sedentary (physically inactive) individuals, or rather, populations, with an average body composition. For these individuals, the current value settings are as follows: a BMI of 18.5 to 25 may indicate optimal weight; a BMI lower than 18.5 suggests the person is underweight while a number above 25 may indicate the person is overweight; a person may have a BMI below 18.5 due to disease; a number above 30 suggests the person is obese (over 40, morbidly obese).
Categories
A frequent use of the BMI is to assess how much an individual’s body weight departs from what is normal or desirable for a person of his or her height. The weight excess or deficiency may, in part, be accounted for by body fat (adipose tissue) although other factors such as muscularity also affect BMI significantly (see discussion below and overweight). The WHO regards a BMI of less than 18.5 as underweight and may indicate malnutrition, an eating disorder, or other health problems, while a BMI greater than 25 is considered overweight and above 30 is considered obese. These ranges of BMI values are valid only as statistical categories
| Category | BMI range – kg/m2 | BMI Prime |
|---|---|---|
| Very severely underweight | less than 15 | less than 0.60 |
| Severely underweight | from 15.0 to 16.0 | from 0.60 to 0.64 |
| Underweight | from 16.0 to 18.5 | from 0.64 to 0.74 |
| Normal (healthy weight) | from 18.5 to 25 | from 0.74 to 1.0 |
| Overweight | from 25 to 30 | from 1.0 to 1.2 |
| Obese Class I (Moderately obese) | from 30 to 35 | from 1.2 to 1.4 |
| Obese Class II (Severely obese) | from 35 to 40 | from 1.4 to 1.6 |
| Obese Class III (Very severely obese) | over 40 | over 1.6 |
United States
In 1998, the U.S. National Institutes of Health and the Centers for Disease Control and Prevention brought U.S. definitions into line with World Health Organization guidelines, lowering the normal/overweight cut-off from BMI 27.8 to BMI 25. The U.S. National Health and Nutrition Examination Survey of 1994 indicated that 59% of American men and 49% of women had BMIs over 25. Morbid obesity—a BMI of 40 or more—was found in 2% of the men and 4% of the women. The newest survey in 2007 indicates a continuation of the increase in BMI: 63% of Americans are overweight or obese, with 26% now in the obese category (a BMI of 30 or more). There are differing opinions on the threshold for being underweight in females; doctors quote anything from 18.5 to 20 as being the lowest index, the most frequently stated being 19. A BMI nearing 15 is usually used as an indicator for starvation and the health risks involved, with a BMI less than 17.5 being an informal criterion for the diagnosis of anorexia nervosa.
Health consequences of overweight and obesity in adults
The BMI ranges are based on the relationship between body weight and disease and death. Overweight and obese individuals are at increased risk for many diseases and health conditions, including the following:
- Hypertension
- Dyslipidemia (for example, high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides)
- Type 2 diabetes
- Coronary heart disease
- Stroke
- Gallbladder disease
- Osteoarthritis
- Sleep apnea and respiratory problems
- Some cancers (endometrial, breast, and colon).
Applications
Statistical device
The BMI is generally used as a means of correlation between groups related by general mass and can serve as a vague means of estimating adiposity. The duality of the BMI is that, whilst easy-to-use as a general calculation, it is limited in how accurate and pertinent the data obtained from it can be. Generally, the index is suitable for recognizing trends within sedentary or overweight individuals because there is a smaller margin for errors.
This general correlation is particularly useful for consensus data regarding obesity or various other conditions because it can be used to build a semi-accurate representation from which a solution can be stipulated, or the RDA for a group can be calculated. Similarly, this is becoming more and more pertinent to the growth of children, due to the majority of their exercise habits.[19]
The growth of children is usually documented against a BMI-measured growth chart. Obesity trends can be calculated from the difference between the child’s BMI and the BMI on the chart.[citation needed]
Clinical practice
BMI has been used by the WHO as the standard for recording obesity statistics since the early 1980s. In the United States, BMI is also used as a measure of underweight, owing to advocacy on behalf of those suffering with eating disorders, such as anorexia nervosa and bulimia nervosa.
BMI can be calculated quickly and without expensive equipment. However, BMI categories do not take into account many factors such as frame size and muscularity.[18] The categories also fail to account for varying proportions of fat, bone, cartilage, water weight, and more.
Despite this, BMI categories are regularly regarded as a satisfactory tool for measuring whether sedentary individuals are underweight, overweight or obese with various exemptions, such as: athletes, children, the elderly, and the infirm.
One basic problem, especially in athletes, is that muscle weight contributes to BMI. Some professional athletes would be overweight or obese according to their BMI, despite carrying little fat, unless the number at which they are considered overweight or obese is adjusted upward in some modified version of the calculation. In children and the elderly, differences in bone density and, thus, in the proportion of bone to total weight can mean the number at which these people are considered underweight should be adjusted downward.
Medical underwriting
In the United States, where medical underwriting of private health insurance plans is widespread, most private health insurance providers will use a particular high BMI as a cut-off point in order to raise insurance rates for or deny insurance to higher-risk patients, thereby reducing the cost of insurance coverage to all other subscribers in a lower BMI range. The cutoff point is determined differently for every health insurance provider and different providers will have vastly different ranges of acceptability. Many will implement phased surcharges, in which the subscriber will pay an additional penalty, usually as a percentage of the monthly premium, based on membership in an actuarially determined risk tier corresponding to a given range of BMI points above a certain acceptable limit, up to a maximum BMI past which the individual will simply be denied admissibility regardless of price. This can be contrasted with group insurance policies which do not require medical underwriting and where insurance admissibility is guaranteed by virtue of being a member of the insured group, regardless of BMI or other risk factors that would likely render the individual inadmissible to an individual health plan.