Since stating my intention to join the #BackTo21 campaign to get my BMI back to what it was when I was 21 years of age, I have had several emails and direct messages on social media questioning the wisdom of my intention.
 |
| Photo by NeONBRAND on Unsplash |
It is clear that despite BMI being a relatively poor metric of health there is overwhelming evidence that at a population level it predicts poor health outcomes. Importantly there is new data that indicates the target BMI for the prevention of type 2 diabetes and the metabolic syndrome depends on your ethnicity. For people of South Asian origin, there is a call to reset the BMI cutoff to 23.9, which for most people is within the normal range.
At the same time, there is a call to classify obesity as an important social determinant of health. Arnaud Chiolero argues below for using BMI as a socioeconomic indicator. Do you agree?
Isn’t it quite amazing that in a previous era corpulence was a sign of affluence, whereas in the modern era obesity is now a sign of poverty? How did we get here?
Getting back to my #BackTo21 campaign; I believe as a doctor I need to walk the talk. How can I tell my Asian patients to drop their BMIs to below 24 if I am not prepared to do it myself? At present my BMI is 25.4 and hopefully, in 12 months time, it will be 22. Instead of trying to talk me out of joining the #BackTo21 campaign, why don’t you join me?
Arnaud Chiolero. Body mass index as socioeconomic indicator. BMJ 2021;373:n1158
Members of the UK parliament have called for an end to the use of body mass index (BMI) as a marker of health because it would inspire “weight stigma, contribute to eating disorders, and can damage an individual’s body image and mental health.” While BMI is appealing because it is easy to measure, it is a notoriously peculiar health indicator, and not a simple marker of adiposity and related health risk.
Despite its limitation as a health indicator, I argue that BMI could be considered as a socioeconomic indicator.
On the one hand, BMI is the result of a multilevel, environmental, socioeconomic, and life course interplay of causal factors. This may explain why it relates in a complex way to various health outcomes and mortality. For instance, there is a U shaped relationship between BMI and mortality, with an optimum level changing with age—high BMI being a weaker predictor of increased mortality in older compared with younger people.23
On the other hand, the socioeconomic patterning of obesity is well documented.4 In high income countries, high BMI is more frequent among the less wealthy, while the reverse is true in numerous low and middle income countries. The increase in mean BMI has also followed the socioeconomic development in many countries worldwide and, with the concomitant reduction in the prevalence of underweight, is a favourable trend. It could therefore be wiser to use BMI as a socioeconomic indicator, at an individual and at a population level, rather than a mortality or any other health outcomes predictor.
Jacqui Wise. Diabetes: BMI cut-offs designed to trigger action are too high for some ethnic populations, say researchers. BMJ 2021;373:n1217
When compared with the risk for developing type 2 diabetes at a BMI of 30.0 in White populations, the equivalent risk in people of South Asian origin occurred at a BMI of 23.9. Lower equivalent cut-offs were also found in Chinese (26.9), Black (28.1), and Arab (26.8) populations.
Conflicts of Interest
MS Research
Medium
Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not reflect the position of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust.
How much do you weigh then?
ReplyDelete76 kg compared to 89 kg at present; all I need to do it lose 13 kg or 2 stone.
DeleteCan you let us in your plans; how are you going to get back to what you weighed when you were 21?
ReplyDeleteExercise, exercise, exercise and a low-carbohydrate diet and intermittent fasting.
Delete