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Why BMI is a flawed way of determining health

Zerodha founder and CEO Nithin Kamath recently offered bonuses for employees who cut their body mass index. But weight isn't an indicator of health.

Health is not inextricably linked to body weight
Health is not inextricably linked to body weight (iStockphoto)

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As a society, fatness scares us. Something makes us slightly uncomfortable when we see it on other people or when the fabric of our favourite dress stretches. If you don't think fat scares you, try this challenge on for size: Before a big event where style is of the essence, put on an outfit that clings a little uncomfortably, stand in the mirror, and tell me honestly if you feel like attending or staying at home in your sweats. If your first reaction is to feel distressed, you may want to ask yourself why.

Most people who display a relative discomfort around "fat" tend to mask their discomfort by appearing virtuously concerned about someone's "health." Take, for instance, Zerodha founder and CEO Nithin Kamath's recent misguided tweet, incentivising weight loss for his team members.

Not surprisingly, the tweet had people pointing out that the statement reeked of discrimination and body shaming.

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It also pointedly ignored what science is showing, and the body positivity movement is shouting about health and size not being inextricably linked. Body mass index isn't the only measure of fitness, obesity or body size.

Yet, many people, including Nithin Kamath, clearly struggle to come to terms with this, unequivocally concluding that being fat equals poor health. Once our minds are made up, we find it difficult to separate fact from opinion, and all of our subsequent subtle actions and reactions stem from this belief. It's as if we think we can run a series of diagnostic tests with our eyes to determine if that person in front of us has healthy metabolic parameters. We fall back on a lazy way of thinking and tar everyone with the same brush.

And yet, the very basis of our viewpoints on the ideal weight may be flawed.

What if I told you that your doctor's office wasn't responsible for the laminated ideal weight charts that are sticky-tacked to their walls; life insurance companies created them? E S Weigly's 1984  piece titled Average? Ideal? Desirable? A brief overview of height-weight tables in the United States and published in the Journal of the American Dietetic Association shows how Metropolitan Life Insurance company published the ideal bodyweights for men and women in 1983. These findings weren't standardised or in any way conclusive, yet we use them. The data used to create these charts are fraught with problems, as they don't account for genetics, body type, environment, or ethnic diversity.

A second way of determining a person's health related to their weight is the BMI scale (Body Mass Index). This mathematical calculation takes into account a person's weight compared to their height and then categorises them as underweight, healthy, overweight or obese. Although this categorisation method is still wildly popular, it's significantly flawed. If you take a Hollywood superstar like Dwayne Johnson, he weighs more than the BMI ideal for his height because he is action-packed with muscle. No one would dare say that he is obese or even overweight. According to Medical News Today, muscle is 18% denser than fat, meaning someone who has more muscle on their body will inevitably weigh more, making this math equation inaccurate. Furthermore, multiple studies published in the International Journal of Obesity have concluded that BMI actually wasn't a reliable predictor of health.

Therefore, these flawed forms of judging a person's weight and health can have consequences beyond the unpleasant tittering gossip behind someone's back. According to the American Psychological Association, overweight patients often wait longer before getting medical help which can exacerbate medical issues. And because doctors are humans with biases, overweight patients are sometimes offered different treatments than average-weight patients and are not represented in medical studies that impact drug dosage administration. As a result, physicians may ultimately misdiagnose illnesses by assuming that their symptoms result from being overweight, not something more sinister.

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This is not to say that I am glorifying obesity and ignoring its health implications. Yes, being overweight can contribute to metabolic diseases, which impact your quality of life and potentially reduce your life span. Also, excess weight on your joints and bones can lead to other complications. And yes, I do not think that being sedentary, overeating processed foods and refined sugars, and trans fats is a wise way to live—it does, indeed, increase your risk of inflammation and inflammatory diseases.

The problem is this: we have tied values and morals to that excess weight. Words like "unhealthy" (as if health is a virtue), lazy, gluttony, or slovenly are thrown around in association with having excess weight. We accept these terms as synonymous with being overweight when they couldn't be further from the truth—just as you can't say that all average-weight people are healthy or all attractive people are successful. In reality, the issue of size is complex. Our modern lives depend on processed foods. Income disparity creates urban food deserts (areas lacking affordable and good quality food options), increased sedentary lifestyles, and a wildly unbalanced work-life balance. We exist in conditions that support excess weight gain.

We need to learn to uncouple size and health. The world needs acceptance and not just of someone's body size. We need to accept that people with opinions aren't the arbiters of someone's worth.

I hope you are listening, Mr Kamath.

Jen Thomas is a Chennai-based women's weight-loss coach

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