BMI and Health: Should we still bother about the number?

Timilehin Olaniyan • June 20, 2023

BMI and Health: Should we still bother about the number?

There is no perfect number for a "healthy weight" for all people. Everyone is different, and the right weight will be different depending on the person," fitness trainer and coach Arabella Featherstone declares.

Medicine uses figures to assess health and measure risks, and the BMI (Body Mass Index) is one of those figures. But for these numbers to make sense, they must be inclusive.

Simply put, the BMI is a measurement that uses weight and height to classify an individual as underweight, normal weight, overweight, or obese. Clinicians use BMI to assess a patient's risk for diseases.

However, the integrity of BMI in predicting an individual's state of health is on trial. What are the limitations of BMI, and how should we use BMI?

What does BMI mean?

BMI is a standard metric for measuring overall wellness via weight status.

To calculate your BMI at home, measure your height and weight using a scale and use one of the formulas below to get your BMI:

Metric units: weight (kilogram) divided by height squared (meters)

BMI = kg/m2

Imperial units: weight (pounds) divided by height squared (inches) multiplied by 703

BMI = 703 (lbs/in2)

Alternatively, you can use a BMI calculator, like the one provided by the National Institutes of Health (NIH). Once you calculate your BMI, you can compare the figure with the standard in the scale below to know where you fall.

In fairness to Lambert Adolphe Jacques Quetelet, the mathematician who developed BMI, he used it as a tool for population studies. That is, the numbers may not be ideal for individuals.

The medical community frequently uses it to mirror a patient's health status, but concerns are growing about its reliability and suitability.

Should we still rely on BMI? Experts weigh in.

BMI puts the normal weight between 18.5 to 24.9kg/m2. That means any figure above or below this range is "abnormal." In fairness to BMI, several studies conclude that people with a BMI that falls outside this normal range have an increased risk of certain diseases.

An article by the NIH identifies some health risks of being overweight and obese as

heart disease
stroke
diabetes
sleep apnea
kidney diseases
and more.

These are some of the most common chronic conditions, so the attention that BMI gets is understandable. And most times, BMI measurement is a routine check in the hospital.

But is BMI worth the hype?

Experts don't think so.

Experts Identify some limitations.

It doesn't factor in other things that contribute to health.

"The number does not tell the full story about a person's presence or absence of disease, nor does it actually tell the story of a person's health," says Wendy Schofer, a pediatrician and weight coach.

Schofer encourages her patients and community clients to see health as a dynamic, ongoing process. She focuses on the history and functional assessment instead of the BMI.

"We all have health, not defined by a number or an action. We have health at all sizes and body shapes," Schofer explains.

Michael Green, a board-certified obstetrician-gynecologist with the Northridge Medical Center, expresses a similar opinion. Green believes that BMI falls short of addressing every individual's unique makeup.

For instance, men have more muscle mass and less fat mass than women, but BMI uses the same scale for both genders. Similarly, BMI doesn't factor in that muscle mass declines with age while fat mass increases. And scientists believe that a higher BMI protects older adults against diseases.

It doesn't differentiate between types of body mass.

Body mass includes muscle, fat, water, and mineral. And the most important health risk determiner is fat mass. Unfortunately, the BMI doesn't directly calculate the percentage of fat.

So athletes or people with a higher muscle mass having low body fat may be wrongly categorized on the scale. So a bodybuilder who looks huge may weigh the same as another person who doesn't build muscle but has more fat.

It gives no information about body fat location.

BMI assumes excess fat deposition in any area of the body portends danger. However, that's flawed. In the real sense, fat deposits in the upper regions of the body, like the stomach, are the real concern.

Those who store fat in the lower areas are less likely to be at risk of chronic diseases.

Healthline says fat accumulating in the abdominal cavity, visceral fat, is dangerous.

Essentially, not all fat is dangerous as BMI wants us to believe.

It disregards race

Quetelet used a sample of White European men for his calculation. However, these cut-off points are accepted globally, neglecting our different body compositions and changing demographics.

But the World Health Organization (WHO) has since adjusted the scale for people of Asia due to more incidences of obesity at lower BMI. But that doesn't solve the problem since individual differences still exist. Moreover, these alterations do not mirror the realities of other races.

While we can't ignore BMI, a unique scale for each race may be more beneficial to stem the incidences of misdiagnosis.

How should we use BMI?

Schofer argues BMI doesn't contribute to the assessment of health at all. She contends that focusing on risk isn't helping individuals struggling with their weight.

"And we tend to overly focus on risk instead of looking at an individual's health status. The last thing my patients and clients with higher BMI want to hear about is their risk of diseases," she concludes.

However, Tara Scott, MD, believes BMI can be a starting point to assess clinical disease risk.

Like other health measures, BMI cannot be used as a single health measure. Instead, it gives more information about the future than the current state of health.

Conclusion

We can't trash BMI, but we can alter our approach.

Knowing your BMI is as important as knowing its limitations. And health professionals should apply more caution when counseling people because there is no perfect number for a healthy weight for all people.

Sources:

Ana Gotter. (2021). Visceral fat. https://www.healthline.com/health/visceral-fat

Connor B, et al. (2022). BMI classification percentile and cut off points. https://www.ncbi.nlm.nih.gov/books/NBK541070/

National Institutes of Health. https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

National Institute of Diabetes and Digestive and Kidney Disease. (2017). Health risks of overweight and obesity. https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks

Thank you for reading Patient Education Essentials, the Write Shift RN blog.

Disclaimer: This article was written as a guest post for Write Shift RN LLC's blog. The information in it may not be wholly fact-checked or edited, allowing the reader to see the writer's work and skills firsthand. This information is not intended as medical advice. It is for informational and educational purposes only. Always talk to your doctor or other qualified healthcare providers about any questions or concerns you may have regarding medical conditions.

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Steroid Injections vs. PRP

By Kristina Van Winkle • October 7, 2024

A Comparative Overview for Pain Management Steroid injections and Platelet-Rich Plasma (PRP) injections are two commonly used pain management treatments. While both aim to alleviate pain and promote healing, they have different mechanisms of action and long-term effects . What Are Steroid Injections ? Corticosteroids are potent drugs used extensively across various medical fields to manage a broad spectrum of conditions, making them one of the most widely prescribed drug classes in the world. They can be administered via nearly every route, including direct injection into painful or inflamed joints. "Corticosteroids" typically refers to the class of drugs that produce glucocorticoid effects. Glucocorticoids are stress hormones that regulate numerous physiologic processes within the body. They have vasoconstrictive, immunosuppressive, and anti-inflammatory effects and play a role in metabolism. What do steroid injections treat? Corticosteroids function by suppressing the immune system and reducing inflammation within the body. They inhibit the production of the body's pro-inflammatory chemicals, leading to decreased inflammation and, consequently, pain. They are prescribed for hundreds of medical conditions, including: Allergic and autoimmune disorders Adrenocortical secretion disorders Infections and inflammation Pathologic hypoglycemia Organ and graft rejections Neurological disorders Hypercalcemia Blood disorders Skin disorders Shock What are the side effects of steroid injections? Although steroids are known to some as “wonder drugs,” they impact various bodily systems, including metabolism, water and electrolyte balance, the central nervous system, and blood cells. As a result, they are associated with many adverse side effects, especially when administered in large doses or over extended periods. Adverse effects may occur in up to 90% of individuals who take them for longer than sixty days. These side effects may include: Suppression of the hypothalamic-pituitary-adrenal axis Gastrointestinal disturbances Osteoporosis and fractures Psychiatric disturbances Carpal tunnel syndrome Cardiovascular disease Immunosuppression Cushingoid features Hyperglycemia Skin disorders Glaucoma Myopathy Cataracts Diabetes The risk of adverse side effects is particularly high when taken systemically. However, side effect occurrences vary when administered as local injections for pain management. Data indicates that steroid injections into joints and the spine can produce systemic effects that can last for weeks. When assessing the risk factors associated with steroid injections, healthcare providers must consider all types and doses of steroids the person is taking, including both oral and injectable forms. Additionally, special caution is advised for certain populations, such as those who may undergo surgery soon, postmenopausal women, and individuals with diabetes. What is Platelet-Rich Plasma (PRP) ? Platelet-rich plasma (PRP) injections use an individual's own blood to promote cellular regeneration. Through the extraction and reinjection of platelets, growth factors, and other bioactive proteins from the person's blood, PRP therapy offers long-lasting improvements, sustained pain relief, and enhanced tissue function. What do PRP injections treat? PRP injections can stimulate healthy cell growth, reduce inflammation, promote tissue repair, form new blood vessels, rejuvenate the skin and hair, and accelerate recovery after a traumatic injury. It can treat a wide range of conditions, including: Pain resulting from traumatic injury or degenerative conditions such as arthritis and chronic back pain Musculoskeletal conditions Tendinopathies and tears Compressive neuropathy Scars and stretch marks Osteochondral lesions Rheumatoid arthritis Erectile dysfunction Muscular injuries Plantar fasciitis Vaginal atrophy Osteoarthritis Epicondylitis Infertility Psoriasis Wounds Bursitis Vitiligo What are the side effects of PRP? Since PRP is derived from the person's own blood, the risk of allergic reactions or rejection is significantly lower compared to other injectables, such as steroids. PRP typically does not cause major side effects, though you may experience some soreness or bruising at the injection site. In rare cases, potential side effects may include: Tissue damage Nerve injuries Bleeding Infection Comparison of Steroid Injections and PRP Injections A study in the Journal of Orthopaedic Surgery and Research compared steroid injections with PRP injections in patients with mild to moderate symptomatic knee osteoarthritis (OA). The findings indicated that both treatments were safe and effective in improving short-term pain and functioning, with no significant differences observed. However, PRP therapy demonstrated superior outcomes in the long term, with benefits extending up to one year. Additionally, a literature review in Cureus Journal of Medical Science analyzed multiple studies comparing steroid injections with PRP in lumbar spondylosis and sacroiliac arthropathy. The review found that PRP was equally as effective, if not superior, to steroid injections in the short term. Neither treatment was associated with major complications, and there were no significant differences in minor complications between the two. The review concluded that both PRP and steroid injections are safe and effective for treating lumbar spondylosis and sacroiliac arthropathy, with some evidence that PRP may offer more benefits in the long term. Research has confirmed that both steroid and PRP therapy are valuable options for pain management and tissue healing. Steroid injections offer potent anti-inflammatory benefits that can provide immediate relief. However, their systemic side effects and limited duration of efficacy should be carefully considered, especially in high-risk populations. While PRP may take longer to show results, its long-term benefits make it an increasingly popular choice for treating various conditions. Ultimately, the choice between these treatments should be based on the specific needs of the individual patient, with careful attention to the patient's medical history. Thank you for reading the Write Shift RN blog. If you need an experienced RN writer for your health or healthcare educational content, contact me !