June 26, 2023
Good morning. In today’s either/view, we discuss whether the Body Mass Index (BMI) should be considered an indicator of health. We also look at the conservation of birds in Tamil Nadu, among other news.
📰 FEATURE STORY
Should the Body Mass Index (BMI) be considered an indicator of health?
We all remember those dreaded days in school when we were lined up to get our height and weight measurements. If the school doctors were generous, they wouldn’t scream those numbers for the whole class to hear. You see, no matter how much textbooks tell us that the Body Mass Index (BMI) is just one piece of the jigsaw that makes up our health, we threw it around recklessly as some kind of an achievement, or worse, something used to deride, to tease others with.
What makes BMI such a popular indicator of health across geographies and cultures? Well, it’s an easy and inexpensive measure for one. It’s a measurement of weight adjusted by height. It’s also the preferred measurement in several national-level or large-scale assessments of population health. But BMI’s shining armour has several chinks. Many health practitioners speculate whether it’s become a dispensible measure.
Context
BMI is found in schools, doctor’s offices, gyms, and in some countries, even as a requirement to get vaccinated. How is BMI calculated? It’s pretty straightforward. You divide your weight by the square of your height (in meters). The standard way then puts you into one of the four categories: underweight (BMI less than 18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9), or obese (30 or greater).
Some groups revise these thresholds according to geographical and ethnic differences. For Asian Indians, the ethnic-specific cut-offs set the 23.0 – 24.9 range as overweight, and obese as 25 or greater.
Category ranges vary across ethnicities because bodies in different climates and zones store fat differently. South Asian bodies are generally smaller and are likely to have more fat around their organs. It makes them more vulnerable to diabetes even when they’re in the range considered “normal” for white people.
On the flip side, a higher BMI is a better predictor of mortality in white people than in South Asians. For South Asians, a BMI greater than 30 has a hazard 1.08 ratio. The hazard ratio for white people in the same range is much greater at 1.99.
But the idea of variable ethnic cutoffs is fraught too. The World Health Organisation argued in 2004 that there’s not enough consensus on the differential ranges.
BMI’s story began in Belgium when it used to be called Quetelet’s index. In the 1830s, Adolphe Quetelet, an academic who studied astronomy, mathematics, statistics, and sociology, was on a quest to find the average man. This figure of the average man became a social standard for men – the physical archetype of the Renaissance man. Other characteristics were likened to those of primates or less than the ideal man. There’s something to be said about the racial origins of fatphobia.
Much of academia and anthropology back then was about excavating the differences between white people and other races to establish the former’s supremacy. Fast forward 140 years later, and a group of researchers used the late sociologist’s index in a study of 7,500 men from five different countries to find an effective and easy extant measure of body fat.
The samples were from the United States, Finland, Italy, South Africa, and Japan. Quetelet’s index emerged on top among the three imperfect indices under consideration as an indicator of relative obesity. One of the researchers, Ancel Keys, named it the Body Mass Index.
In the 21st century, when its limitations grew clearer, BMI is more accurately described as a measure of body size. It doesn’t account for many other physiological factors, including muscle mass. This simple indicator exists in a world where there are over 59 types of obesity. Does that mean it’s a good starting point to kick off health assessments, or is the BMI just a lazy measure that’s redundant in the world we live in now?
VIEW: A starting point
BMI is a handy tool in epidemiological research. Tracking it over time and a large population has generated helpful insights on the risk of heart disease, Type 2 diabetes, and some types of cancer. People with higher body mass index (BMI) tend to have more body fat on average, making it a practical tool for studying obesity rates worldwide.
Researchers and practitioners can use this data to study a wide range of lifestyle and health modifications due to genetics, the environment, and other variables. It can help identify obesogenic environments and occupations. It can benefit urban planning, in recreating areas with, say a higher concentration of restaurants into locations that accommodate healthier lifestyle practices like walking, cycling, or even modifying dietary preferences.
A perk that makes BMI a universally popular tool is its cost-effectiveness. It’s also pretty easy to calculate. To study individual health, BMI may have its limitations. However, if reviewed conjunctly with other health indicators like waist circumference, it could provide a holistic picture.
COUNTERVIEW: All sizzle, no steak
Let’s call it for what it is. BMI is a study of the human frame. Its “normal” is skewed toward white people’s bodies. Specifically, white men. It labels other body types as aberrant, even if they’re healthy in many aspects. It doesn’t represent women and people of colour. It enforces racist stigma against black people and the African body type. It’s especially harmful as a tool to predict health risks in black women’s bodies. Its correlation with mortality is simply weak there.
It’s not just that BMI is race and gender-insensitive. The index doesn’t help understand either metabolism or obesity. It doesn’t directly measure fat and is apathetic to bone density and muscle mass. So, a person with greater bone density may have a higher BMI, but it says nothing about their health. If the chances of misleading results are high, is it necessary to use BMI even as a starting point?
As for using it in conjunction with other measures, BMI might not help there either. United Kingdom-based Medical Research Council (MRC) Epidemiology Unit’s researchers found that regardless of BMI, waist circumference is strongly and independently linked to type two diabetes risk. Besides, there’s evidence that the use of BMI in healthcare and self-assessment adds to the systemic fatphobia in doctors. It could lead to lower-quality care and even misdiagnosis.
Reference Links:
- More Than Skin Color: Ethnicity-Specific BMI Cutoffs For Obesity Based on Type 2 Diabetes Risk in England – American College of Cardiology
- Is B.M.I. a Scam? – The New York Times
- Adolphe Quetelet (1796–1874)—the average man and indices of obesity – NDT
- Ethnic Differences in BMI and Disease Risk – Harvard School of Public Health
- Doctors urged to move beyond BMI alone as a health measure – CNN
- Why BMI is inaccurate and misleading – Medical News Today
What is your opinion on this?
(Only subscribers can participate in polls)
a) Body Mass Index (BMI) should be used as an indicator of health.
b) Body Mass Index (BMI) shouldn’t be used as an indicator of health.
🕵️ BEYOND ECHO CHAMBERS
For the Right:
Selective conscience: the overriding aim of Modi’s politics has been to show Indian Muslims their place and to insist that the organic citizens of India are Hindus
For the Left:
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🇮🇳 STATE OF THE STATES
AI model to predict rainfall (Delhi) – Researchers at IIT Delhi’s DST Centre of Excellence in Climate and other institutions have developed an artificial intelligence model that can predict monsoon rainfall. The model was made with MIT, USA, and JAMSTEC in Japan. The data-driven model will be used for state-wide monsoon rainfall prediction. It has proven to perform better than current physical models, with a 61.9% success rate for the 2002-2022 test period.
Why it matters: In India, accurate monsoon prediction is important for farmers and the government. It’ll help farmers and the government in preparing for the upcoming seasons, disaster management, allocation of resources, etc. The AI model can be done by a few people on a personal computer, making it more convenient.
Conservation of birds (Tamil Nadu) – The state now has a bird authority to help in the conservation of birds. The authority will help improve conditions for nesting, map view locations, and help restore sanctuaries. It’ll also help in mapping locations across the state visited by native and migratory birds. This will help in preparing an action plan to have new protected areas.
Why it matters: Tamil Nadu has 17 bird sanctuaries, 14 of which are Ramsar sites. A few months ago, the state government announced a ₹25 crore allocation for the International Bird Conservation Centre. Tamil Nadu plays an important role for migratory birds in the Central Asian Flyway, a collection of migratory routes which aquatic birds take.
Maoist posters resurface (Odisha) – In a couple of districts in the state, residents began to panic as suspected Maoist posters were found in the areas. In Kalahandi, they were allegedly put up by Maoists on tree trunks on the road to Taprang village. The posters paid tribute to Maoist cadres neutralised in an exchange with security forces. They also allege that they were tortured to death.
Why it matters: In April, residents of Jashipur panicked after seeing posters of suspected Maoists hanging on the main gate of the Jhadbeda Tribal High School. However, police officials said these were authentic Maoist posters but the work of someone trying to create panic among residents. The most recent incident was posters by the banned outfit Kandhamal-Kalahandi-Boudh-Nayagarh (KKBN).
Green crisis (Goa) – Several of the state’s agricultural land and green cover are making way for farmhouses as some of the rich and powerful descend on the state. In a month, 1 lakh square feet of eco-sensitive land was given for construction, with another 60 sq km planned. This could be a recipe for disaster. The town and country planning (TCP) ministry is looking to rectify errors in the regional plan. Several pieces of legislation have failed to protect the state’s farmland and eco-sensitive zones.
Why it matters: Land is arguably the state’s greatest resource and a boon for realtors. A Sotheby’s India survey showed 61% of high-net-worth individuals are keen to buy real estate this year, with 30% looking at farmhouses and holiday homes. Goa has seen a surge in demand for luxury properties and resorts. The regional plan’s arbitrary zoning changes are faulty, according to urban planners.
Flood-hit regions (Assam) – Almost 5 lakh people in 19 districts have been affected due to the recent floods. More than 10,000 hectares of cropland have been submerged and crops destroyed. More than 42,000 domestic animals were also affected. The district administration has set up 140 relief camps and 75 relief distribution centres in 14 districts.
Why it matters: Due to the disruption of the supply chain, vegetable prices have increased in the Guwahati market. In the aftermath of torrential rain, the Brahmaputra River’s water level is above the danger mark at Neamatighat in Jorhat and Dhubri. In the past 24 hours, flood waters breached 1 embankment and damaged 14 others.
🔢 KEY NUMBER
$255.5 million – The World Bank approved a $255.5 million loan to help India develop technical education, raise its standards, and expand job prospects for students. More than 3.5 lakh students are expected to benefit.