For decades, healthcare in America has linked weight to health status.
Since individuals with a higher body mass index (BMI) are more likely to have health problems, it has been presumed that higher weight is the cause of specific diseases with weight loss being the solution. A recent story from the University of Georgia website headlined “Current medical training perpetuates anti-obesity bias” offers some compelling data that we’ll look at here.
Research, including a paper published in Medical Science Educator, shows that using BMI to determine health overestimates the number of unhealthy people. Instead, healthcare providers should be looking at improving cardiometabolic health to best help their patients.
According to recent statistics, nearly 74 percent of adults in the United States are overweight or obese. Nearly one in three adults are overweight, defined as having a BMI between 25 and 29.9. More than two in five U.S. adults have obesity, defined as having a BMI of 30 or higher. BMI is a calculation that estimates weight status based on height and weight.
Historically, medical schools have taught the use of BMI to gauge patients’ health status. This may be problematic for more than one reason.
First, about half of those categorized as overweight by their BMI are, in fact, metabolically healthy. Second, about one in three people with a normal BMI are unhealthy when looking at non-weight health measures. Thus, normal BMI and physical fitness should not be equated. Third, making assumptions about health and lifestyle based on weight may have serious negative consequences for patients.
Weight stigma is a type of discrimination that wrongly connects obesity with laziness and overconsumption not taking into account the more valid biological and systemic factors that impact weight. Bias that may lead physicians and other health care providers to be less empathetic towards overweight and obese patients can result in lower quality medical care. Studies have shown that the burden of weight stigma and associated stress may be more detrimental to health than being obese.
Steps should be taken to shift the focus away from weight and onto more comprehensive factors that determine health. Cardiometabolic risk factors such as blood pressure, insulin resistance and cholesterol levels increase the likelihood of developing diabetes and cardiovascular disease. Conversations between patients and health care providers can focus on these cardiometabolic risk factors as well as inflammatory markers and lifestyle factors like smoking, physical activity and nutrition.
A 2021 survey of medical schools in the United States and the United Kingdom, published in the Journal of Human Nutrition and Dietetics, found that most medical students receive an average of 11 hours of nutrition training. Much of this training is focused on the science of nutrition, not the practical aspects that are needed to personalize nutrition recommendations. Ultimately, the current focus on weight and BMI only worsens anti-obesity bias in healthcare settings, which can increase the risk of eating disorders.
Physicians and other providers need to go beyond the common advice to “just lose weight” and advise patients on steps to take to improve their health that may or may not change their weight.
LeeAnn Weintraub, MPH, RD is a registered dietitian, providing nutrition counseling and consulting to individuals, families and organizations. She can be reached by email at RD@halfacup.com.
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