AMA House of Delegates adopted policy clarifying how body mass index (BMI) can be used as a measure in medicine.
The policy is part of the AMA Council on Science and Public Health (CSAPH) report, which evaluated the problematic history with BMI and explored alternatives.
The CSAPH report outlined the harms and benefits of using BMI and highlighted that BMI is an imperfect measure of body fat in multiple groups because it does not account for differences across race/ethnic groups, sexes, genders, and age-span.
Based on the report’s findings, the new policy supports AMA in educating physicians on the issues with BMI and encouraging the use of alternative measures for diagnosing obesity.
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Council Findings: Harms, Benefits, and Limitations
The CSAPH report evaluated the problematic history with BMI and explored potential alternatives.
It acknowledged harms and benefits of BMI, concluding that BMI is an imperfect tool for measuring body fat across diverse populations.
Major limitations identified include that BMI does not account for differences across race/ethnic groups, sexes, genders, and age-span.
The report notes that BMI is significantly correlated with fat mass in the general population but loses predictive value when applied to individuals.
Implications for Practice
The AMA policy supports educating physicians about the benefits and limitations of BMI.
Physicians should consider alternative, valid measures of risk when diagnosing obesity, rather than relying solely on BMI.
The policy encourages integrating multiple metrics into clinical decision-making to improve patient care.
Measures and Alternatives to BMI
BMI should be used in conjunction with other valid measures of risk, including but not limited to:
measurements of visceral fat
body adiposity index
body composition assessments
relative fat mass
waist circumference
genetic/metabolic factors
Population Differences and Equity Considerations
Relative body shape and composition differences across race/ethnic groups, sexes, genders, and age-span are essential considerations when applying BMI as a measure of adiposity.
BMI should not be used as the sole criterion to deny appropriate insurance reimbursement.
Expert Commentary
Quote from AMA Immediate Past President Jack Resneck, Jr., M.D.:
"There are numerous concerns with the way BMI has been used to measure body fat and diagnose obesity, yet some physicians find it to be a helpful measure in certain scenarios."
Resneck emphasizes that physicians must understand both the benefits and limitations of using BMI in clinical settings to determine the best care for their patients.
Ethical, Practical, and Real-World Implications
Historical harm and racist exclusion associated with BMI use are acknowledged.
BMI’s origins in data largely from previous generations of non-Hispanic white populations raise concerns about applicability across diverse groups.
Caution is advised against using BMI as a sole determinant in clinical and administrative decisions (e.g., insurance reimbursement).
Emphasis on equity: tailoring assessment to individual risk profiles and demographic context.
Real-World and Educational Relevance
The policy aligns with broader efforts to improve obesity assessment through multi-modal evaluation.
It supports ongoing physician education and resource provision to enhance patient care and reduce disparities.