![]() Medical providers and others will surely question what to do if we throw out BMI as a clinical metric. The total costs associated with weight discrimination were $430 billion in 2019, which included $206 billion in financial costs and $224 billion in lost well-being. Second, weight discrimination is expensive. ages 10 years and older experience discrimination based on their weight severe enough to have impacts on their health, quality of life, job opportunities, and our economy. ![]() We estimated that each year 34 million people in the U.S. What we found was sobering.įirst, weight discrimination is common. In a comprehensive study we recently conducted in collaboration with Deloitte Access Economics and Dove, we document for the first time the effects of weight discrimination on the U.S. While attempts have been made to estimate the costs of obesity on the economy, none of these prior studies parsed out how much weight-based stigma or discrimination, as opposed to the adiposity itself, factors into the equation. This raises a reasonable question: What purpose is served by continued collection of these data even as the very practice of BMI assessment itself negatively affects healthcare access and quality of care? The same question can be asked about the assessment of BMI in many other settings and sectors in which BMI surveillance has been deployed (e.g., life insurance assessments, military physicals, school gym classes, mass marketed online BMI calculators for consumers).Ī substantial array of evidence documents the myriad harmful and far-reaching impacts of the "war on obesity" and the weight stigma it has fomented. Thus, BMI assessment may be causing risk (e.g., loss of trust, delayed care) while providing minimal to no benefit. Indeed, in many of the instances in which BMI is assessed in medical settings, the information is not pertinent to medical decision making and often not even used. Additionally, misplaced BMI assessments can unnecessarily divert clinician focus to weight, an easy default but often misguided explanation for various signs and symptoms, and can result in missed diagnoses, sometimes with grave consequences.īMI as a metric has become so formally entrenched in clinical interactions that it is rarely questioned. This can lead to patients opting not to follow physician advice, even when that advice is not weight-focused, and not pursuing follow-up care due to faltering trust - a vital element of effective doctor-patient relationships. Clinicians' focus on BMI can lead to unproductive weight-related conversations that fracture the doctor-patient relationship and may introduce mistrust. When patients do arrive to care, a focus on BMI can cause more problems than it resolves. ![]() Studies and patient stories tell us that anticipating being weighed in medical settings leads many to delay or avoid medical care altogether, resulting in missed preventive care or worse. Yet, a growing body of research on weight stigma in medicine has identified routine BMI assessments as a key barrier to care for people living in larger bodies and for others experiencing weight-based shame. BMI has now become the organizing principle of a massively sprawling surveillance system and the default tool in society's arsenal in the "war on obesity." Though BMI was never intended as a measure to be applied to an individual's health, by the 1990s, as panic arose over increasing weights nationwide, Quetelet's metric - once so obscure that it was known only in the rarefied world of historians of 19th Century mathematics - became a household word. In the 20th Century, BMI was resurrected as a risk prediction tool for insurance companies. The genesis of BMI as a metric dates back nearly 2 centuries to the work of Belgian mathematician (not physician) Adolphe Quetelet, who had the singular idea to create a quick way to approximate body composition in the society. Then buying it is what most of us in the health professions have already done, usually without questioning. Would you buy it? Of course not, who in their right mind would?Įxcept, that is, if that "new gadget" is a body mass index (BMI) calculator.
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