Bigger Medical Insurance.
Over the past few years, body mass index, a ratio of a person’s height and weight, has effectively become a proxy for whether a person is considered healthy. Many U.S. companies use their employees’ BMIs as a factor in determining workers’ health care costs, and people with higher BMIs could soon have to pay higher health insurance premiums, if a rule proposed in April by the Equal Employment Opportunity Commission is adopted.
But a new study led by UCLA psychologists has found that using BMI to gauge health incorrectly labels more than 54 million Americans as “unhealthy,” even though they are not. The researchers’ findings are published online in the International Journal of Obesity.
“Many people see obesity as a death sentence,” said A. Janet Tomiyama, an assistant professor of psychology in the UCLA College and the study’s lead author. “But the data show there are tens of millions of people who are overweight and obese and are perfectly healthy.”
The scientists analysed the link between BMI, which is calculated by dividing a person’s weight in kilograms by the square of the person’s height in meters and several health markers, including blood pressure and glucose, cholesterol and triglyceride levels, using data from the most recent National Health and Nutrition Examination Survey.
The study found that close to half of Americans who are considered “overweight” by virtue of their BMIs (47.4 percent, or 34.4 million people) are healthy, as are 19.8 million who are considered “obese.”
Given their health readings other than BMI, the people in both of those groups would be unlikely to incur higher medical expenses and it would be unfair to charge them more for health care premiums, Tomiyama said.
Among the other findings:
- More than 30 percent of those with BMIs in the “normal” range – about 20.7 million people – are actually unhealthy based on their other health data.
- More than 2 million people who are considered “very obese” by virtue of having a BMI of 35 or higher are actually healthy. That’s about 15 percent of Americans who are classified as very obese.
Tomiyama, who directs UCLA’s Dieting, Stress and Health laboratory, also called DiSH, found in previous research that there was no clear connection between weight loss and health improvements related to hypertension, diabetes, and cholesterol and blood glucose levels.
She said she was surprised at the magnitude of the numbers in the latest study.
“There are healthy people who could be penalised based on a faulty health measure, while the unhealthy people of normal weight will fly under the radar and won’t get charged more for their health insurance,” she said. “Employers, policy makers and insurance companies should focus on actual health markers.”
Jeffrey Hunger, a co-author of the paper and a doctoral candidate at UC Santa Barbara, said the research shows that BMI is a deeply flawed measure of health. “This should be the final nail in the coffin for BMI,” he said.
Hunger recommends that people focus on eating a healthy diet and exercising regularly, rather than obsessing about their weight, and strongly opposes stigmatising people who are overweight.
The proposed EEOC rule would allow employers to charge higher insurance rates to people whose BMI is 25 or higher. A BMI between 18.5 and 24.99 is considered normal, but the study emphasises that normal BMI should not be the primary goal for maintaining good health.
Tomiyama is planning a new study of people with high BMIs who are very healthy. Prospective participants may contact her laboratory for more information.
Co-authors of the International Journal of Obesity study are Jolene Nguyen-Cuu, manager of Tomiyama’s laboratory, and Christine Wells, a UCLA statistical analyst.
The research was funded by the Hellman Fellows Fund.
Broader Medical Information.
In a study appearing in the May 10, 2016 issue of JAMA, Børge G. Nordestgaard, M.D., D.M.Sc., of Copenhagen University Hospital, Herlev, Denmark and colleagues examined whether the body mass index (BMI) value that is associated with the lowest all-cause mortality has increased in the general population over a period of 3 decades.
Previous findings indicate that while average BMI has increased over time in most countries, the prevalence of cardiovascular risk factors may be decreasing among obese individuals. Thus, the BMI associated with lowest all-cause mortality may have changed over time. This study included three groups from the same general population enrolled at different times: the Copenhagen City Heart Study in 1976-1978 (n = 13,704) and 1991-1994 (n = 9,482) and the Copenhagen General Population Study in 2003-2013 (n = 97,362). All participants were followed up from inclusion in the studies to November 2014, emigration, or death, whichever came first.
The researchers found that the BMI value associated with the lowest all-cause mortality has increased by 3.3 over 3 decades from 1976-1978 to 2003-2013, from 23.7 to 27. In addition, the risk for all-cause mortality that was associated with BMI of 30 or greater vs BMI of 18.5 to 24.9 decreased from an adjusted hazard ratio of 1.3 to 1.0 over this 30-year period. “These latter findings were robust in analyses stratified by age, sex, smoking status, and history of cardiovascular disease or cancer.”
The authors write that an interesting finding in this study is that the optimal BMI in relation to mortality is placed in the overweight category in the most recent 2003-2013 cohort. “This finding was consistent in both the whole population sample (optimal BMI, 27) and in a subgroup of never-smokers without history of cardiovascular disease or cancer (optimal BMI, 26.1). If this finding is confirmed in other studies, it would indicate a need to revise the WHO categories presently used to define overweight, which are based on data from before the 1990s.”
Regarding the increase in the BMI value associated with the lowest all-cause mortality, the researchers write that “further investigation is needed to understand the reason for this change and its implications.”