The Problem With the AMA's New BMI Policy

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I’ve received a ton of requests to talk about the AMA’s new policy regarding the use of Body Mass Index (BMI).

Let’s take a look. The quotes below are from the AMA’s press release about this.

Under the newly adopted policy, the AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations.

I just want to point out that the AMA is way beyond fashionably late to this party. Anti-racism and anti-weight-stigma activists have been pointing this out for literally decades and it would have been appropriate for the AMA to acknowledge that work, at least.

Due to significant limitations associated with the widespread use of BMI in clinical settings, the AMA suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors.

So what has happened here, is that the AMA has not even fully extricated themselves from the initial trap they fell into before falling into another trap. We don’t need different ways to pathologize bodies based on shared size (rather than shared symptomology or cardiometabolic profile,) we need to stop pathologizing bodies based on size. We need to stop basing healthcare decisions on the result of poorly conducted, correlational research that links being higher-weight to health issues while actively failing to even take a cursory look at confounding variables like weight stigma, weight cycling, and healthcare inequalities.

The policy noted that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level. The AMA also recognizes that relative body shape and composition differences across race/ethnic groups, sexes, genders, and age-span is essential to consider when applying BMI as a measure of adiposity and that BMI should not be used as a sole criterion to deny appropriate insurance reimbursement.

Again, this is information that has been available for decades.

I got excited for about point two seconds when I read that last bit, thinking that they were intending to recommend the end of BMI-based denials of procedures. Then I remembered just how in bed the AMA is with the weight loss industry. (Recall that, in order to declare “ob*sity” a disease, they overrode the recommendation of their own Committee on Science and Public Health which had studied the question for a year, and instead capitulated to weight loss industry pressure.) That’s when I realized that what they are likely trying to do here is help the weight loss industry – in particular those who sell dangerous drugs and surgeries - to expand their market by suggesting that there shouldn’t be a minimum BMI for their (highly profitable) wares.

And when I say the AMA is in bed with the weight loss industry, that’s not just a feeling I have. A quick look at the 2022 annual report for the AMA Foundation finds that Elli Lilly (whose Wegovy competitor drug Tirzepatide is expected to get FDA approval as a weight loss drug this year and has been forecasted by Wall Street analysts to be the most profitable drug of all time) gave donations between $500,000 and $999,999, our old friends at Novo Nordisk came in between $100,000 and $249,999, and Merck, which just announced that they are developing a drug to compete with Wegovy and Tirzepatide also shelled out between $500,000 and $999,999.

That said, in my work I will certainly be using this to push back against BMI-based care denials.

There are numerous concerns with the way BMI has been used to measure body fat and diagnose ob*sity, yet some physicians find it to be a helpful measure in certain scenarios,” said AMA Immediate Past President Jack Resneck, Jr. M.D. “It is important for physicians to understand the benefits and limitations of using BMI in clinical settings to determine the best care for their patients.

Nope. There are literally no benefits to using BMI in clinical settings (except for those who profit from it.) BMI, along with the entire made-up concept of “ob*sity” serve only to perpetuate and excuse weight stigma, interrupt care, and encourage healthcare providers to practice stereotypes instead of medicine. The best thing we could do is to let it go.

In the meantime, I’m glad that the AMA has taken a small step in the right direction and I hope for more and larger steps soon – people’s lives depend on it, and those lives should always be prioritized over weight loss industry profits.

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More research and resources:
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.