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Is BMI method really the best measure of a person's weight?

For as long as they have been around, BMI charts have been the subject of intense debate. By Lauren Taylor

BMI (which stands for Body Mass Index) charts have for decades been used as an indicator of whether we are underweight, a healthy weight, overweight or obese - the system was devised in the 19th century and coined in a medical paper in 1972. But it's also long been a topic of debate because it works purely on weight and height measurements (age is taken into account too) and doesn't distinguish between fat and muscle.

The simple measurement is your weight in kilograms divided by height in metres, and divided by height again. Below 18.5 is classified as underweight, over 25 is overweight, and over 30 means you're in the obese category.

What is BMI helpful for?

BMI is currently recommended by the National Institute for Health and Care Excellence (NICE) and the Royal College of Paediatrics and Child Health. Being overweight or obese is associated with a higher risk of major conditions like heart disease, stroke and type 2 diabetes, and BMI scales can help identify if someone is more likely to be at risk.

It provides invaluable insight into a general overview of the population as a whole - figures released by the World Health Organisation (WHO) last week showed that childhood obesity has increased 10-fold in the past four decades. It's worth noting, BMI in children is measured slightly differently to adults (using BMI centile on a child growth chart). World Obesity Federation data shows that obesity is steadily climbing in adults too, and by 2025 it's predicted that 41% of UK adults will be obese.

What are the disadvantages of the BMI system?

In short, people are categorised based purely on measurements, without taking into account things like their build and fitness levels, which may be very important.

If someone has a lot of muscle (which weighs more than fat), the BMI index will be overestimated by the calculation - so a fit, strapping rugby player could have relatively low body fat levels but a high BMI, for example.

While athletes will probably be well aware of how healthy they are regardless of BMI, where fat appears on someone's body is important in determining health and risk of disease. A 2014 study by the Mayo Clinic in the US found that people with a normal BMI but a large belly (ie. those who carry most of their body fat around the middle) were more likely to die younger or from weight-associated illnesses.

The NHS website says a healthy waist circumference for men is less than 94cm (37 inches) and less than 80cm (32 inches) for women. Your middle is a particularly dangerous place to carry excess fat, compared to, say, your bottom or thighs. This visceral fat makes you more likely to develop heart disease or diabetes.

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Shaping up: the size of someone’s waist could be a better way to judge their health, some experts believe

Are there any better ways to measure who is at risk?

As the BMI index doesn't correspond to the same degree of weight in different individuals, Public Health England recommend that it's not the only method you can use to work out whether or not you're overweight or obese.

The University of Wolverhampton's Professor Alan Neville, who specialises in biostatistics for health, sport and exercise, has written a paper on the need to redefine age and gender-specific overweight and obese BMI index cut-off points. He says that although monitoring BMI is sensible and will help identify people who are overweight, in most cases he believes waist circumference (divided by height, square-rooted) would be a more accurate measurement.

"Waist circumference would be a much more sensitive measure for people who are carrying too much fat and are much more sensitive to metabolic risk. There's very little (chance) muscle could interfere with a waist circumference measurement," he says.

BMI may also be more or less relevant depending on your age. "It's quite easy to show that younger people with a BMI over 30 don't have as much fat as older people over 30," Professor Neville says. "While younger people will carry a higher proportion of muscle in their 20s than someone in their 50s."

"I've done calculations that show some people in their 20s with a BMI of 33 or even 34 in the case of males, have the same fat as the people in their 40s (with the same BMI). And someone (in their 50s) with a BMI of 29 could actually be at more risk than someone with a BMI of 32 who is younger."

Other methods for measuring body fat are available, but they're more expensive.

The DEXA (dual-energy X-ray absorptiometry) Body Scan claims to be the most accurate way of measuring visceral fat - it reveals the amount and distribution of fat and muscle mass, and rates the result for your age, height and gender.

It's not as cheap as a quick calculation though; a scan with a consultation is £159 (bodyscanuk.com).

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