If BMI is so outdated what should be used instead?

[AutisticLegoLover]

Inspired by another thread where some posters are slating BMI as outdated.
BMI is a blunt tool, I agree, but what should be used instead? The old height weight charts were devised by American insurance companies or so I read in an eating disorders book. BMI was devised by analysing white European men. It's not possible to have everyone measured by callipers so what should be used? I personally think BMI is very generous and has a large range of healthy weight for height. 18.5-24.9 has a range of something like 3.5 stone for me but as a guide it's useful and ideally should be used alongside blood pressure and cholesterol and waist measurement. Not everyone can access BP and cholesterol checks easily though.
I am a retired GP Practice nurse and we used BMI but also had a height and weight chart on the wall. The height and weight charts are less generous. Still, it's just a blunt tool, a guide, an easy starting point.

What should be used instead to be more accurate for the whole adult population?

I think BMI is pretty useful for the vast majority of the population and the ones who don’t like it are never the extremely muscular ones but the ones who don’t like the answer it gives them (Ie that they’re more overweight than they’d like to think)

Well there is that 😁

Agree with this.
I only ever see fat activists on YouTube moaning that the BMI is racist or whatever. As a currently obese person I feel like it fits me fine. I can see and feel the difference between when I'm in the healthy, overweight and obese categories...

I think BMI is really useful - as a guide. Whenever anyone says to me that BMI is rubbish and I ask why they always start on about Rugby players. But the majority of us aren't Rugby players or weight lifters or elite athletes and therefore for most of us it is a blunt tool that is helpful.

People always use outliers (rugby players, weightlifters) to “disprove” BMI as a useful tool. All those examples show is that it is just a tool, but for your average man or woman on the street it is a very useful one.

I’m currently overweight according to BMI, size 14 - many women don’t want to admit that size 14 is (for many, as I expect it is height related too, although I’m 5’6” so not short) overweight. I feel overweight, and if I could lose a stone or two I’d feel so much better.

My only gripe with BMI is that it is not my fault I have ludicrous boobs! If I had normal ones I'd be in the healthy range 😂

I think it's not a useful tool for very muscular people but it works OK for everyone else. It's not a sophisticated tool but it gives a rough guide. For my height I can supposedly go up to 11 stone 6lbs. However at 11 stone I'm carrying a lot of extra fat and look overweight (I have little muscle). I think most people can see when they're carrying too much weight.

I agree with this. It may not be useful for athletes but for the majority of us it’s fine. I can see I’m overweight and I don’t like that bmi puts me slightly into the obese category. If I was really denying it I would say it’s rubbish and not at all accurate, but I’d be kidding myself.

BMI is useful as a 'guide', but unfortunately it's used by the NHS as a cut off point.
For example, IVF treatment and some surgeries, ignoring that bodies are built differently.

@MorrisZapp how can your boobs take you outside the healthy range when that range is around 3 stone? Surely if you were very slim but with huge boobs you'd still be in the healthy range? Sorry a quick google tells me the range is about 37lbs. That's a lot of weight to carry in boobs. I might be missing something though as not quite awake yet.

I think it’s fine. I have a BMI of 31 and I know I’m fat. I’m not in denial. Just lacking in willpower.

To some extent i do agree with you re the fertility treatment policy, but after having DD1 (ovulation induction on the NHS) i did let my weight slide into the obese territory. Speaking to my consultant about ttc #2, the policy has given me the added kick i needed to sort myself out. I'm now 8kg down in 5 weeks and hoping for another 8kg before our next appointment. So as much as i hate to admit it, it has achieved its aim there for me! Maybe showing evidence of committed weight loss would be just as good as an alternative as meeting the BMI cut off? 🤷🏻‍♀️

Apparently this one is good as it accounts well for waist/hip ratio and muscle

https://en.m.wikipedia.org/wiki/Body_shape_index

https://www.omnicalculator.com/health/a-body-shape-index

My only gripe is applying it for teenage girls.

Sorry, not waist hip ratio. Waist/weight ratio.

I think it's alright for some people but I have been considered a healthy weight with a GP when a size zero (and not well) yet many years later a GP had no interest in my obese BMI as visually I was clearly a healthy weight.

My children were born within an ounce of each other birthweight but one was massive and rolly and one was half the size and skinny. I guess the heavy one takes after me.

I am distinctly average height/ size, definitely not a rugby player or statuesque.

I once read about a fancy weight loss clinic in Primrose Hill that swore by calliper and how many inches can you pinch as their preferred metric. Not that I'm advocating for that either. It's enough to give anyone a complex.

I had a boob reduction in the NHS due to crippling back pain. They took away nearly 1/2 a stone. So it had quite a big impact on my body weight.

@MorrisZapp how can your boobs take you outside the healthy range when that range is around 3 stone?

Presumably because if you would be at the top of the healthy range if you had small boobs, having massive ones cpuld push you over into overweight.

@WashableVelvet that's really interesting, thank you. I'm one inch from low risk to very low so that's spurred me on to lose an inch off my waist. I have IBS and endometriosis and am always bloated so I'm not sure waist measurement is a great tool for me but still I'll lose that inch. Both my parents had/have cardiovascular disease and my mum had a heart attack at 60 so I'm wanting to reduce risk where possible. My mum was then slim, didn't drink much or smoke at all but wasn't very active and her diet wasn't the best. The consultant said it was a result of stress.

BMI is spot on for the vast majority of the population, people just don't like the answer they get and would rather delude themselves that they are the twin of an elite athlete.

Even with the boobs, it's obvious to me I'm still fat! Am just over the healthy BMI.

Waist circumference is an alternative and guess what, I'm stuck 2 inches over a healthy waist measurement and the boobs are making no difference to that at all.

Yeah. Most of the criticisms of BMI are from people who would love to delude themselves that they are comparable to a competitive athlete.

BMI is accurate for about 99% of the population. Unless you're a top-level competitive athlete in a sport which depends on significant amounts of muscle mass, yes, it applies to you.

But people aren't built that differently. Skeletons vary in weight by very little.

What is the NHS IVF BMI cut off?

BMI puts my very lean DP as obese but guess what, he's a weightlifter, so he knows he needn't pay attention to it because he already understands macros and all that jazz. Most (not all) people who it doesn't apply to probably wouldn't need to use it because they are already very health focused.

Me on the other hand am not a body builder and I do need to pay attention to it. Because it does apply to me. I have been borderline obese and I have been very low end of healthy and at every point it's been fairly accurate.

Hmm. Suspect people who are saying it’s outdated just don’t like what it’s telling them.