BMI......BM "Why?"

Last night we had a couple of friends over for some pizza and beers.  At one point, one of them returned to the table after using the bathroom.

"You guys have a scale?  I haven't seen one of those in a while!"

It was a good point.  We've had a bathroom scale lying on the floor for as long as I can remember, but I'm not so sure why.  Sure, it provides us instant feedback about how much we weigh any time we step aboard.  But in terms of providing a good measure of health, does it really matter?

My neighbor's comment lead to a brief discussion about the current measure of healthy body weight as it relates to height, and that's Body Mass Index (BMI).  This number uses two measures, height and weight, to compute your number.  That's it.  However, there are plenty of people walking around who are "skinny" and unhealthy, and many who would "fail" the BMI test but who are pictures of good health by all other measures.

For 10 straight years, I was required to have an annual physical while I worked at the New York City Department of Education.  Each year, I was given a thorough work-up, followed by a brief 5 minutes chat in my doctor's office to discuss results.  Every year, I'd hear the same warning:

"You are borderline overweight.  Something you should keep your eye on."

Finally, after years of the same speech, I said, "Look, my weight has been the same every year I've come to you, within 3-4 pounds.  In fact, I've been the same weight since college.  I honestly don't feel like I have to worry about a weight problem."

His response was, "I know, but the insurance companies like to use this straight forward measure to help determine outcomes."

What's my point?  Get comfortable questioning your health care providers.  It was always funny to me to hear anti-universal health care coverage folks decry, "I don't want anyone coming between my doctor and me!"  Well, unless you pay your doctor in cash (meaning you don't have private insurance), there has always been a hidden third party involved.  And that third party has a major financial incentive at stake that may be influencing decisions made in the office or clinic.

If insurance companies like tidy numbers like BMI, it should make you question things.  By this standard of health, your average NFL running back (5"11 and 215 lbs.) would have a BMI of 30.0.  That puts these athletes in the "obese" category.  Does this make sense?

Piggybacking on my last post, the take-home message is this:  be your own biggest advocate.  Don't accept your health care interventions at face value.  I'm not suggesting that you should tie yourself into a knot by becoming an online MD.  Rather, don't be afraid to ask, "Why?"  You may be surprised at the answers.