BMI: The Mismeasurement of Weight and the Mistreatment of Obesity

People who seek medical treatment for obesity and/or an eating disorder do so with the hope their health plan will pay for part of it, but whether it's covered or not, often comes down to a standard that was invented almost 200 years ago by a Belgian mathematician and astronomer as part of his quest to use statistics to define the "average man."

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Many critics say BMI was never meant as a health or lifestyle diagnostic tool. Dr. Fatima Stanford, an obesity medicine specialist and the Equity Director of the Endocrine Division at Massachusetts General Hospital put it succinctly when she said "BMI does not come from science or medicine."
Dr. Stanford and other experts have openly stated that BMI can be useful in tracking population-wide weight trends, but it falls short by failing to account for differences among the sexes and ethnic groups, and it can target some people, including athletes, as overweight or obese because it does not distinguish between muscle mass and fat.
Unfortunately, BMI has become the standard “go-to” tool that determines who, when it comes to health consequences, is most at risk - and who qualifies for often-expensive treatments.
Without using BMI as the principle tool, many studies have shown that people who are overweight or obese are at greater risk for a host of health problems, including diabetes, liver issues, osteoarthritis, high blood pressure, sleep apnea, and cardiovascular problems; this is beyond debate. The BMI measure is commonly included in the prescribing of weight loss drugs.
Some of the newest and most effective drugs, such as Wegovy, limit use to patients who have a BMI of 30 or higher - the BMI obesity threshold - or the lower level of 27, but then only if the patient has at least one weight-related medical condition, such as diabetes.
Doctors can prescribe medications to patients who don't meet those BMI requirements, but insurance companies in most cases will not cover the cost.
While most insurers, including Medicare in the USA, cover some forms of bariatric surgery for weight loss, they may require a patient to have a BMI of at least 35, along with other health conditions, such as high blood pressure or diabetes, to qualify. With medications, it can be even trickier. Medicare, for example, does not cover most prescription weight loss drugs, although it will cover behavioral health treatments and obesity screening.
Dr. Stanford says that "It's very frustrating because everything we do in obesity medicine is based on these cutoffs."
Serena Nangia, communications director for Project Heal, a non-profit that helps patients get treatment, whether they are uninsured or have been denied care through their health plan said “For eating disorders, insurers often use BMI to make coverage decisions and can limit treatment to only those who rank as underweight, missing others who need help.”
Serena went on to say "Because there's such a focus on BMI numbers, we are missing people who could have gotten help earlier, even if they are at a medium BMI. If they are not underweight, they are not taken seriously, and their behaviors are overlooked."
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