Is BMI Bogus?
January 14, 2010 5:11 AM   Subscribe

Is BMI Bogus? My employer is providing an incentive for the employees to be healthy. Assessment of health is based upon cholesterol, blood pressure, no nicotine usage, and BMI. I feel that blood pressure and cholesterol have a large genetic component and that BMI doesn’t reflect who is and who is not healthy. I need help making a thoughtful, respectful argument.
posted by lostinsupermarket to Health & Fitness (47 answers total) 1 user marked this as a favorite
 
Well, for one thing, it's a blunt instrument. You could point out that bodybuilders and Olympic powerlifters and folks like that have huge BMI numbers that are usually characteristic of morbid obesity.
posted by box at 5:18 AM on January 14, 2010


Just roll with it. I tried the malcontent schtick for awhile many moons ago at work. Didn't get me anywhere.
posted by netbros at 5:18 AM on January 14, 2010 [23 favorites]


This doesn't fully fix your problem, if you are at a truly good weight, but the incentive could be based on CHANGES to your personal baseline.

E.g., you get full credit for cholesterol if your LDL is < 100; otherwise, you get credit for some reasonable decrease. Same for BMI: full credit if BMI < 25; partial credit for a percentage decrease.
posted by teragram at 5:21 AM on January 14, 2010


The simplest response to BMI being is that lots of heavily muscled, but definitely not fat sportsmen would qualify as obese.

I'm afraid criteria overall are reasonably sensible when taken in aggregate and given the circumstances (it's your employer, and it's incentive-led). Things like caliper pinch tests may be more indicative of waist fat - itself subcutaneous fat - but they're quite invasive and I can see why your employer wouldn't go for it).

Even if cholesterol and blood pressure were genetically influenced, they're still indicative of health - your employer cares about outcomes and if you're lucky enough to have good genes then more power to you. If not, there is an incentive - both from your employer and generally - to improve your health.
posted by MuffinMan at 5:24 AM on January 14, 2010


Here's an interesting history of the BMI.

Also, from the CDC:
BMI is used as a screening tool to identify possible weight problems for adults. However, BMI is not a diagnostic tool. For example, a person may have a high BMI. However, to determine if excess weight is a health risk, a healthcare provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings. (emphasis mine)
posted by ferociouskitty at 5:25 AM on January 14, 2010 [4 favorites]


Your employer is giving people an extra benefit that they are not required to by law?? How dare they!!

Seriously, don't look a gift horse in the mouth. Be happy there is something that will benefit you and your coworkers, even if it doesn't match what you think should be the standard for healthy living. It would be impossible to implement a program like this going on a case-by-case genetic history basis.
posted by Grither at 5:27 AM on January 14, 2010 [5 favorites]


Perhaps you could argue on the basis of violating HIPAA? It should be your right to not have to publicly announce your health information.
posted by fermezporte at 5:41 AM on January 14, 2010


FWIW, if they make any of this info public, then yes, it would be a HIPAA violation. Any employee health incentive program is bound by HIPAA. If you see your BMI on a bulletin board, file a complaint with OCR immediately @ http://www.hhs.gov/ocr/privacy/.

My understanding is that these programs are perfectly legal if they're voluntary. I could be wrong, though.
posted by paanta at 5:49 AM on January 14, 2010


fermezporte, that would only work if the incentive is mandatory. Which would make it something other than an incentive, I think.
posted by mediareport at 5:49 AM on January 14, 2010


A doctor once told me that BMI isn't a helpful measurement for South Asian men because their fat tends to sit in the belly area to a disproportionate degree. He told me that waist measurements were much more informative for this group as they had a more direct relationship with cardiovascular health.
posted by SebastianKnight at 5:51 AM on January 14, 2010


Get them to reward actions instead of results, optionally? (i.e. proof of time spent weekly at gym, yoga classes, etc.)

My "bad" cholesterol is low (and my "good" cholesterol is optimal) even when I eat bacon and eggs every morning, so I feel for you if you've got the opposite scenario going on (i.e. your numbers make you look like you're on a dietary suicide mission even when you're eating healthy). That's where you suggest an alternate reward system for folks who prove they're exercising through sign in sheets, etc.
posted by availablelight at 5:58 AM on January 14, 2010


The DOL issued guidelines for compliance with HIPAA. Wellness programs which "discriminate" (in quotes because it's the DOL usage) on the basis of a health factor by giving rewards for meeting healthy standards have to meet the following criteria:

-The plan has to promote wellness and can't be a subterfuge to discriminate based on a health factor.

-The plan can't be unduly burdensome to the employee.

-Rewards have to be available to all similarly situated employees.

-The rewards can't be worth more than 20% of the amount of employee-only coverage (for employee only rewards) and 20% of the employee and dependent coverage (for rewards for employees and dependents). So, you can only give 20% aggregated for meeting health standards. 20% for meeting BMI and 20% for meeting blood pressure is not OK as it's more than 20% combined. They can give 20% for meeting health factors and 10% for filling out a questionnaire, for example.

-The plan must provide a reasonable alternative for persons who can't achieve the health goal due to a medical condition, or if its medical unadvisable for the employee to participate. The alternative or a procedure for an alternative must be disclosed in the literature.

That's just HIPAA and not ADA, etc. I'm not your benefits professional, etc. Not all plans are subject to HIPAA. This is just summarized from the DOL Field Assistance Bulletin (FAB 2008-02).
posted by MarkAnd at 6:02 AM on January 14, 2010 [4 favorites]


My job does this too for BMI and nicotine, but they gave a discount for having a BMI < 30 which is pretty generous. Failing that you also get the discount if you are over but can show some particular amount of weight loss during the year which I forget exactly.
posted by reptile at 6:06 AM on January 14, 2010


I feel that blood pressure and cholesterol have a large genetic component and that BMI doesn’t reflect who is and who is not healthy. I need help making a thoughtful, respectful argument.

May I thoughtfully and respectfully say that what you feel is incorrect. You are advancing a defeatist argument. You want to believe that nothing is within your control, that all is imposed from the outside.

But that is not true. Even if there is a genetic component, that is no argument to give up and do nothing. In fact it is an argument to redouble your efforts.
posted by mono blanco at 6:19 AM on January 14, 2010 [3 favorites]


See "The Obesity Myth" by Paul Campos for good scientific research on the meaninglessness of BMI.
posted by Jeanne at 6:20 AM on January 14, 2010 [4 favorites]


(Newer research suggests that "slightly overweight" BMI is actually correlated with a small decrease in death rates, though there are obviously a lot of potential confounding variables.)
posted by Jeanne at 6:22 AM on January 14, 2010 [1 favorite]


I am obese by any standard you want to mete out, and my bp is low and my cholesterol is great.

I think genetics do play a big part especially since I know a family THAT RUNS FREAKING MARATHONS AND EATS "PERFECTLY" and still has issues.

As far as BMI, yep, blunt instrument, and if someone is heavily muscular, they would be classified as obese.
posted by St. Alia of the Bunnies at 6:26 AM on January 14, 2010


The simplest response to BMI being is that lots of heavily muscled, but definitely not fat sportsmen would qualify as obese.

If this doesn't describe you or the people you work with, then I think you should just play along. Since there are several factors they are relying on in their judging, the outcome is more likely to be realistic than if they were going with just BMI alone.
posted by hermitosis at 6:34 AM on January 14, 2010 [1 favorite]


box is right that BMI is a "blunt instrument" (except I'd be remiss if I didn't point out that there is no powerlifting in the Olympics), but as hermitosis says, that doesn't mean it isn't often useful. BMI is a rough estimate of bodyfat in sedentary populations based on height and weight. It's broadly accurate for a large group of people, including, in my experience, most of the folks who complain about how inaccurate it is. If you are a strength athlete, you know that BMI doesn't mean anything to you and will use more accurate means of bodyfat measurement if necessary. If you aren't one, the BMIs of strength athletes isn't an argument for why it doesn't apply to you.
posted by ludwig_van at 7:14 AM on January 14, 2010 [4 favorites]


If you aren't one, the BMIs of strength athletes isn't an argument for why it doesn't apply to you.

It always strikes me as odd when people who get no exercise at all will say that the BMI is invalid because it classifies bodybuilders as overweight.
posted by foodgeek at 7:42 AM on January 14, 2010 [8 favorites]


Send your boss a link to Kate Harding's BMI Project. I think it's an excellent illustration of how BMI can be accurate or a total bunch of hooey. BMI has come under some scrutiny for not including a variety of factors, and while I think there is some value in it, it's not the best measuring stick for everyone. When you send the link explain that while you think the new employee health program is an excellent idea, you are also concerned that BMI is not a fair measure of everyone's health and progress and mention that you think the link illustrates this well.
posted by katemcd at 7:49 AM on January 14, 2010 [1 favorite]


Yes, BMI is bogus (for the purpose of commenting on the healthfulness of an individual's weight.)
posted by Zed at 7:57 AM on January 14, 2010


It's basically bollocks. Can't they use % body fat instead? While body fat measurement tools are not super accurate, they aren't completely misleading like BMI often is.
posted by chairface at 7:57 AM on January 14, 2010


Send your boss a link to Kate Harding's BMI Project. I think it's an excellent illustration of how BMI can be accurate or a total bunch of hooey.

How is it an illustration of that?
posted by ludwig_van at 8:10 AM on January 14, 2010


Re: Usefulness of BMI - It's super useful to describe the american obesity problem, since really, we're not a nation of powerlifting supermen. But individually, if you happen to be super muscular, or whatever, it can be thrown off.

Re: The plan - First, make sure it follows the right privacy laws. And also the right benefits laws. And then you can talk to your boss / implementor of the program and see if you can't get an alternate scale to use instead of BMI (fat percent measured by calipers or whatever). You can find many examples of very fit people who BMI misreads, and just say that you want an alternate way of "proving" health.

Re: Blood Pressure & Cholesterol: Yeah, genetics has a fair amount of influence, but really, so does exercise and the right monitoring by a doctor (ie. medication). So it's not totally out of your control, and it correlates with health.
posted by cschneid at 8:27 AM on January 14, 2010


See also.
posted by wittgenstein at 8:34 AM on January 14, 2010


I don't want to derail, but I don't know that that BMI project link is a very good argument. What is it trying to say? To me, it mostly seems to be saying that people in different weight categories can be attractive. Fine, I hope most people wouldn't argue with you there, but those pictures say very little about their health, which is what the OP is asking about.
posted by MadamM at 9:21 AM on January 14, 2010


If you are fat, arguing about athletes will do nothing but call attention to your weight issues.

If you are skinny, arguing that BMI says you should gain weight will make you look like you are bragging.

If you are heavily muscled and BMI classifies you as obese, make a joke of it and enjoy the opportunity to poke fun at your employer.

There is no win other than the last.
posted by rr at 9:26 AM on January 14, 2010


How is it an illustration of that?
I also always wonder how that is so when I see that gallery as "proof" that BMI is bogus. I used to have a BMI of 38, but I did not look "that" fat, especially with the right clothes. I always thought that people who were morbidly obese were "those other people" that you sometimes see, who are really, really fat. But when I found at that my BMI was 38 and how dangerous that was (my BMI was not that high because I was a bodybuilder or anything like that) my thoughts were not: "that's ridiculous!", but I thought "huh, I never realised that all that talk about the dangers of obesity are actually about me!".
posted by davar at 9:27 AM on January 14, 2010


By the way: the official guidelines are that being overweight (not obese) is not a problem (or at least: you don't have to lose weight) if you do not have any other risk factors. So the people in some of the links that say they are perfectly healthy but have a BMI of 25.1 and therefore get a weight loss speech every time they go to the doctor may want to consider switching doctors.
posted by davar at 9:41 AM on January 14, 2010 [2 favorites]


Your employer is giving people an extra benefit that they are not required to by law?? How dare they!!

I suppose that's one way to look at it. Another is that they are taking a fairly Orwellian interest in their employees' personal lives, and from the sound of it, giving additional benefits to certain people based on either their genetics or outside-of-work habits. They're also humiliating employees who happen to be less able physically. (I wonder if they will ding the guy in a wheelchair for having a bad BMI?)

If the incentive is for improving your health, that's a little obnoxious. If they're flat-out rewarding people who already happen to be healthy, that's just moronic.

At any rate, it's just another one of those things where the company goes, "we had this great idea to make things better!" and everyone groans because you know that means it's going to make life hell for the average working person. If you can find someone who will listen, go ahead and argue, but don't expect too much of a rational response.
posted by drjimmy11 at 10:00 AM on January 14, 2010 [2 favorites]


(If a company actually, genuinely wanted its employees to be healthy, I can think of two things they could do:

1) Free gym memberships.
2) Shorter work hours, to have time to use them.

Try asking for those, just for a laugh.)
posted by drjimmy11 at 10:03 AM on January 14, 2010 [1 favorite]


The clearest example to me of the bogosity of BMI was a friend's experience. She was a little overweight, both by BMI and by more reliable measures. So she started exercising a little — very mild by anyone's standards; biking to work a few days a week, walking instead of driving, that kind of thing — and became trimmer, more energetic, healthier by any plausible standard. But her BMI went up, because she'd replaced some fat with muscle. She was soon in much better health than before, but her BMI had gone from "overweight" to borderline "obese".

The thing is that once you're an adult your BMI only varies with your body weight. It does not at all take into account what that body weight is composed of. Body fat percentage is a much more indicative measure. If you want your company to use an incentive that might actually promote their employees' health, try suggesting something that measures body fat, resting heart rate, sleep patterns. They'll ignore you, of course, because the popularity of BMI as a measure stems from the fact that it's extremely cheap to measure BMI.
posted by hattifattener at 11:07 AM on January 14, 2010 [1 favorite]


You are correct in that genetics plays some contribution to factors such as cholesterol and blood pressure. Not just in determining what they are, but in determining what is healthy for you. For example, it may possibly be that due to all my genetic polymorphisms and environmental factors it is better for me to carry a blood pressure slightly above the population normal. So I'd be doing something wrong to drop it down but your employer would penalise me anyway. (Note: I don't know if this is true for me in particular, just that it is possible in general). Same goes for cholesterol, the optimal profile for each person is, well, for each person and we don't actually have the tests of the knowledge yet to even determine what that is.

Now genetics isn't the only, or generally even the major, cause to these parameters but anyone who says it's irrelevant is wrong (I don't have references today, can probably find some tomorrow, but stuff like this is the basis of my whole field (nutrigenomics).) It's that word population, the guidelines are set to be a generalisation across a large number of people, and even then there's quibbling and contention about which exact numbers are correct. The main argument you have there is that your employer is rewarding or penalising you for conforming to a population average rather than actually looking at what is optimal for you as an individual, and given a large enough employee base there will be at least a few people forced into numbers which are not right for them as an individual.

Oh you also might want to add in white coat hypertension. My blood pressure goes up every time I got to the Dr or even just at the sight of a cuff by now. I've had a few crappy Doctors in the last few years who have made it worse (hint to doctors: taking it over and over and over as it slowly gets higher and I eventually start to panic, not going to get you that normal reading you're looking for). I don't actually have a blood pressure problem otherwise.

As for BMI, the CDC is correct in that it's a screen. It's like a single symptom in a list of other symptoms and doesn't tell you enough to make a decision on it's own. Body composition measurements would be a lot more accurate but you need to have a full body scan for that, those resistance machines are frequently misleading.

If BMI the limits you're given are generous enough (e.g. the example was given up there of an upper cutoff of 30) then it's probably OK since anyone outside that either is unhealthy or will have a demonstrable reason why they aren't (body building, whatever). But if the cutoff is 'within normal' then they probably want to consider that that number differs by location for no obvious reason and that it's very possible to be just outside that level while still being 100% healthy. For example the two weeks before the marathon I did last year I was just above BMI 25 because of the extra muscle on my legs and because I was drinking extra liquids. Being penalised for doing sports would be against the spirit of the whole thing. Oh and if they don't put in a lower limit for BMI then they clearly care more about how their workforce looks than their health (this isn't likely but still). Lastly I'd be worried about how and when they weigh you. My Dr has me down as being about three kgs heavier than I am because they made me do it fully dressed in the middle of winter, and they even told me not to bother taking off my shoes (I did anyway, those boots weigh a kg each).
posted by shelleycat at 11:31 AM on January 14, 2010


It's utter crap to use BMI in way your employer is attempting. I'm 5'10" & 175 lbs. According to the BMI tables, I am slightly overweight. People who look at me say I'm really skinny. FWIW, I run triathlons and do fairly well, so I know I'm in pretty decent shape. My friend is 5'8 and weighs 210. According the BMI, he's obese. However, his shoulders are a mile wide, his skull is the size of a watermelon and he's got wrists that are more than twice the width and thickness of mine. He's my tri buddy - and this "obese" guy routinely finishes in the top 20% in his age group.
posted by centerweight at 12:23 PM on January 14, 2010


Response by poster: Thanks to everyone for opinions on this. This has been an intense day of discussion in the work place as well about this very topic. From what I've learned, the decision to use BMI was not an easy one to get to but was the one, as many pointed out here, is the least invasive and is the cheapest to execute. Testing results will be saved within employee files but they are reviewing why and for how long.

What I will share is that measurements begin next week. Quite a few individuals are taking this as an opportunity to compete - not against themselves - but to compete and obtain the highest incentive available. So, discussions around fasting, drinking loads of water, Nyquil, hanging out in a walk in cooler, laying down, and the like (not all in conjunction) in order to intentionally skew the testing results to get the highest possible incentive.
posted by lostinsupermarket at 1:22 PM on January 14, 2010


I think these situations go better when you can provide an alternative solution rather than just criticize what someone else has done. Therefore, I'd submit that a better, fairer way to incentivize healthy behaviour would be to provide lifestyle bonuses (such as a benefit for people who exercise for a certain length of time with a certain frequency) instead of using personal health information (to which employers as general rule should have access anyway.)
posted by Kurichina at 1:33 PM on January 14, 2010


Wait, fasting, water, Nyquil, walk-in coolers? Wow.

lostinsupermarket, if you write an AskMe question about how to game these assessments, I'd be honored to post it on your behalf.
posted by box at 1:59 PM on January 14, 2010


Yo may find assessment isn't based only on BMI. My employer does a similar thing, but the BMI calculation is accompanied by a questionaire designed to gauge general health and fitness levels, thus the results and recommendations are far more accurate than you might otherwise think.

The thing with work stuff, and disagreeing about it, is you gotta think "is this the hill I want to die on?" Sometimes, it will be. More often, it won't be.
posted by smoke at 2:42 PM on January 14, 2010


Penn and Teller's Show, Bullsh*t also has arguments against BMI, in their Obesity episode. It's either on netflix or youtube.
posted by emkelley at 2:44 PM on January 14, 2010


Well now... if cheating is the order of the day (i.e., will benefit you) is there any better approach than a few days of high salt foods and craploads of water?
posted by rr at 5:35 PM on January 14, 2010


is there any better approach than a few days of high salt foods and craploads of water?

In this case, a pound or two of bacon washed down with a gallon of water is the breakfast of champions.
posted by foodgeek at 5:42 PM on January 14, 2010


Yes, just between us several MeFi-er, it has recently become clear that BMI is pretty meaningless, and since your employer is using it, they're missing a clue or two. BUT if your HR department believes in it, and your manager believes in it, AND YOU VALUE YOUR JOB, you'd better just shut your mouth and get back to work. And I mean that in the most positive way, as in "it's best for you and your career."
posted by exphysicist345 at 6:34 PM on January 14, 2010


is the least invasive and is the cheapest to execute.

Actually eyeballing you all and mentally classifying as fat vs not-fat would be way cheaper and much less invasive. Hey, if it's good enough for the crappy doctor I mentioned before it's got to be good enough for your employees, and it's possibly as valid if they're only going by BMI and everyone is doing dangerous stuff to game the system.

The rush to try and lose as much weight as possible worries me, because it suggests that the lowest weight possible will be desirable under the new system. This brings me back to my previous comment in that if it's really health related than they need a lower limit as well as an upper one. Rewarding anorexics is never a good HR move, neither is rewarding crash dieting. This 'highest incentive possible' should be awarded to those within a broadly-defined normal weight range already, which hopefully most of you already are. So maybe you need to talk to the higher ups about the effect this is all having and actually make sure the limits they're setting are both safe and biologically reasonable?
posted by shelleycat at 7:01 PM on January 14, 2010


Response by poster: In case I wasn't clear: you have the option to NOT participate in the healthy rankings and associated incentives. I and many, many others (including within my leadership chain) are not participating. It's entirely voluntary. Nothing punitive associated with lack of participation; no "row the boat because everyone else is rowing" mind set either.

I - still (yes, really) - don't think these are valid measurements of health and it puts unreal expectations on participants.

And with some folks at work talking about cheating the system, I just think it's morphed into something fairly ridiculous now.
posted by lostinsupermarket at 7:39 PM on January 14, 2010


I don't have anything to add to the coments on BMI above, but this editorial in the NEJM addresses the larger question of employee health incentives in general.
posted by TedW at 7:32 AM on January 15, 2010


I'm fairly healthy and budget-conscious but something about this gives me the, "Count me out and never mention this in my presence again" vibe. Is it opt-in/opt-out?
posted by chrillsicka at 10:56 AM on January 15, 2010


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