Reply to NYT: Is BMI a scam?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]"This explains why muscular athletes often have high B.M.I.s despite having little body fat" is only true for men. There's a literature on this. Women can't put on enough muscle naturally to have high BMIs without also having high body fat.

In general, whether this is an accurate indicator is separate from whether it makes sense to focus on. I'd argue it doesn't make tons of sense to focus on, but the reason I'd give is one that they don't even mention, which is that long-term, significant weight loss is really hard. Even if being overweight is making you unhealthy, if you're not going to change that and it's really stressful to think about, then it's better to focus on things you can change. But that doesn't mean we have to say it's a bad indicator, and that it makes people feel bad is totally separate from whether it has predictive value. (And the bit about "People who have felt discriminated against because of heavier weight are also about 2.5 times more likely to have mood or anxiety disorders" suggests a pretty obvious alternative causal explanation.) [/quote]

But it IS a bad indicator at the individual level. Did you see the other thread where people are splitting hairs over whether a 5'4" woman who wants to get back to 112 has disordered thinking because 112 is either 1-2 or 3-4 pounds away from being underweight? This makes absolutely no sense at all, but people think the idea of being underweight/overweight based on BMI is some super scientific measure. It's not, and it means very little.[/quote]

Just because something is being misused doesn't mean it doesn't have explanatory value in another context. And with any continuous variable that we split into discrete categories, there's going to be some amount of arbitrariness close to the lines. Is "18" really that different from "19"? Of course not. But if someone shows up with a BMI of 17 in your office, there are questions you should be asking them that you would not ask someone at a 'normal' weight, not because there's no overlap between the answers to those questions between underweight and normal-weight people, but because it's a matter of probability. [/quote]

There's plenty of evidence that doctors treat obese people horribly, so even in a medical context BMI isn't really being used in a productive way. Why can't doctors just look at more specific markers of health? People with high BMIs can be healthy but instead they have their medical issues ignored and they get treated as though any issue they have is their own fault for eating too much. 
From the article:
[quote]. In a 2016 study of more than 40,000 adults in the United States, researchers compared people’s B.M.I.s with more specific measurements of their health, like their insulin resistance, markers of inflammation and blood pressure, triglyceride, cholesterol and glucose levels. Nearly half of those classified as overweight and about a quarter of those classified as obese were metabolically healthy by these measures. On the other hand, 31 percent of those with a “normal” body mass index were metabolically unhealthy.[/quote]

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