The Body Mass Index or "BMI" was devised by Adolph Quetelet and developed between 1830 and 1850. Mr. Quetlet was developing a field he called Social Physics, which would eventually develop into Sociology. The ratio of human body weight to squared height was explicitly argued to be appropriate for overall population study of general thickness. Even in its infancy, it was not meant for individual assessment of health - a fact then echoed by Ancel Keys years later (1972) in his paper Journal of Chronic Diseases.
The BMI is used these days by health, medical, and insurers' actuary tables to determine if a person is at a healthy weight: 20-25 good, 25-30 overweight, 30+ obese. These numbers get subtle fudging to have the formula apply to all ages and sexes; placing them on a statistical chart of overall health even when this was not its intended purpose.
This once simply fictional formula of health evaluation is going to start costing some incredibly real dollars for many individuals. The United States Equal Employment Opportunity Commission has proposed rules allowing employers to penalize their employees up to 30% of health insurance costs should they fail to meet "Health" criteria such as reaching a specific BMI. Companies such as CVS Caremark already have "carrot or stick" policies that unfairly single out those who do not meet the BMI standard. Those who do not submit their BMI along with other information can face penalties up to $600.00 in addition to being charged higher health care premiums.
In a released statement CVS had this to say about its current policies: "To encourage a higher level of participation in our wellness review, we reviewed best practices and determined that an additional cost for those who do not complete the review was the most effective way to incent our colleagues to improve their health care and manage health costs."
However, a new study at UCLA and published in the International Journal of Obesity is a direct response to measures taken by companies like CVS and the proposed rule changes by the EOCC. It has shown that using the BMI to gauge health incorrectly classifies more than 74 million Americans as "unhealthy" when placed into their BMI category.
UCLA researchers are led by Dr. Janet Tomiyama, who directs UCLA's Dieting, Stress and Health laboratory. Dr. Tomiayma has led numerous other studies and has found in previous research that there was no clear connection between weight loss and health improvements related to hypertension, diabetes, and cholesterol and blood glucose levels.
This current study evaluated over all metabolic health using markers such as blood pressure, triglycerides, cholesterol, and insulin resistance; then broke down the metabolically healthy and unhealthy individuals into their BMI stratification. 47% of the overweight individuals were metabolically healthy. 29% of the obese subjects were metabolically healthy and would be unlikely to incur higher medical expenses. These among other findings.
More than 30% (20.7 Million) of normal weight individuals are actually unhealthy based upon other health data.
More than 2 million individuals of obesity type II/III individuals are actually metabolically healthy.
"There are healthy people who could be penalized based on a faulty health measure, while the unhealthy people of normal weight will fly under the radar and won't get charged more for their health insurance," said Dr. Tomiyama. She added that employers, policy makers, and insurance companies should focus on "actual health markers."