BMI? reliable or just a short cut?

[nealiiih]

Hello everyone!

I just joined and this is my first post, I love the site! Forgive me if I've posted in the wrong area for this topic.

Does anyone here believe in the use of BMI? I have read across journals that it is a quick and easy reference tool for practitioners to use. Is it an accurate and/or valid tool to use to advise your patients on health/wellness/need for weight loss? In my opinion, I look at a more holistic approach rather than just BMI- vitals, lipid panels, labs, clinical presentation, activity, and the patients general feeling of wellness, except for when the patient is clearly obese or the lifestyle could clearly benefit from some weight loss.

I'm asking as a nurse and a patient. Last week, I got a birth control refill and their process at the women's health clinic is to conduct a brief assessment before giving the refill prescitoption. I had an NP who looked early 30's (my age) but she's almost a size zero, and living in Southern California, this seems to be the norm....but I digress.

I'm 150 lbs 5'5" though I lift and do cardio and yoga four times a week, I mostly eat clean, have muscle mass and do not have a dainty bone structure, I am a size 6. Nonetheless, my BMI is barely 25, which is considered 'overweight.' the cut off is 149 lbs for my height which then would be a BMI of 24 which would be "healthy weight range." This I can handle.

What I can't handle is she used my upcoming wedding as a way to open the conversation about me loosing weight. "Don't you want to get in better shape for your wedding?" she asked. (Earlier in the assessment she noticed the ring on my finger, assumed I was married, I corrected her and said I was engaged) She mentioned "loosing weight for my wedding" not once but twice and mentioned my BMI. I told her I'm a size 6 and short of starvation paired with my current activity level, weight loss is an immense struggle. Please note my BP was 91/60 HR 65. My lipids are great. I wish I could bottle it up and sell it.

I had the feeling she was looking at numbers only and not the actual patient, head buried in chart. I left the clinic in tears (silly me). As an RN, I would never advise a patient to loose weight based on a borderline BMI alone, she had not asked about lifestyle or activity level or anything, all she could see was that number. Does all that matter? The consensus across the internet and a few medical journals is that BMI is bogus, but then why do practitioners continue to use this as a standardized tool?

[Rose_Queen, BSN, MSN, RN]

Because a tool that works some of the time is better than no tool at all. Accuracy is debatable, especially with those who have a lot of muscle mass. Personally, I feel it should be used more as a guideline than a full-fledged diagnostic and that other things should come into play when evaluating the health of a patient.

[morte, LPN, LVN]

i sure as hell wouldn't be seeing that practitioner again. simple minded.

[NOADLS]

BMI doesn't account for people as an individual. It is a great tool for looking at a population, but body shape and body fat are key indicators of health (and attractiveness). Is the weight up there? or is it down there? or right dead center as grippable love handles? I can think of several women that are 5'4-5'5 and are all roughly 115-120 pounds. A few have a lot of weight distributed to their breasts, some look quite chubby and then I know a soccer player who has legs that look like tree stumps, but a slim upper body.

[eroc]

At 5'9" I have been 220lbs @ 6% BF Shredded. (BMI obese)

And up to 265 @ 13% BF could still see all the lines of my Abs (BMI Severely obese)

People look a numbers and try to simplify health……it is far more complex than a number. It is the entire picture.

An excessive amount of fat generally leads to health problems= poor diet and lack of exercise.

[seasidesoul]

BMI doesn't look at the whole story, nor does it apply to the entire population. My goal is always to treat my patients as individuals. I can see, to some extent, why BMI can be a useful tool when it comes to gathering statistics, but I don't think it factors in enough information when it comes to each individual.

As for your practitioner... I'd run away from her, fast.

[nealiiih]

thank you for the replies. I appreciate the perspective. the more I think about my interaction with her, the more bizarre it actually was. in my opinion she's clinically inept for not looking at the whole picture.

[Nonyvole, BSN, RN]

BMI was created by a statistician who was looking for a way to describe normality in the human body. It has better applications for public health and studies that use large - as in thousands - sample sizes. (This guy came up with it in 1832. That's over 180 years of usage now...)

I'd much rather look at body fat percentages as part of the entire picture.

My BMI calls me obese. I'm 61 inches, 155 pounds. Ish. You can see my abs and I refuse to wear skinny jeans because of how much muscle is on my thighs. If I had a clinician tell me that I needed to lose weight based on just my BMI, I'd be going to a different clinician. And giving that one a piece of my mind as I left.

[applewhitern, BSN, RN]

I wonder if this practitioner was selling weight-loss products on the side? Some of the doctors I know do this.

[sallyrnrrt, ADN, RN]

I use BMI, as only one bit of data, There are so many other important considerations, Level of glycemic diet, Activity muscle mass, age structure, endocrine physiology......the provider may have tunnel vision

[mvm2]

You being a size 6 says a lot about your frame. You must be a petite girl. My height and weight is almost the same as yours and I wear a size 12. Use to wear 8 but after babies and getting older its hard to do. I want to loose 30 pounds but it is not happening. Though many people say I don't look like I weigh what I do because of the way I carry it. They swear I can't be anymore then 130 but unfortunetly the scale does not agree.

Don't worry about it you will look fabulous on you wedding day just the way you are.

[Libby1987]

I don't think her use of BMI was the main issue here. She seriously suggested that you should want to lose weight for your wedding? She should seriously consider going to How to be Professional and not Mind**** your Patients School.