BMI- (Big) Brother’s Mandatory Info

16 07 2010

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This is not a  political blog, so please do not read more into this than the simple (fair and balanced) reporting of the facts. This just seemed very timely given our several posts in a row discourse on  weight, sugar, fat, health, eats, etc. Officially announced by the government today was the fact that by 2014 all EHR (electronic health records which all health care providers are mandated to migrate to) must contain a BMI measurement. The BMI is the body mass index, calculated by using the height and weight measurements. It is what is currently used to define normal, overweight and obese individuals. We covered some of this from a post back in October, but I think the current situation bears some repetition. The basic premise is to gather data based on BMI. That we know. I suspect that the data collected allows the following determination: we know what a healthy weight should be and if your BMI reads “overweight” or “obese” you can be classified as such, for whatever purposes that might be. It is based on the assumption that the BMI is a great (read unfailing) measure of fitness and fatness.

But is it? The BMI is in essence a guideline developed in the 19th century. In addition, there is an ongoing debate about the accuracy of the BMI. On the opposite side of the scales, people are asking whether a measure that defines about 1/3 of the population as overweight/obese is simply an inaccurate or outmoded measure. How well does just BMI correlate with risk? For example, some world-class athletes like rugby player Jonah Lomu have a high BMI. According to BMI measurements Arnold Schwarzenegger and Sylvester Stallone are or were all obese or overweight at one time (like when they were buff during the Rocky and Terminator days).  Are there more accurate measures we should use? Should we be looking at fat distribution and body polymorphisms? I don’t know, but perhaps these are questions to be asked.

I worry that this may lead to things like the  “Comprehensive Wellness Program” designed by the state of North Carolina to enforce compliance among state employees. Things like that give me goose stepping nightmares. I am all for a more healthful population, but we must strive for individual wellness, not government mandated numbers. Wellness (which includes good physical health) should be each individual’s goal. It must be individually nurtured, not uniformly impressed. Wellness requires choice and participation by election. To try to achieve some “ideal” without any respect for the individual situation (including physical limitations that result in overweight situations) while perhaps expedient, is ultimately poorly conceived. When I was ana ttending at the teaching hospitals and universities, I always taught to treat the patient, not some lab result. I can not tell you the number of times interns, residents and fellows were off to initiate some intervention and when we stepped back, treated the patient and repated the lab or measurement we found the first one was in error. For now it’s just data collection. I hope that’s where it stays!

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