Rethinking overreliance on BMI to improve patient care


While body mass index (BMI) has long been used in health screenings, the current approach of BMI as an evaluative and predictive diagnostic tool has come under clinical scrutiny, particularly when negative weight bias undermines patients’ access to care.

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The July issue of AMA Journal of Ethics® (@JournalofEthics) explores medicine’s historical and current reliance on BMI and examines the ethical deployment of BMI in clinical encounters, both in practice and training.

The July issue includes the following articles:

  1. Teaching How to Avoid Overreliance on BMI in Diagnosing and Caring for Patients With Eating Disorders

    1. This article considers potential unintended but foreseeable negative consequences, including iatrogenic harm, of using BMI to distinguish typical from atypical anorexia nervosa, despite both illnesses sharing the same behaviors and complications. 
  2. How Should We Approach Body Size Diversity in Clinical Trials?” 

    1. Despite concerns about clinical outcomes for patients with obesity, clinical trials report few data about such patients.
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  3. AMA Code of Medical Ethics’ Opinions Related to Clinical Use of BMI

    1. The AMA Code of Medical Ethics offers guidance on the use of diagnostic tools that could be sources of harm to patients.
  4. Use and Misuse of BMI Categories

    1. Before the late 20th century, overweight and obesity were not considered population-wide health risks, but the advent of weight loss drugs in the 1990s accelerated hypermedicalization via BMI use. 

At the 2023 AMA Annual Meeting in Chicago last month, the House of Delegates adopted significant new policy on the use of BMI as a clinical measure.

In the journal’s July “Ethics Talk” podcast, Editorial Fellows Astrid Floegel-Shetty and Kratika Mishra discuss the development of this month’s issue, and fat stigma researcher Ragen Chastain talks about how patients can be harmed by BMI surgical guidelines. The July issue also features five author-interview podcasts.

Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

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Submissions for the 2023 Conley Contests are being accepted through fall. U.S. MD and DO students, resident physicians or fellows in programs accredited by the ACGME or AOA are eligible to submit entries. The winning prize for the best essay and artwork, respectively, is $5,000.

Learn more about the Ethics Essay Contest and the Art of Medicine Contest.

Upcoming issues of the journal will focus on robotic surgery and palliative psychiatry. Sign up to receive email alerts when new issues are published.