He may technically have a high BMI but that will comprise a lot of lean muscle and, accordingly, this should count as physically healthy. Take a professional boxer such as Frank Bruno. As for a point of reference, a BMI of 18 became, after much debate and controversy, the minimum acceptable measurement for models in the 2006 Milan fashion week.īut numbers, and statistics, can sometimes mislead, and in fact there are occasions when the human eye can be better at adjudicating obesity than the BMI. At the other end of the scale, anything below 18.5 is also generally regarded as distinctly unhealthy: a score below 17.5 in fact might well indicate anorexia, and 15 is usually taken as the upper limit of ‘starvation’. BMI above 40 is ‘bariatric’ or ‘morbidly obese’ and may well need hoists to help mobilise. The generally accepted view is that a BMI of 25–29.9 indicates that one is ‘overweight’, while 30 or above classifies one as obese having a BMI above 35 suggests one is ‘grossly obese’, so that even for routine elective surgery, such a patient may need to discuss their options with the anaesthetist. Its appearance of scientific impartiality allows it to help maintain a patient–clinician relationship where a statement based on simple clinical observation alone may come across as indelicate. The BMI is a surrogate measure of fatness, and as fatness is an indicator of health (‘if you have a BMI of over 25, you have an increased risk of serious health problems’ 1), it is presumably to the essence of its use that the BMI can help identify ‘fatties’ in a potentially non-threatening, almost politically-correct way. If its use is to properly help determine whether someone is obese and hence in need of some intervention to help restore health, or to reduce their risk of ill health, then those who use it should understand it rather better than most of them seem to do. In short, it was designed with Belgians in mind, and does not work so straightforwardly on such populations as Bangladeshis, Botswanans, or boxers. However, these factors are invariably ignored. It can all seem so clear and precise that it may be something of a surprise to discover that its proper use in contemporary clinical practice generally requires that other factors also be taken into account. From this study, which he hoped would allow him to determine the ‘average’ man, he formulated what became known as the Quetelet formula, but which is now known as the BMI, and is calculated by dividing an individual's weight in kilograms by their height in meters squared. Adolphe Quetelet's interest in the emerging discipline of statistics in the mid 1830s saw him collect data on men's heights and weights at various ages. The BMI can be traced back, rather surprisingly, to a famous Belgian.
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