The Value of Body Mass Index (BMI): An interview with Dr. Michele Reed
A Belgian mathematician initially discovered the relationship between height and weight that we now know as the Body Mass Index (BMI). He discovered this connection in a Western European population. It was never intended to assess individual fitness. On top of being discovered in the context of European body standards, BMI can generate weight-based discrimination and does not account for differing muscle mass and different ethnic groups’ typical body types. Despite its shortcomings, today's healthcare world continues to rely on this measurement. From dictating whether patients can receive medical coverage for specific procedures to generating beliefs that one's health is solely dependent on this measurement, relying on this system alone paints a limited picture.
Eager to explore the effectiveness of BMI in healthcare for diverse communities along with how patients can navigate this measurement, Sensis interviewed Dr. Michele Reed. Dr. Reed, the “Fit Doc,” is an African American, New York-based family physician whose practice emphasizes the significance of holistic health, cultural nuances, and patient advocacy. Through utilizing social media and serving as a community leader (i.e., physician of two school districts and her church congregation), her platform has allowed her to spark meaningful dialogues about healthcare and how treatment goes beyond the scale.
What inspired your career today?
Dr. Reed emphasizes that her upbringing allows her to see that traditional notions of fitness go beyond weight and standard treatment. Instead, she notes that fitness includes disease prevention, and can be categorized into mental, physical, sexual, and spiritual health. During medical school, she explains that seeing a gap in their training allowed her to develop a holistic approach to medicine today.
“In medical school, we’re taught how to recognize and treat disease. There wasn’t a big focus on how to prevent things…Nutrition when I was in medical school was about twelve [credit] hours and we know that what you put in your body is worth more than the twelve [credit] hours your doctor has gone to school for. I’ve gone outside and taken nutrition classes, become an integrated health coach, and a personal trainer.”
What types of patients do you typically see? What is the demographic makeup of your patients?
With office locations in Southeast Queens and Long Island, communities known for their diversity, she serves a unique group of patients.
“Rosedale is in Southeast Queens, and we have a Caribbean demographic. You have your Endo-Caribbean people, people that might even be from Africa. We have people that are from Latinx countries in the Southeast Queens area because you have your Guianese, Trinidad- we have all of it…In Long Island, it’s like the UN with everyone together”
How do you navigate the multiculturalism of your patients’ backgrounds?
“You always have to know who's in the room. Who am I talking to? There might be something culturally that I might say to a Hispanic male patient versus when I’m talking to a Hispanic female who is not sexually active, I might not say it the same way.”
As a medical professional, Dr. Reed strives to understand who her patient is so she can tailor her messaging to their cultural needs.
How strongly does your practice rely on BMI?
Dr. Reed describes how BMI is collected primarily for insurance purposes; however, her medical practice recognizes that her patients’ health is more complex.
“Body mass index is something they (insurance companies) want to make sure everybody gets diagnoses for everybody’s chart for every visit. No two people are the same. If we’re looking at this as a standard to see who is underweight, overweight, obese-there’s a lot of gray area because if you have an increased muscle mass, that will drive your body mass up.”
Understanding that health goes beyond the number on the scale, her offices aspire to create a complete picture of each patient's overall fitness by digging deeper to determine their diet and general habits (e.g., frequency of exercise).
“We want to know everything about you-what you eat, who's in your circle, what type of work you do, what hours you work, who do you eat with, where do you like to eat- because that gives you a clue of what people are interested in. As a doctor, we look at the whole person because everything is related.”
Is there a relationship between different cultural groups having specific body types?
During her appointments with diverse patients, she is both mindful that BMI is not one-size-fits-all and that generalizations of body types for specific ethnic groups are not always true. For instance, she explains that while a patient’s BMI may indicate they are obese, she will factor in their cultural background and the fact that they may carry weight differently and are not necessarily unhealthy.
“Keeping in mind, culturally, we're all built differently as far as our body build. You can even compare people within certain races and say, ‘this is the standpoint I’m going to use as you're the perfect weight and you’re not’ because everybody is built differently.”
On the flipside, she also is mindful that body stereotypes for certain ethnic minorities are not always correct. For example, although Asian Americans tend to have slender figures, she may very well see persons of Asian descent that do not have this build.
Do you see a need for persons of color to seek out healthcare providers from similar racial backgrounds?
While the quality of the doctor-patient relationship matters most, Dr. Reed understands that this relationship looks different for everyone. She notes that some may benefit from having a physician that shares their cultural background while others may not.
“Sometimes that person might not necessarily look like you and sometimes he/she does. There are websites you can go on to find someone that looks like you.”
How is BMI harmful?
“They don’t know if that person with a BMI of 24 is Anorexic or if they’re a diabetic that can’t retain anything and their electrolyte balance is off - we don’t know. You can never look at someone on a piece of paper and say they’re healthier than someone else.”
She explains that BMI is not representative of a patient’s health and does not account for the patient having weight-impacting conditions or excellent fitness regimes.
How can patients advocate for themselves?
Dr. Reed emphasizes that patients have numerous rights they can exercise, from having accompaniment to their appointments (i.e., having a family member on speakerphone during a medical exam, so they understand the diagnosis and how to administer medications) to requesting a medical summary.
For patients wary of weight discrimination or who are being impacted by eating disorders, she shares that they can present “Don’t Weigh Me” cards to establish their preference against being weighed and can request the medical reasoning for why this information is needed.
Most importantly, she describes the significance of ensuring her patients leave her office fully confident in articulating their diagnosis and options along with making sure they are comfortable speaking to their physicians. Aware that some patients have restrictive healthcare policies and unique needs, she reiterates the value of forming relationships with medical professionals that have their best interests in mind.
“As their doctor[s], we’ve done our best to educate them as to what is going on. They need to find doctors that listen to what their concerns are (because sometimes their insurance prevents them from seeing specialists).”
Conclusion: Although BMI continues to be utilized, particularly for insurance purposes, medical professionals such as Dr. Reed are striving to redefine traditional health. Rather than relying on BMI as the ultimate measure of an individual’s fitness, her medical practice evaluates her patients’ other forms of health (i.e., mental, physical, sexual, and spiritual), examines their daily habits, and respects their cultural backgrounds (i.e., traditional foods, language, typical body types). For instance, a person of color that regularly works out and whose cultural cuisine is calorie-dense will have a higher muscle mass and subsequently, a BMI that indicates they are overweight. Rather than accepting their BMI at face-value, Dr. Reed takes it upon herself to explore the gray area and factors in this patient’s increased muscle, pre-existing conditions, and cultural diet. Mindful that some healthcare plans still rely solely on BMI despite these unique factors, she educates her patients on how to advocate for themselves to receive the best care. For example, individuals have the power to access resources that connect them with physicians from their cultural background and can ask why documentation of their weight is medically required. With increased patient education and changing health norms, more are understanding that an acceptable BMI, which was discovered in the context of a European population, is not a complete picture of health for all.
