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BMI and People with Dwarfism: what you need to know

What is BMI and how does it affect people with dwarfism?

BMI stands for Body Mass Index. BMI is a calculation using heigh and weight. BMI is person’s weight in kilograms divided by the square of height in meters. A high BMI can indicate high body fatness. BMI screens for weight categories that may lead to health problems, but it does not diagnose the body fatness or health of an individual.

The American Medical Association released a report in June 2023 that the use of BMI alone is an imperfect clinical measure. This report stressed that BMI should not be used to deny care. Here is the full text of the report: https://www.ama-assn.org/system/files/a23-csaph07.pdf

Should BMI be used for people with dwarfism?

While BMI is low-cost and quick to measure, it is unreliable for people with dwarfism. BMI can over or underestimate a person’s body fat. BMI should not be used as a single measurement to determine if person with dwarfism is overweight. Instead, use multiple measures such as weight history, recent weight gain and common sense to determine if someone with dwarfism is overweight.

Who invented BMI?

BMI was invented by a Belgian Actuary named Adolphe Quetelet in the 1800’s. The calculation was based on European soldiers in the 1800’s. Quetelet used arbitrary measures to determine an “ideal” weight. He did not take into account that some people have more muscle, that some body types tend to run smaller while others can be healthy at a higher weight. He certainly didn’t consider that people with disabilities come in many sizes and shapes and can be very healthy despite having a higher BMI. The BMI was also only based on white men. BMI can be inaccurate for people from other populations who come in different sizes than European soldiers in the early 1800’s.

Quetelet was ableist. He based the “healthy” BMI ranges using a Gaussian or normal distribution, your standard bell curve. Quetelet believed that the average man was both physically and morally average. Quetelet was not a doctor, nor did he consult any medical professionals when creating the BMI. He was seeking to characterize the “average man.” He was not trying to determine who was healthy, just what was ‘normal’.

Not only is BMI inaccurate but BMI can be harmful.

Why is BMI Harmful?

1.) BMI is inaccurate. It is based on heights weights of white male soldiers who lived 200 years ago.

2.) People with dwarfism don’t fit in standard BMI charts. Dr. Julie Hoover-Fong, the Chair of the Little People of America Medical Advisory Board, published a letter in 2013 to the American Journal of Medical genetics strongly advised against applying current BMI guidelines to adults with dwarfism. She notes that BMI is “inaccurate as a surrogate of body fat or predictor of health outcomes.” The conclusion was “average stature BMI recommendations must not be applied to short stature individuals as an indicator of fatness, disease, or mortality risk.”

3.) Focus on BMI can lead to disordered eating. Giving a young adult an impossible weight goal is demoralizing and dangerous. It can lead to eating disorders such as anorexia and bulemia, as the weight goal is physically impossible to reach. for further reading, read If the body mass index stops measuring health and starts causing shame, change the game .

4.) BMI is racist. Not only is BMI old, but it has racist origins. Quetelet wanted to measure the ‘ideal man’ and only used European men. BMI does not take into account people’s ethnicity. For example, many people of Asian descent have a thinner build that average. A BMI of 23 could be overweight for some Asian cultures who have a naturally thinner build but “ideal” according to the BMI charts. There are other people who naturally are taller with bigger bones and are healthy at a higher BMI. Why should we be basing ‘ideal weight’ on 200 year-old research done only on young soldiers?

5.) BMI is used to delay or deny medical care. Some people with dwarfism have been refused surgeries because their weight was too high according to the BMI. Additional, some workplace wellness programmed charged people more for health insurance if their BMI was too high. This practice is no longer legal thanks to a lawsuit from AARP in 2016.

6.) People naturally lose a few inches as they grown old. BMI is not age adjusted so it misclassifies older people as overweight.

What to do?

A healthy weight is vital for people with dwarfism. Our joints develop arthritis and other problems earlier. Healthy weight can prevent diabetes, cancer and heart disease and and increase life expctancy.

Make sure your medical providers understand that BMI should not be used for people with dwarfism. If they do not, then find another doctor.

Measure changes in waste circumference, skin fold measurement, changes in clothing size and weight change over time.

Monitor your weight and pay attention if you are gaining weight. Work with your medical team to improve your diet and exercise routine. There are many exercises that can be safe for people with dwarfism listed here: https://ksginfo.org/medical/.

Also, there is a facebook group for healthy exercises for people with dwarfism.

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