Rethinking our approach to BMI highlights the need for speed

Moving too quickly in medicine can be disastrous. The previous century is littered with examples, from the scandal of thalidomide – a morning sickness drug that had never been tested on pregnant animals – to the embrace of low-fat diets, based on scanty evidence. But there’s also danger in moving too slowly, and the body mass index (BMI) is a case in point.

We have known for decades that the measure – a simple calculation based on a person’s weight and height – is too blunt a tool, unable to distinguish between fat and muscle or account for global diversity. Its benefits are that it is fast, cheap and simple, but by using it for so long, millions have been erroneously labelled as overweight, a diagnosis with knock-on effects such as being denied fertility treatment and certain surgeries.

But there are better alternatives, and these are finally beginning to be used. Last year, The Lancet helped catalyse this overdue change by recommending that BMI alone should not be used to measure obesity, a suggestion that was promptly taken up by 75 international medical organisations.

This points the way out of wider medical inertia, which comes not just from the much-needed safeguards put in place after the mistakes of the 20th century, but also from a lack of good evidence, clear consensus and the leadership needed to make change happen.

We need only look to the triumph of the covid-19 vaccines, which were produced in a previously unthinkable timeframe and saved an estimated 14 million lives in their first year of use, to see that fast, safe, evidence-based action is possible.

This kind of action is what’s needed across many languishing areas of healthcare. Better menopause care, new psychiatric treatments, more male contraception options and novel antibiotics are just a few of these.

It is right to be cautious, but the time has come to move fast without breaking things.