BMI and weight don’t necessarily predict the whole picture of health. Yet in medical school, patients are told to lose weight because training focused on weight and BMI exacerbates anti-obesity stigma and increases the risk of eating disorders. Yet that same training doesn’t provide medical students with sufficient education on how to encourage healthier eating habits or what good nutrition means. At least, that’s according to a study published in 2010 by the University of Georgia. Medical Educator.
“Mainstream medicine is still very focused on the link between weight and health,” said Carney Gunsalas, lead author of the paper and assistant professor at the Augusta University/University of Georgia Health Partnership. “Because obese and overweight people are more likely to have health problems, it’s easy to jump to the conclusion that weight itself is causing those problems. And if we assume that weight is causing the problems, it seems reasonable to assume that losing weight is the solution.”
Nutrition is an important determinant of health, but this study suggests that American physicians are not receiving the effective training they need to advise their patients on the subject. The researchers recommend small changes in medical education and how health professionals interact with patients that could have an impact on some of the health challenges facing modern society.
Focus on health, not weight
BMI classifies people into four categories: underweight, healthy weight, overweight, and obese. It is taught in medical schools as a way to measure general health. These researchers argue that BMI overestimates the number of people who are unhealthy, and that medical education should focus on objective measures of cardiometabolic health.
The main difference is that cardiometabolic health also includes indicators such as blood pressure, insulin resistance, cholesterol levels, and other indicators that are more accurate predictors of overall health.
For example, previous studies have demonstrated that approximately half of Americans who are overweight by BMI standards are metabolically healthy. Additionally, approximately one in three people whose BMI was within the healthy range were actually unhealthy when assessed by more comprehensive criteria.
“When we look at the latest research on bariatric surgery and the use of drugs like Ozempic and Wegovi, it appears that patients can experience health benefits without having to lose weight,” said Dr. Ellen House, co-author of the study and an associate professor in Medical Partnerships. “We really like black and white in medicine, but when the benefits appear to precede and be independent of weight loss, the conversations that doctors have with their patients need to change to focus on health, not weight loss.”
The researchers note that current medical education also lacks training to teach students how to address weight bias against patients, whether they are overweight or underweight, which does not take into account biological and systemic factors that may be related to weight, such as the availability and affordability of healthy foods and access to safe places to exercise.
“Overweight patients are less likely to receive appropriate testing and treatment for health concerns,” says House, a licensed psychiatrist. “Asthma and cancer go unnoticed because doctors attribute symptoms to weight, when weight is not the cause of the patient’s concerns.”
Missed interactions with doctors impact patient outcomes. Being told to simply lose weight based on BMI standards demoralizes patients and makes them less likely to talk about the issues they’re having. Reframing the conversation to focus on healthy behaviors, like doing the things you love and being more active, can move people towards better health in a more positive way.
“Doctors believe they are trying to help people become healthier by recommending weight loss, but they just don’t realize the harm their advice can cause,” says Gunsalas. “If I could wave a magic wand and ask doctors to do one thing differently when working with patients, it would be to start with the premise that every patient wants to be healthy and is capable of being healthy.”
