For years, fitness professionals have been trained to use Body Mass Index (BMI) as a prescreening tool when individuals join a fitness program. It was part of the recommendations by the American College of Sports Medicine (ACSM) for evaluating health risks; tobacco use, cholesterol profile, and family history for cardiovascular disease were also part of that process. In 2015, the ACSM updated their guidelines, and guess what? No BMI screening was included.
Why Is BMI No Longer a Screening Tool?
The changes to the ACSM guidelines were positioned largely around decreasing barriers for individuals to start an exercise program. After years of research, what they found was that BMI was not a driver of cardiovascular events during exercise. Anecdotally, I can say from experience that I had a lot of (sometimes angry) individuals wanting to join the corporate fitness center who needed a medical release because their BMI was "too high" and they had one other risk factor, such as not knowing their cholesterol or current tobacco use. So for our staff and their members in corporate fitness environments across the country, I thought this was a positive change.
But it leaves me wondering if we should be looking at BMI at all. There's a lot of back and forth in the wellness community about the "value" of BMI. The screening tool was always meant to be a field test to determine appropriateness of weight for a given height. And truly, it's an easy measure to determine; there are BMI calculators all over the internet. But that may be the end of its utility as a screening tool. There are a lot of questions about how meaningful the information really is to either the individual being assessed or the practitioner with whom they're working.
If We Don't Use BMI, What Should We Use?
This is something of a loaded question and points to our cultural obsession with "healthy" body weight. Do we need to screen for fatness? What's the value in those figures? Certainly measuring percent body fat or circumference might provide more meaningful ways to track an individual's desire to lose weight. But there are caveats on providing that information, too. Our staff members are providing those measures as field tests in our clients' corporate fitness centers, and the accuracy can be questionable, particularly for body fat assessed by skinfold testing.
We have a responsibility in our clients' fitness center environments to help the members live well in the ways that are meaningful to each individual. That might mean helping someone work on gradual, healthy weight loss. It might also mean working with someone to help them learn to appreciate the difference between feeling good when they move their body and feeling bad when they step on the scale.
The goal for our staff is to help the members they serve improve their health in all the ways that are articulated. When tools like BMI are so limiting (and potentially harmful to the psyche), we have to take a hard look at whether those tools are helping us achieve that goal. With so many other fantastic programs in our books to help people move more, try new areas of healthy living, and even remember what it felt like to play at recess, I think we have just what we need to create positive, successful, healthy environments for our corporate and senior living clients.