less as healthy, even if they need medical treatment.
For eating disorders, insurers often use BMI to make coverage decisions and can limit treatment to only those who rank as underweight, missing others who need help, says Serena Nangia, communications director for Project Heal, a nonprofit that helps patients get treatment, whether they are uninsured or have been denied care through their health plan.
“Because there’s such a focus on BMI numbers, we are missing people who could have gotten help earlier, even if they are at a medium BMI,” Nangia shares. “If they are not underweight, they are not taken seriously, and their behaviors are overlooked.”
Stanford says she, too, often battles insurance companies over who qualifies for overweight treatment based on BMI definitions, especially some of the newer, pricier weight loss medications, which can cost more than $1,500 a month.
“I’ve had patients doing well on medication and their BMI gets below a certain level, and then the insurance company wants to take them off the medication,” Stanford says, adding she challenges those decisions. “Sometimes I win, sometimes I lose.”
While perhaps useful as a screening tool, BMI alone is not a good arbiter of health, according to Stanford and many other experts.
“The health of a person with a 29 BMI might be worse than one with a 50 if that person with the 29 has high cholesterol, diabetes, sleep apnea, or a laundry list of things,” says Stanford, “while the person with a 50 just has high blood pressure. Which one is sicker? I would say the person with more metabolic disease.”
Additionally, BMI can overestimate obesity for tall people and underestimate it for short ones, experts say. And it does not account for gender and ethnic differences.
Case in point: “Black women who are between 31 and 33 BMI tend to have better health status even at that above-30 level” than other women and men, Stanford says.
Meanwhile, several studies, including the long-running Nurses’ Health Study, found that Asian people had a greater risk of developing