Source: Patricia Serna / Unsplash
A recent article in the New York Times brought attention to a new health screening tool: the BRI, or the Body Roundness Index. Hurray! Let’s kick the dreaded and flawed Body Mass Index (BMI) to the curb. Finally, the Body Roundness Index offers an effective screening tool to identify and correct poor health outcomes. Or does it?
A closer look at Body Mass Index
The Body Mass Index tool has messed with my head for decades. It’s everywhere. I get on a digital bathroom scale, and the readout has green, yellow, and red zones based on BMI, trying to coax me out of yellow and into green.
While in my doctorate program, we studied health care economics. The Accountable Care Act (ACA) guidelines enacted at the time were built into the electronic health record (EHR) and billing systems. When a patient’s weight flagged a BMI in the obese range, the EHR alerted the doctor to “counsel” the patient on weight management and check a box stating this conversation occurred. In turn, they received compensation for the visit.
These tactics were followed in hopes of changing the course of the “obesity epidemic.” Clearly, this approach didn’t work. All it did was keep people from going to the doctor to escape the humiliation. I experienced this embarrassment firsthand: I once sat wrapped in paper, one week after major surgery, and the chart-carrying doctor entered the room and greeted me by saying, “You’re obese.” True story.
Body Roundness Index: A new measurement tool
Maybe the Body Roundness Index was an attempt to depend on a better tool. Maybe it was motivated by the waist-hip ratio or women with an over 35-inch waist being at risk for metabolic syndrome. Intentions are well-meaning – metabolic health risk is a real thing – but the body is the target once again. This time, it’s the shape as opposed to height and weight.
Oh dread, roundness. Now, I’m going to have nightmares of yellow cloth measuring tapes. I was the kid with the round belly who wore tankinis before they were a thing. Cover that belly, for heaven’s sake!
I understand the science of metabolic health and visceral fat, but any time we use the shapes of bodies as a determinant of health, we start visually categorizing. It’s like the Dr. Seuss Sneetches’ belly stars. In Sneetchville, they represent differences. In Humanville, they represent discrimination.
Think back to all of the times that humans (and maybe Sneetches too) have discriminated against people because of the way they look. When I was a physical education major, we learned about three different body types: endomorph, ectomorph, and mesomorph. No one body type was better than another; they just were. Some body types had an advantage in certain sports, but it was accepted that you couldn’t change your body type. Just like an apple can never be turned into a pear.
Why these screening tools aren’t effective
Let’s be honest: When we identify someone’s shape as wrong, it’s not a great motivator for change. In fact, it’s just the opposite. Introjected motivation is a shame-driven motivator. It emphasizes changing the way we look, and the body becomes the target.
The only lasting and sustainable behavioral change must be intrinsic, not extrinsic. We need to look inside, folks. Focus on behaviors that can be changed – with an emphasis on befriending the body in an effort to feel better, have more energy, and find clarity by doing things that bring connection and joy.
I hope we never bring the scary yellow tape measure into the schools or doctor’s office. Let’s not give anyone a reason to hate their body. Hating our bodies hasn’t worked to change them. We’ve missed the mark again.
