De-emphasizing BMI in health decisions

Since 2021, Dr. Scott Hagan, assistant professor, has emerged as a strong advocate for a paradigm shift in how we perceive and approach weight loss and obesity management as both patients and physicians.

In this video for the UW Medicine Newsroom this summer, Hagan discussed the limitations of Body Mass Index (BMI) and highlighted the importance of adopting a more holistic and individualized approach to weight management.

Hagan stressed that factors like metabolic health, lifestyle, and genetics should play a more prominent role in determining an individual's health status than BMI alone. Hagan additionally urges his fellow physicians to consider the wider arsenal of tools available in modern medicine beyond the simplistic “calories in; calories out” philosophy, having previously authored opinion pieces to this effect in The New England Journal of Medicine and in Journal of General Internal Medicine (with co-author Dr. Karin Nelson), and lecturing on the topic for DOM Grand Rounds.

Hagan's advocacy for a new approach was buoyed in June of this year by the “really big deal” policy change from the American Medical Association (AMA), which has deemphasized the role of BMI as a primary metric for assessing health. The AMA's policy shift marks a seismic departure from conventional medical wisdom. BMI, a long-standing metric used to categorize individuals as underweight, normal weight, overweight, or obese, has often been criticized for its limitations. Hagan, who has been a vocal critic of the BMI-centric approach, welcomes this change, emphasizing that it's long overdue.

Moreover, Hagan's advocacy coincides with a growing interest in alternative weight management solutions, such as the use of medications like Ozempic, which he has discussed as a welcome option for some patients but not a panacea, especially for patients for over the age of 65.

As the medical community increasingly shifts its focus away from BMI, Hagan continues to lead the charge in promoting a more comprehensive approach to weight loss and obesity management, ensuring that individuals receive the personalized care they deserve.

Having seen his patients struggle with obesity for years and struggled with it himself, Hagan writes, “I look forward to a future when we embrace a language of compassion in our conversations with patients with obesity that acknowledges the realities of this disease.”