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BMI may cost you higher insurance premiums despite questions over accuracy

Andrew Taylor
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With his Popeye forearms and washboard abs, Thomas Lacombe looks a picture of health.

Yet a tool widely used by government agencies, weight loss companies and insurers for gauging healthy weight suggests Mr Lacombe, a personal trainer and model, is fat.

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Is BMI useful?

Thomas Lacombe, has a BMI rating that puts him in the overweight category because BMI doesn't distinguish between fat and muscle.

"I'm not in the healthy weight bracket," he said. "I'm literally overweight."

Mr Lacombe is 189 centimetres tall and weighs 97 kilograms, giving him a Body Mass Index of 27.2 – well outside the healthy weight range of 20-25, according to insurance company Bupa's BMI calculator.

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"That measurement right now doesn't really make sense," Mr Lacombe said.

The Bupa website cautions against using BMI – calculated by dividing your weight in kilograms by your height in metres squared – as a diagnostic tool.

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It also suggests BMI can be an inaccurate measure of healthy weight for pregnant women, children, older people, athletes and "very muscular" people such as Mr Lacombe: "It may also need to be adjusted for some ethnic groups, including people of Asian, Aboriginal or Torres Strait Islander descent."

A Bupa spokesman said: "It is true that certain populations will not get an accurate picture of the healthiness of their weight in comparison with their height."

The accuracy of BMI has been questioned, yet insurers may charge higher premiums for life insurance on the basis of a heightened BMI.

"Life insurance is the only one that includes BMI as a part of the assessment process," Bupa's spokesman said.

Allianz Australia spokesman Nicholas Scofield said: "BMI is used in a similar way to other health risk factors such as smoking and excessive alcohol consumption."

Mr Scofield said BMI was not used in a "rigid manner" for pricing.

"Someone needs to be fairly overweight before it affects their premium," he said. "However, past a certain point, the clear link with health outcomes makes BMI a credible metric for underwriting and pricing."

A spokeswoman for TAL, Nicola Clancy, said the life insurance company offered discounts for people with a BMI within the healthy range, while "premiums only increase for people with a BMI of 34 and above".

"We've found people with a significantly higher BMI are more likely to suffer health problems," she said.

Dr Tony Bartone, the vice president of the Australian Medical Association, said BMI offers a "rough idea" of healthy weight: "The number is not the issue, it's how you interpret it that's the issue." panel showing equation to calculate your bmi

Associate Professor Amanda Salis, from The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders at Sydney University said BMI can alert someone to the need for a full health check.

"It is better as an estimate of population health than as an indicator of individual health," she said.

Professor Mark Harris, executive director of the University of NSW's Centre for Primary Health Care and Equity, said the BMI was a simple measure that could be used alongside measuring the waist in routine practice.

"Other measures are more complex and may require costly equipment or imaging," he said. "The disadvantage is that it may not pick up variable body composition and shape, especially the mix of muscle and fat."

A range of factors also needed to be considered, including physical activity, diet, medications and mental health, he added.

Gordon Lynch, a professor at the University of Melbourne's Department of Physiology, said BMI was based on a reasonable assumption that your weight should be related to your height.

Professor Lynch said mounting evidence suggested that measurements of abdominal obesity as waist circumference and waist-to-hip ratio were more important as predictors of health risk.

"Waistline fat is thought to be particularly dangerous because it secretes hormones and other compounds thought to contribute to the development of chronic diseases, such as cardiovascular diseases and cancers," he said.

Being physically inactive was more of a health risk than being overweight, he added. "Thin and inactive people are just as likely to develop chronic diseases, like heart disease and diabetes, as overweight people."