Body Mass Index

Lord Addington Excerpts

Thursday 22nd April 2021 Grand Committee

Asked by

[Lord Addington]

To ask Her Majesty’s Government what assessment they have made of the effectiveness of Body Mass Index as a medical guideline.

[Lord Addington (LD)]

My Lords, this is a subject of which I have spoken in the past, but what inspired this debate in my name was the report and subsequent publicity from the House of Commons Women and Equalities Committee, chaired by Caroline Nokes MP. The report points out that on an arbitrary line with an ideal point in the middle, when it applies to people, most are not at that middle point. When that is used to identify health, you are effectively saying that a lot of people are not healthy. That idea is suggested as a good guide to what one should be—I have spoken about it in the past. However, not everyone is in the middle. The guide says that one should be X height and X weight.

The report spoke about the damaging effect of body image, predominantly among the female population, particularly the young. It is yet another thing that says, “This is what you should weigh, look like and be.” But it should not be just like that. It is worth remembering that in the current environment this applies also to males. It is increasingly applied to all young people and, indeed, the whole population. There is an accepted norm. The internet has exacerbated a situation that has always been there.

Most of us in this debate will have spoken about retouching photographs and making sure that they are idealised versions of people. That is now taken to a new level. Some of the work that we have been doing was referred to in a debate on a Private Member’s Bill last week regarding restricting plastic surgery. These issues are adding to the problems, but if this approach is taken as a medical guideline, you are getting the wrong information on which medical procedure might be taken. Given the information that is put out, along with the press coverage, we should be worried.

I wish that I could have given some of my time to other noble Lords taking part in this debate. With conditions such as anorexia, someone can be told, “You are not light enough to receive help for that eating disorder, because you don’t hit a certain point on the graph.” Regardless of what that person’s frame or exercise patterns have been, by taking that decision, one is actually making someone’s medical condition more difficult to treat because somebody is looking at the guideline and saying, “This is where you should be.” This is a difficult situation for everybody. Certain medics will be better at this than others.

Here, I should probably say why I took an interest in this issue in the first place. According to this measure, I, like everybody I played rugby with, was dead a while ago. As somebody who once had somebody put a hand on his shoulder and say, “You were born to play prop forward,” I possibly have a bit of an axe to grind. To use myself as an example, I once had a neck injury and a chap—he became best man at my wedding and I was best man at his—looked at me and said, “You’ve got a neck injury? What neck?” We have to carry a bit of this.

This approach does not work for people like me. We are constantly told to lose weight. I remember being told by a doctor when I was having a check-up for some insurance, “Well, according to this, you are too heavy,” and in the same week being shouted at by a coach, “You’re not eating enough for my exercise programme.” Of the two, I know which one I listened to. But if you take this type of information that pays absolutely no attention to physique or exercise pattern, you will get bad answers, which do not help with any form of general public health pattern. You cannot say, “This is what you should be.”

I know that we are trying to move slightly away from this approach. I have heard people say, “Take certain measurements and get the relationship across.” If you do a calculation like that, you are still going to get it wrong, even if it is slightly more accurate slightly more often. Medical professionals should be looking at somebody individually. If they cannot do that, they should withhold an opinion. I know that it is more convenient to look at a chart and say, “You are X height, you should be X weight,” but it does not work. It never has.

I have done some work on this in the past. This approach was invented in the late 1950s, I think, although the noble Lord may have better information. It was thought that it would do as a general guideline. We have got bigger since, with higher protein diets, and are slightly taller and bigger-framed. It is out of date even for an active person who is not carrying any muscle mass. If you are any form of athlete or taking any form of physical activity, you will acquire some muscle mass and muscle is much heavier than fat. Get a person healthy and fit and make sure that they do not hit your medical targets: why do we still have this? It does not seem to work at any conceivable level. It is telling people to attain to something and repeating the messages, “Nobody is perfect” and “Do something else”. It encourages damaging behaviour. It gives wrong information to medical professionals, who often look at somebody and say, “Ignore it.” Why are we still using it? Can we not just take it out and ask for assessments? An assessment is looking at somebody and assessing their activity patterns. Otherwise, we are going to continue to have these problems.

This is either wasting printing paper or slowing certain people down from getting the help and treatment that they need. Adhering to it makes it more difficult to get early treatment for eating disorders. Everybody knows that you must get in early, establish the patterns of behaviour and convince that person to change those patterns of behaviour. Anything working against that should be removed.

I could go on at length, but the danger of being totally self-indulgent is looming towards me, so I will conclude my remarks by asking the Government just a couple of questions. First, if this was proposed to the Government now, would they use it? Would they take and use an arbitrary level that does not correctly assess anything other than for a small percentage of the population? Secondly, if the Government would not take on something like that now, what would they recommend to doctors to assess health and well-being in the general population? Would it be easier to administer or not? The answer is probably not, but a bit of effort might help us to get a better public health outcome.