"BMI Indicating 'Obesity': Reasons Behind the Racism Controversy [News SeolCham]"

(44) Only Korea Has Strict Obesity Standards? How About Other Countries?
The Concept First Created by a Mathematician in 1870
Racial Discrimination Controversy Also "19th Century White Male Standard"

Editor's Note'Seolcham' is a newly coined term meaning to refer to explanations for more detailed information. In [News Seolcham], we aim to pinpoint and explain in more detail the parts of the news that require fact-checking or further explanation.

As calls to revise South Korea's obesity standards emerge, interest in the appropriate Body Mass Index (BMI) is growing. The main point is the need to raise the current standard that classifies obesity from a BMI of 25 or higher to 27 or higher, with criticism that Korea's obesity classification is stricter compared to other countries having existed for some time.

BMI is calculated by dividing weight (kg) by the square of height (m), and is classified as ▲underweight (18.4 or below) ▲normal (18.5 to 22.9) ▲overweight (23 to 24.9) ▲obese (25 or above). The current standard was created considering the correlation between weight and the risk of cardiovascular and cerebrovascular diseases and mortality.

BMI is regarded as one of the health indicators, but surprisingly, it was created not by the medical community but by a mathematician. In 1870, Belgian mathematician Adolphe Quetelet, who was studying social physics, first devised BMI while developing the concept of the 'average man.' It was intended to compare characteristics of various people based on an average, and at that time, it had no connection to medicine or health.

The insurance industry, which needed to predict customer lifespan when developing products, actively incorporated this. In 1895, the American life insurance company Metropolitan began publishing reports on obesity and mortality, which included a 'height-weight table' created based on customers' age, height, and weight data. This report, aimed at predicting customer lifespan, was published until 1983.

Subsequently, the medical community also began actively publishing research on appropriate weight and mortality. Since the WHO registered 'obesity' in the International Classification of Diseases in 1975, there has been a growing perception that obesity should be recognized as a 'disease' requiring treatment. In 2013, the American Medical Association officially classified obesity as a disease.

However, BMI has continuously been a subject of debate. It is difficult to assess an individual's health status based solely on weight and height. For example, athletes with high muscle mass may be classified as 'obese' according to BMI, but considering their exercise and dietary habits, it is hard to equate them with ordinary people who do not exercise.

There have also been controversies regarding racial discrimination. Since BMI was originally created based on the ideal body type of 19th-century white men, it is difficult to apply it uniformly to women or other races. In June last year, the American Medical Association pointed out that BMI is racially discriminatory and does not reflect differences in sex, race, and medical conditions. They recommended considering alternatives such as Body Adiposity Index (BAI), Relative Fat Mass (RFM), waist-to-hip ratio, and waist circumference instead of BMI.

Meanwhile, recently in Korea, there have been calls to raise the obesity standard to a BMI of 27 or higher. The Health Insurance Research Institute under the National Health Insurance Service announced at the Korean Society for Health Education and Health Promotion Autumn Conference on the 8th that after tracking 8.47 million adults who underwent general health checkups in 2002-2003 for 21 years, the lowest mortality risk was found near a BMI of 25.

Lee Sun-mi, director of the Health Management Research Center at the institute, said, "Considering both mortality and the risk of cardiovascular and cerebrovascular diseases, the conclusion is that the current obesity standard needs to be raised to at least 27 or higher."

Currently, countries around the world set their own obesity standards considering mortality risk and disease occurrence. The World Health Organization and the United States classify obesity as a BMI of 30 or higher. China considers 28 or higher as obese, and Japan classifies obesity as 26.1 (women) or 27.7 (men) or higher depending on sex.