Do you know Ilona Maher?
IYKYK. If not, you need to get to know her…
She’s a rugby player. Two-time Olympian. Olympic medalist. And according to Olympic.com, she is a “TikTok sensation.” She also has 3.3 million followers on Instagram. I am one of them.
She’s an icon.
And she is tackling some important issues — body image, physical health, mental health, and cyberbullying — on her social media platforms.
Before the Olympics began, Ilona responded to a bully online, who posted a comment that read, “I bet that person (referring to Ilona) has a 30% BMI.”
Sidenote →BMI stands for body mass index, and an individual with a BMI greater than 30 is obese, according to the World Health Organization. And it is funny/not funny that the mean person commenting on Ilona’s social media thought her BMI was 30%… This is funny/not funny because BMI is a ratio; not a percentage (more on the history and calculation of a BMI below).
In response to basically being called fat by a random person on her social media, Ilona Maher spoke up. In an epic social media post, she said —
“I think you are trying to roast me, but this is actually a fact. I do have a BMI of 30. Well, 29.3 to be more exact. I have been considered overweight my whole life…
I chatted with my dietician because I go off of facts and not just what pops up here (pointing to her head) you know? … And we talk about BMI and we talk about how it really isn’t helpful for athletes. BMI doesn’t tell you much; it just tells you about your height and weight and what that equals. I said it before — I’m 5’10” and 200 pounds. I have about 170 pounds of lean mass on me…
BMI doesn’t tell you what I can do.
It doesn’t tell you what I can do on the field.
Or how fit I am.
It’s just a couple of numbers put together.
It doesn’t tell you how much muscle I have…
So, I do have a BMI of 30, and I am considered overweight.
But alas — I’m going to the Olympics.”
I see three takeaways from Ilona’s post…
First, no one wins when we are nasty to one another online. In a post from way back in December of 2022, Ilona admits to “crying a little bit,” after commenters on her feeds called her a man and masculine and then asked if she was on steroids. These types of comments to elite female athletes are unacceptable. No one wins when we are nasty to each other online. Comments can be hurtful. They can be damaging. They are unnecessary. Stop being mean online. Practice saying only nice things and what you are grateful for (or nothing at all).
Second, Ilona, who is a college graduate and obviously so well-spoken, seeks out professional/expert advice about her health. In her now-viral video about her BMI, she talks about working with her dietician. Ilona is educated, smart, well-spoken, and a stellar rugby player — and yet, she works with professionals and experts when it comes to her health. She says in her video that she “goes off of facts” and not what just pops into her mind. She doesn’t consult Dr. Google. She works with experts who can provide her with the best evidence that will lead to optimal health. Seeking out professional health advice — trusting the experts (physicians, dieticians, epidemiologists) — is not a sign of weakness or a lack of independence. It is wise and healthy decision-making.
Finally, BMI is just a number.
BMI is a ratio; it is NOT a percent. It is your weight divided by your height squared (use an online calculator if you are measuring in pounds and inches).
The BMI was created by Adolphe Quetelet, a Belgian statistician, mathematician, and astronomer in 1832. Quetelet was obsessed with bell curves and wanted to establish the quantifiable characteristics of the “normal man.”
QUICK PAUSE — the BMI was NOT created for medical or health purposes. And it was a tool for measuring male bodies (most likely, white male bodies).
In the 1950s, the BMI measurement was used by Metropolitan Life Insurance Company after the company noticed that policyholders who were overweight/obese (had a higher ratio of weight to height) were submitting more claims.
QUICK PAUSE — again, BMI was not created nor was its original use for medical or health purposes; in this case, it was used to adjust/increase life insurance policy rates.
The term body mass index or BMI was coined in 1972 by a physiologist, Ancel Keys, who noted that the BMI measurement was a CONVENIENT measure to summarize the total number of people who were overweight or obese in POPULATION studies.
QUICK PAUSE — again, BMI was not created nor was its original use for individual medical or health purposes. A researcher found in the 1970s that BMI was a quick and convenient variable/measurement for population/public health studies.
And Ancel Keys was right. BMI is such a convenient and CHEAP way to measure obesity in a population. When we look at the percentage of adults in the United States who were obese in 1985 compared to 2010, we see that there is an ENORMOUS increase in obesity among adults. Across the whole country.
From a population/community health standpoint, this shows us that obesity is increasing in our communities and throughout our nation.
BUT —
We cannot fall prey to the ecologic fallacy.
In epidemiology, an ecological fallacy is when we assume that the characteristics or conclusions we make about a group or at the population level are true for individuals.
I’ve never thought about the faults, problems, and disastrous effects of these population vs. individual dynamics applying to the measures we use to quantify obesity until I started listening to Ilona and giving a lot of thought to how we measure and think about obesity.
Just because BMI is a convenient measure of obesity at the population level and in public health/epidemiological research does NOT mean it is an appropriate measure for understanding individual health. As Ilona stated —
“Health cannot be measured in a single number.”
To understand our individual health, we need to look at a host of measurements, including waist circumferences, percent body fat, cholesterol levels, blood pressure, blood sugar, metabolism, and waist-to-hip ratio, among others. Additionally, we need to have conversations about family histories, living environments, nutrition, genetics, and more to get a complete picture of one’s health.
Your BMI does NOT define you. Nor does it define your health status.
Truth be told — I love the CDC slides that show increasing obesity rates in the United States (the two shared above are just part of 25+ slide deck that shows annual obesity increases). As an epidemiologist, this is powerful information. And important information as we are seeing a correlation between rising rates of obesity (as defined by BMI) and increasing incidence of cancer, especially in younger adults.
HOWEVER — individual BMI data must be collected and shared (often through patient medical records) for people like me to do the population/public health research like what is presented above. And I want to ask the questions —
At what and at whose expense are we collecting and prioritizing BMI data?
If public health is prioritizing BMI data — is there an incentive for physicians and other practitioners treating patients to collect or use other forms of data to help their patients understand their health status? If we only use BMI in our health research, how will physicians know what other measures should be used to quantify and define health for their patients?
Public health — researchers, communicators, and educators — needs to do better.
BOTTOMLINE —
BMI is a convenient measure that needs to be removed from the center of our conversations about weight and health. We need to think holistically about what measures help us to define what it means to be healthy as individuals. And we need to remove it from the center of our research.
We all need to advocate against BMI measurements. We need to ask our physicians to look at our health holistically — with particular attention to waist circumferences, percent body fat, cholesterol levels, blood pressure, blood sugar, metabolism, and waist-to-hip ratio, among others. As well as our family histories, living environments, nutrition, genetics, and more to get a complete picture of one’s health.
And you should definitely follow Ilona, who is leading the charge and showing the world that Olympic medalists are healthy and in peak form despite having a BMI of 30.
❤️ you Ilona.
What thoughts, questions, and personal experiences do you have about BMI? defining health? labels or measurements we use — for convenience — to determine someone’s health status?
And, as always — please share this post with your friends and family. If we are going to change the way we define health and create healthy communities, we need to be in conversation with one another.
Epi(demiology) Matters is written by Dr. Becky Dawson, PhD MPH — an epidemiologist, teacher, mom, wife, and dedicated yogi. She is a tenured professor at Allegheny College, Research Director at a community hospital, and an exclusive contributor (all things health & medicine) at Erie News Now (NBC/CBS). Her goal is to create healthy communities for all. She writes Epi Matters — first & foremost because epidemiology does matter (to all of us) and she hopes that each post will help to educate and empower readers to be healthy and create healthy communities.
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