{"id":30,"date":"2023-09-29T09:59:05","date_gmt":"2023-09-29T13:59:05","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/?post_type=chapter&#038;p=30"},"modified":"2024-01-19T15:35:56","modified_gmt":"2024-01-19T20:35:56","slug":"body-mass-index","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/chapter\/body-mass-index\/","title":{"raw":"Body Mass Index","rendered":"Body Mass Index"},"content":{"raw":"<strong>Body Mass Index (BMI)<\/strong> is an anthropometric body measurement that is calculated by<strong> weight divided by height<\/strong>. See <strong>Figure 3<\/strong>\u00a0for the formula based on the imperial and metric system calculations. Adapted from WHO, Health Canada (2003) describes the following categories of BMI:\r\n<ul>\r\n \t<li>Underweight (BMI less than 18.5) - increased risk of developing health problems.<\/li>\r\n \t<li>Normal weight (BMI 18.5 to 24.9) - least risk of developing health problems.<\/li>\r\n \t<li>Overweight (BMI 25 to 29.9) - increased risk of developing health problems.<\/li>\r\n \t<li>Obese (BMI 30 and over) - high risk of developing health problems.<\/li>\r\n<\/ul>\r\nHowever, Obesity Canada (Rueda-Clausen et al., 2020) outlines recommended BMI classifications that take into consideration ethnicities.\u00a0For information check out the <a href=\"https:\/\/obesitycanada.ca\/wp-content\/uploads\/2021\/05\/6-Obesity-Assessment-v6-with-links.pdf\" target=\"_blank\" rel=\"noopener\">Canadian Adult Obesity Clinical Practice Guidelines<\/a> on pg. 3 for information related to South-, Southeast- or East Asian ethnicity.\r\n\r\nAlso, you can check out the nomograms provided by Health Canada, called the <a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/food-nutrition\/healthy-eating\/healthy-weights\/canadian-guidelines-body-weight-classification-adults\/quick-reference-tool-professionals.html\" target=\"_blank\" rel=\"noopener\">Canadian Guidelines for Body Weight Classification in Adults - Quick Reference Tool for Professionals<\/a>.\r\n\r\n&nbsp;\r\n\r\n<strong>Steps in measuring BMI<\/strong> are:\r\n<ul>\r\n \t<li>Measure height and weight.<\/li>\r\n \t<li>Calculate BMI based on formula outlined in <strong>Figure 3<\/strong>. Round the BMI to one decimal point. For example, if the client weighs 50 kilograms and is 1.5 metres, then the BMI is: 22.2. If the client\u2019s weight is 160 lbs and is 5.2 in feet, then, the BMI is: 29.3.<\/li>\r\n<\/ul>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-300x169.jpg\" alt=\"\" width=\"523\" height=\"295\" class=\"alignnone wp-image-147\" \/>\r\n\r\n<strong>Figure 3<\/strong>: BMI formulas\r\n\r\n&nbsp;\r\n<div align=\"left\"><\/div>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Knowledge Bites<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nAlthough it is important to be aware of this formula, it is <strong>essential to be aware of how it is a flawed and racist<\/strong> health standard particularly for people of colour and for people with high muscle mass.\r\n\r\nLet\u2019s start by briefly reflecting on the<strong> origins of BMI<\/strong>, which will help you begin to understand its limitations.\r\n\r\nBMI is commonly known as an indirect reflection of total body obesity. Originally, BMI was developed based on data from <strong>European populations of white men<\/strong> (AMA as cited by Tanne, 2023; Stewart, 2022). This is an important point considering that body shape, structure, and composition are influenced by factors such as sex, race, and age (Tanne, 2023). For example, people who are Black have higher levels of bone mineral content and density than people who are white (Wager &amp; Heyward, 2000). In addition, it has been found that in comparison to white women, Black women have muscles and bones that are heavier and have an increased quantity of body water (Aloia et al., 1997). Also, the BMI measurement can\u2019t differentiate fat from muscle (Karasu, 2016). As a result, someone with increased muscle mass may be identified as obese according to the BMI standard. Additionally, people who are South Asian typically have smaller body frames which influences BMI (Nair, 2021). These differences make a measurement such as BMI (which focuses merely on weight and height) an inaccurate measurement of body fat and obesity.\r\n\r\nDespite Billewicz and colleagues writing in the 1960s that formulas like BMI couldn\u2019t measure fat, it still remains a well known and commonly used measure in today\u2019s society to identify obesity (as cited in Karasu, 2016). It is only recent that organizations such as the American Medical Association (2023) have finally highlighted that BMI alone is not appropriate for measuring body fat and that it doesn\u2019t take into consideration differences across age, sex, and race.\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\"><strong>Contextualizing Inclusivity<\/strong><\/h2>\r\nIf using BMI in your practice, keep in mind that you need to <strong>use the sex assigned at birth<\/strong> in the trans and gender-diverse population when determining a client\u2019s normal BMI. This can be quite distressing for some clients so it is important to be sensitive to this. There\u00a0 may be weight requirements for certain gender-affirming surgery making a sex-based measurement such as BMI problematic in this population.\r\n\r\nHealth Canada (2003) indicates that the BMI classification system <strong>should be used carefully<\/strong> with certain racialized groups, people with lean or muscular builds and those over 65 years of age. If BMI data is collected in the setting you work, it is important to<strong> have a critical eye<\/strong> in how you use it and possibly draw your colleagues\u2019 attention to its limitations particularly with racialized groups. Additionally, be aware of how the data may affect different clients from an emotional, psychological, and physical perspective. For example, some Black adolescents are constantly told to lose weight because their BMI is high. This can be distressing for them, and can result in mental health issues, eating disorders, and maladapted healthcare seeking behaviours (i.e., avoiding going to health care visits).\r\n\r\nBased on the North American standards for BMI, it may appear that many Asians have a lower incidence of obesity. However, in a study on Asian Americans, it was noted that they are more likely to gain weight centrally which is associated with comorbidities such as diabetes and cardiovascular disease (Li et al., 2022). Lower cut-offs for BMI for Asians may be needed to better reflect the difference in patterns of adiposity (Li et al., 2022).\r\n\r\n<strong>Cases to reflect upon:<\/strong>\r\n\r\n(1) A young black female was assessed as being overweight based on the original BMI scores. This led to the young female joining a weight loss program and losing most of the required weight. However, when she got to what was considered the high end of her weight range, her family became extremely concerned because she was becoming very thin and rather gaunt. A family physician was consulted and indicated that her weight loss be considered successful at the top end of the scale.\r\n\r\n(2) A college football player has a low body fat percentage but a BMI of 33. As the healthcare provider, you may recognize that this BMI is in the obese range. Without acknowledging the limitations of BMI measurements, one might suggest a lifestyle change. However, it is important to recognize that BMI cannot differentiate between muscle and fat.\r\n\r\n<\/div>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nIf someone\u2019s BMI is high or low, you should have a discussion with the client <strong>focusing on their health and well-being<\/strong>. It is important to ensure they are an <strong>active partner<\/strong> in the discussion and the health decisions made. When engaging in discussions, be sure you consider social determinants of health such as food security. If someone isn\u2019t food secure, you should consider discussing resources that may support them (e.g., food banks and certain healthy alternatives). You should also consider trends in BMI and whether there has been a trend upward or downward; thus, comparing the measurement to previous BMI is important.\r\n\r\n<\/div>\r\n<\/div>\r\n<h2><strong>Activity: Check Your Understanding<\/strong><\/h2>\r\n<span>[h5p id=\"4\"]<\/span>\r\n<h2><strong>References<\/strong><\/h2>\r\nAloia, J., Vaswani, A., Flaster, E. (1997). Comparison of body composition in black and white premenopausal women. J Lab Clin Med, 129(3), 294-299. <a href=\"https:\/\/doi.org\/10.1016\/S0022-2143(97)90177-3\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/S0022-2143(97)90177-3<\/a>\r\n\r\nAmerican Medical Association (2023). AMA adopts new policy clarifying role of BMI as a measure in medicine. <a href=\"https:\/\/www.ama-assn.org\/press-center\/press-releases\/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ama-assn.org\/press-center\/press-releases\/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine<\/a>\r\n\r\nHealth Canada (2003). Canadian Guidelines for Body Weight Classification in Adults: Quick Reference Tool for Professionals. <a href=\"https:\/\/www.canada.ca\/content\/dam\/hc-sc\/migration\/hc-sc\/fn-an\/alt_formats\/hpfb-dgpsa\/pdf\/nutrition\/cg_quick_ref-ldc_rapide_ref-eng.pdf\">https:\/\/www.canada.ca\/content\/dam\/hc-sc\/migration\/hc-sc\/fn-an\/alt_formats\/hpfb-dgpsa\/pdf\/nutrition\/cg_quick_ref-ldc_rapide_ref-eng.pdf<\/a>\r\n\r\nKarasu, S. Adolphe Quetelet and the evolution of body mass index. Psychology Today. <a href=\"https:\/\/www.psychologytoday.com\/ca\/blog\/the-gravity-of-weight\/201603\/adolphe-quetelet-and-the-evolution-of-body-mass-index-bmi\" target=\"_blank\" rel=\"noopener\">https:\/\/www.psychologytoday.com\/ca\/blog\/the-gravity-of-weight\/201603\/adolphe-quetelet-and-the-evolution-of-body-mass-index-bmi<\/a>\r\n\r\nLi, Z., Daniel, S., Fujioka, K., &amp; Umashanker, D. (2023). Obesity among Asian American people in the United States: A review. Obesity (Silver Spring, Md.), 31(2), 316\u2013328. <a href=\"https:\/\/doi.org\/10.1002\/oby.23639\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1002\/oby.23639<\/a>\r\n\r\nNair, T. (2021). More than skin color: Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England. American College of Cardiology. <a href=\"https:\/\/www.acc.org\/Latest-in-Cardiology\/Articles\/2021\/10\/18\/15\/35\/More-Than-Skin-Color\" target=\"_blank\" rel=\"noopener\">https:\/\/www.acc.org\/Latest-in-Cardiology\/Articles\/2021\/10\/18\/15\/35\/More-Than-Skin-Color<\/a>\r\n\r\nRaphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social Determinants of Health: The Canadian Facts. Ontario Tech University Faculty of Health Sciences and Toronto: York University School of Health Policy and Management. <a href=\"https:\/\/thecanadianfacts.org\/The_Canadian_Facts-2nd_ed.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/thecanadianfacts.org\/The_Canadian_Facts-2nd_ed.pdf<\/a>\r\n\r\nRueda-Clausen, C., Poddar, M., Lear, S., Poirier, P., &amp; Sharma, A. Canadian Adult Obesity Clinical Practice Guidelines: Assessment of People Living with Obesity. Obesity Canada. <a href=\"https:\/\/obesitycanada.ca\/wp-content\/uploads\/2021\/05\/6-Obesity-Assessment-v6-with-links.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/obesitycanada.ca\/wp-content\/uploads\/2021\/05\/6-Obesity-Assessment-v6-with-links.pdf<\/a>\r\n\r\nStewart, S. (2022). The racial origins of BMI. Anti-Racism Daily. <a href=\"https:\/\/the-ard.com\/2022\/04\/05\/the-racial-origins-of-bmi-weight-measuring\/\" target=\"_blank\" rel=\"noopener\">https:\/\/the-ard.com\/2022\/04\/05\/the-racial-origins-of-bmi-weight-measuring\/<\/a>\r\n\r\nTanne, J. (2023). Obesity: Avoid using BMI alone when evaluating patients, say US doctors\u2019 leaders, 381, p. 1400. <a href=\"https:\/\/doi.org\/10.1136\/bmj.p1400\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1136\/bmj.p1400<\/a>\r\n\r\nWagner, D., &amp; Heyward, V. (2000). Measures of body composition in blacks and whites: A comparative review. The American Journal of Clinical Nutrition, 71(6), 1392-1402. <a href=\"https:\/\/doi.org\/10.1093\/ajcn\/71.6.1392\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1093\/ajcn\/71.6.1392<\/a>","rendered":"<p><strong>Body Mass Index (BMI)<\/strong> is an anthropometric body measurement that is calculated by<strong> weight divided by height<\/strong>. See <strong>Figure 3<\/strong>\u00a0for the formula based on the imperial and metric system calculations. Adapted from WHO, Health Canada (2003) describes the following categories of BMI:<\/p>\n<ul>\n<li>Underweight (BMI less than 18.5) &#8211; increased risk of developing health problems.<\/li>\n<li>Normal weight (BMI 18.5 to 24.9) &#8211; least risk of developing health problems.<\/li>\n<li>Overweight (BMI 25 to 29.9) &#8211; increased risk of developing health problems.<\/li>\n<li>Obese (BMI 30 and over) &#8211; high risk of developing health problems.<\/li>\n<\/ul>\n<p>However, Obesity Canada (Rueda-Clausen et al., 2020) outlines recommended BMI classifications that take into consideration ethnicities.\u00a0For information check out the <a href=\"https:\/\/obesitycanada.ca\/wp-content\/uploads\/2021\/05\/6-Obesity-Assessment-v6-with-links.pdf\" target=\"_blank\" rel=\"noopener\">Canadian Adult Obesity Clinical Practice Guidelines<\/a> on pg. 3 for information related to South-, Southeast- or East Asian ethnicity.<\/p>\n<p>Also, you can check out the nomograms provided by Health Canada, called the <a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/food-nutrition\/healthy-eating\/healthy-weights\/canadian-guidelines-body-weight-classification-adults\/quick-reference-tool-professionals.html\" target=\"_blank\" rel=\"noopener\">Canadian Guidelines for Body Weight Classification in Adults &#8211; Quick Reference Tool for Professionals<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Steps in measuring BMI<\/strong> are:<\/p>\n<ul>\n<li>Measure height and weight.<\/li>\n<li>Calculate BMI based on formula outlined in <strong>Figure 3<\/strong>. Round the BMI to one decimal point. For example, if the client weighs 50 kilograms and is 1.5 metres, then the BMI is: 22.2. If the client\u2019s weight is 160 lbs and is 5.2 in feet, then, the BMI is: 29.3.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-300x169.jpg\" alt=\"\" width=\"523\" height=\"295\" class=\"alignnone wp-image-147\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-300x169.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-1024x576.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-768x432.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-65x37.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-225x127.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems-350x197.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/bodymeasurements\/wp-content\/uploads\/sites\/402\/2023\/12\/Metric-and-Imperial-systems.jpg 1280w\" sizes=\"auto, (max-width: 523px) 100vw, 523px\" \/><\/p>\n<p><strong>Figure 3<\/strong>: BMI formulas<\/p>\n<p>&nbsp;<\/p>\n<div style=\"text-align: left;\"><\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Knowledge Bites<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p>Although it is important to be aware of this formula, it is <strong>essential to be aware of how it is a flawed and racist<\/strong> health standard particularly for people of colour and for people with high muscle mass.<\/p>\n<p>Let\u2019s start by briefly reflecting on the<strong> origins of BMI<\/strong>, which will help you begin to understand its limitations.<\/p>\n<p>BMI is commonly known as an indirect reflection of total body obesity. Originally, BMI was developed based on data from <strong>European populations of white men<\/strong> (AMA as cited by Tanne, 2023; Stewart, 2022). This is an important point considering that body shape, structure, and composition are influenced by factors such as sex, race, and age (Tanne, 2023). For example, people who are Black have higher levels of bone mineral content and density than people who are white (Wager &amp; Heyward, 2000). In addition, it has been found that in comparison to white women, Black women have muscles and bones that are heavier and have an increased quantity of body water (Aloia et al., 1997). Also, the BMI measurement can\u2019t differentiate fat from muscle (Karasu, 2016). As a result, someone with increased muscle mass may be identified as obese according to the BMI standard. Additionally, people who are South Asian typically have smaller body frames which influences BMI (Nair, 2021). These differences make a measurement such as BMI (which focuses merely on weight and height) an inaccurate measurement of body fat and obesity.<\/p>\n<p>Despite Billewicz and colleagues writing in the 1960s that formulas like BMI couldn\u2019t measure fat, it still remains a well known and commonly used measure in today\u2019s society to identify obesity (as cited in Karasu, 2016). It is only recent that organizations such as the American Medical Association (2023) have finally highlighted that BMI alone is not appropriate for measuring body fat and that it doesn\u2019t take into consideration differences across age, sex, and race.<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\"><strong>Contextualizing Inclusivity<\/strong><\/h2>\n<p>If using BMI in your practice, keep in mind that you need to <strong>use the sex assigned at birth<\/strong> in the trans and gender-diverse population when determining a client\u2019s normal BMI. This can be quite distressing for some clients so it is important to be sensitive to this. There\u00a0 may be weight requirements for certain gender-affirming surgery making a sex-based measurement such as BMI problematic in this population.<\/p>\n<p>Health Canada (2003) indicates that the BMI classification system <strong>should be used carefully<\/strong> with certain racialized groups, people with lean or muscular builds and those over 65 years of age. If BMI data is collected in the setting you work, it is important to<strong> have a critical eye<\/strong> in how you use it and possibly draw your colleagues\u2019 attention to its limitations particularly with racialized groups. Additionally, be aware of how the data may affect different clients from an emotional, psychological, and physical perspective. For example, some Black adolescents are constantly told to lose weight because their BMI is high. This can be distressing for them, and can result in mental health issues, eating disorders, and maladapted healthcare seeking behaviours (i.e., avoiding going to health care visits).<\/p>\n<p>Based on the North American standards for BMI, it may appear that many Asians have a lower incidence of obesity. However, in a study on Asian Americans, it was noted that they are more likely to gain weight centrally which is associated with comorbidities such as diabetes and cardiovascular disease (Li et al., 2022). Lower cut-offs for BMI for Asians may be needed to better reflect the difference in patterns of adiposity (Li et al., 2022).<\/p>\n<p><strong>Cases to reflect upon:<\/strong><\/p>\n<p>(1) A young black female was assessed as being overweight based on the original BMI scores. This led to the young female joining a weight loss program and losing most of the required weight. However, when she got to what was considered the high end of her weight range, her family became extremely concerned because she was becoming very thin and rather gaunt. A family physician was consulted and indicated that her weight loss be considered successful at the top end of the scale.<\/p>\n<p>(2) A college football player has a low body fat percentage but a BMI of 33. As the healthcare provider, you may recognize that this BMI is in the obese range. Without acknowledging the limitations of BMI measurements, one might suggest a lifestyle change. However, it is important to recognize that BMI cannot differentiate between muscle and fat.<\/p>\n<\/div>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p>If someone\u2019s BMI is high or low, you should have a discussion with the client <strong>focusing on their health and well-being<\/strong>. It is important to ensure they are an <strong>active partner<\/strong> in the discussion and the health decisions made. When engaging in discussions, be sure you consider social determinants of health such as food security. If someone isn\u2019t food secure, you should consider discussing resources that may support them (e.g., food banks and certain healthy alternatives). You should also consider trends in BMI and whether there has been a trend upward or downward; thus, comparing the measurement to previous BMI is important.<\/p>\n<\/div>\n<\/div>\n<h2><strong>Activity: Check Your Understanding<\/strong><\/h2>\n<p><span><\/p>\n<div id=\"h5p-4\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-4\" class=\"h5p-iframe\" data-content-id=\"4\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Body Mass Index\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<h2><strong>References<\/strong><\/h2>\n<p>Aloia, J., Vaswani, A., Flaster, E. (1997). Comparison of body composition in black and white premenopausal women. J Lab Clin Med, 129(3), 294-299. <a href=\"https:\/\/doi.org\/10.1016\/S0022-2143(97)90177-3\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/S0022-2143(97)90177-3<\/a><\/p>\n<p>American Medical Association (2023). AMA adopts new policy clarifying role of BMI as a measure in medicine. <a href=\"https:\/\/www.ama-assn.org\/press-center\/press-releases\/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ama-assn.org\/press-center\/press-releases\/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine<\/a><\/p>\n<p>Health Canada (2003). Canadian Guidelines for Body Weight Classification in Adults: Quick Reference Tool for Professionals. <a href=\"https:\/\/www.canada.ca\/content\/dam\/hc-sc\/migration\/hc-sc\/fn-an\/alt_formats\/hpfb-dgpsa\/pdf\/nutrition\/cg_quick_ref-ldc_rapide_ref-eng.pdf\">https:\/\/www.canada.ca\/content\/dam\/hc-sc\/migration\/hc-sc\/fn-an\/alt_formats\/hpfb-dgpsa\/pdf\/nutrition\/cg_quick_ref-ldc_rapide_ref-eng.pdf<\/a><\/p>\n<p>Karasu, S. Adolphe Quetelet and the evolution of body mass index. Psychology Today. <a href=\"https:\/\/www.psychologytoday.com\/ca\/blog\/the-gravity-of-weight\/201603\/adolphe-quetelet-and-the-evolution-of-body-mass-index-bmi\" target=\"_blank\" rel=\"noopener\">https:\/\/www.psychologytoday.com\/ca\/blog\/the-gravity-of-weight\/201603\/adolphe-quetelet-and-the-evolution-of-body-mass-index-bmi<\/a><\/p>\n<p>Li, Z., Daniel, S., Fujioka, K., &amp; Umashanker, D. (2023). Obesity among Asian American people in the United States: A review. Obesity (Silver Spring, Md.), 31(2), 316\u2013328. <a href=\"https:\/\/doi.org\/10.1002\/oby.23639\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1002\/oby.23639<\/a><\/p>\n<p>Nair, T. (2021). More than skin color: Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England. American College of Cardiology. <a href=\"https:\/\/www.acc.org\/Latest-in-Cardiology\/Articles\/2021\/10\/18\/15\/35\/More-Than-Skin-Color\" target=\"_blank\" rel=\"noopener\">https:\/\/www.acc.org\/Latest-in-Cardiology\/Articles\/2021\/10\/18\/15\/35\/More-Than-Skin-Color<\/a><\/p>\n<p>Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social Determinants of Health: The Canadian Facts. Ontario Tech University Faculty of Health Sciences and Toronto: York University School of Health Policy and Management. <a href=\"https:\/\/thecanadianfacts.org\/The_Canadian_Facts-2nd_ed.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/thecanadianfacts.org\/The_Canadian_Facts-2nd_ed.pdf<\/a><\/p>\n<p>Rueda-Clausen, C., Poddar, M., Lear, S., Poirier, P., &amp; Sharma, A. Canadian Adult Obesity Clinical Practice Guidelines: Assessment of People Living with Obesity. Obesity Canada. <a href=\"https:\/\/obesitycanada.ca\/wp-content\/uploads\/2021\/05\/6-Obesity-Assessment-v6-with-links.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/obesitycanada.ca\/wp-content\/uploads\/2021\/05\/6-Obesity-Assessment-v6-with-links.pdf<\/a><\/p>\n<p>Stewart, S. (2022). The racial origins of BMI. Anti-Racism Daily. <a href=\"https:\/\/the-ard.com\/2022\/04\/05\/the-racial-origins-of-bmi-weight-measuring\/\" target=\"_blank\" rel=\"noopener\">https:\/\/the-ard.com\/2022\/04\/05\/the-racial-origins-of-bmi-weight-measuring\/<\/a><\/p>\n<p>Tanne, J. (2023). Obesity: Avoid using BMI alone when evaluating patients, say US doctors\u2019 leaders, 381, p. 1400. <a href=\"https:\/\/doi.org\/10.1136\/bmj.p1400\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1136\/bmj.p1400<\/a><\/p>\n<p>Wagner, D., &amp; Heyward, V. (2000). Measures of body composition in blacks and whites: A comparative review. 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