Moving too fast in medicine can be disastrous. The past century is full of examples, from the scandal with thalidomide – a drug for morning sickness, which never tested on pregnant animals – to adopt low-fat diets based on scant evidence. But there is also a danger in moving too slowly, and an example is body mass index (BMI).
We’ve known for decades that the measure—a simple calculation based on a person’s weight and height—is too blunt a tool to distinguish between fat and muscle or account for global diversity. Its advantages are that it is quick, cheap and simple, but its use for so long has led to millions of people being misdiagnosed as overweight, a diagnosis with knock-on effects such as refusal of fertility treatments and certain surgeries.
But there are better alternatives and they are finally starting to be used. Last year, Lancet helped catalyze this overdue change by recommending that BMI alone not be used to measure obesity, a proposal that was immediately adopted by 75 international medical organizations.
This points the way out of a wider medical inertia that stems not only from much-needed safeguards introduced after the mistakes of the 20th century, but also from a lack of good evidence, clear consensus and the leadership needed to effect change.
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One need only look at covid-19 vaccines to see that rapid, safe, evidence-based action is possible
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One need only look at the triumph of covid-19 vaccines, which were produced in a previously unthinkable time frame and saved an estimated 14 million lives in the first year of use, to see that rapid, safe, evidence-based action is possible.
This kind of action is needed in many languishing areas of healthcare. Better menopause care, new psychiatric treatments, more male contraceptive options and new antibiotics are just a few of them.
It is right to be cautious, but the time has come to move quickly without breaking things.
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