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How do you measure your health? Doctors say weight and BMI are only part of the answer

Sunshine Orta raises his hands in celebration, at the top of a hike, with a scenic vista behind him.
Provided
Sunshine Orta likes to hike and get outdoors -- but he says he also likes to ice cream and hang out on the couch, and he doesn't think people should be judged for how they spend their time: "I think fat people -- and all people -- deserve respect whether they hike or not."

Sunshine Orta identifies as a “small fat.”

He wears large clothing and feels stigmatized by some medical providers, but he’s small enough, he says, to not have to worry about things like fitting in an airplane seat.

“I have a certain amount of thin privilege,” he said.

Orta is part of what he calls the “fat community,” which celebrates full-figured physiques while denouncing the stigmas attached to those body types.

“If I had to design a utopia, it's one where fat people can just be,” Orta said. “There's no moral impetus for them to constantly try not to be fat.”

Sunshine Orta smiles from behind an ice cream cone.
Photo provided
Sunshine Orta likes ice cream. In choosing photos to share for this story, he said he was conscious of the bias and stigma against fat people in society. Orta, who advocates for a society where fat people aren't dehumanized, spoke on a new policy that considers more factors in patient health than the body mass index.

He’s excited to see movement on one weight-related measurement: the body mass index. The scale is derived from a formula that calculates a person's height and weight, and it’s long been used to determine whether that individual is underweight, normal weight, overweight, or obese.

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“I hate it in almost every context,” Orta said.

This month, the American Medical Association issued a policy recognizing that the formula is an “imperfect way to measure body fat” and does not “account for differences across race, sexes, genders, and age-span.”

In a statement, Dr. Jack Resneck, Jr., the AMA’s immediate past president, said “it’s important for physicians to understand the benefits and limitations of using BMI in clinical settings to determine the best care for their patients.”

Dr. Stephen Cook, a physician at the University of Rochester Medical Center, sees BMI as just one metric to consider when addressing health problems like blood sugar, blood pressure and cholesterol.

“People whose weight is high, but they have other metabolic issues, when you cluster those together, that's the bigger risk factor than just the BMI alone,” said Cook, who has done studies on family-based interventions for obesity.

He said family history, age and race also must be considered when evaluating someone’s health.

“We don't get to choose the body we get just like we don't get to choose our parents,” Cook said, “But we want to be as healthy as we can, because there's a lot of things that are out of our control.”

Racquel Stephen is WXXI's health, equity and community reporter and producer. She holds a bachelor's degree in English literature from the University of Rochester and a master's degree in broadcasting and digital journalism from the S.I. Newhouse School of Public Communications at Syracuse University.