Understanding BMI and BRI: A Q&A with Columbia’s Bariatric NP Gio Dugay

Body Mass Index (BMI) is a widely used tool in healthcare, but how useful is it really? With new discussions about alternative measures like the Body Roundness Index (BRI) and debates over BMI's accuracy, it’s important to understand how it’s used today and whether better options exist. To clarify, we spoke with Giovanni Dugay, nurse practitioner for Columbia’s Center for Metabolic and Weight Loss Surgery, who shares insights on BMI, its applications, and potential alternatives.

What exactly is BMI, and what does it measure?

I generally tell patients that BMI is like your 'fatness score.' It’s a formula—your weight in kilograms divided by your height in meters squared. That spits out a number: under 25 is considered normal, 25-30 is overweight, and over 30 is obese. But it’s really just a calculation, and it doesn’t tell the whole story.

Why is BMI still used in healthcare?

BMI has been around for a long time because it’s a simple, quick measurement that can be used to assess weight-related health risks. Most insurance companies still use it to determine eligibility for weight loss treatments, including medications and surgery. But the problem is that BMI doesn’t take into account muscle mass, fat distribution, or overall health.

What are some of the biggest issues with BMI?

BMI doesn’t distinguish between muscle and fat, so a very muscular person can have a high BMI and be labeled as obese when they aren’t. A perfect example: Evander Holyfield, the heavyweight boxer, had a BMI of 41, which classified him as severely obese. But he had 2% body fat! NFL players walk around with BMIs over 40, and while they may have sleep apnea, they aren’t necessarily unhealthy because of their weight. BMI can be misleading in cases like these. That’s why I always say BMI should be used carefully—it’s just one piece of the puzzle when assessing health.

What is the Body Roundness Index (BRI), and how does it compare to BMI?

BRI is a newer tool that aims to measure fat distribution instead of just height and weight. It looks at waist circumference relative to height, which gives a better picture of where fat is stored. This matters because excess fat around the midsection is linked to higher risks of heart disease and diabetes. I only recently learned about BRI myself, but after looking into it, I found over 700 scholarly papers discussing its use.

Could BRI replace BMI in healthcare?

Not yet. Right now, BMI is still the standard because it’s widely accepted and easy to calculate. BRI is interesting because it provides a better picture of health risks, but for it to replace BMI, insurance companies, healthcare providers, and researchers all need to get on board. It will take time.

Are there other tools emerging that could improve how we measure obesity?

Right now, BRI is gaining attention, but we’re still using BMI as the main tool. Some researchers are pushing for lowering BMI thresholds, redefining obesity, and incorporating AI-driven analysis. But we’re not quite there yet.

If BMI isn’t perfect, how should patients think about their health?

BMI is just one factor. I always tell patients that their weight alone doesn’t determine their health—what really matters is their overall condition. Are they on blood pressure meds? Do they have diabetes? Are their cholesterol levels high? A person with a ‘normal’ BMI could still be unhealthy, while someone classified as ‘obese’ might be in great shape. You have to look at the whole picture.