BMI has been the benchmark in evaluating health and fitness for many years. The formula is quite simple: weight in kilograms divided by the square of height in meters. This would easily tell if one is underweight, within the healthy weight range, overweight, or obese. But with new research findings, scientists are now questioning its accuracy and usefulness as a total measure of body composition.

The report, published in The Lancet Diabetes & Endocrinology, has sparked a global conversation on rethinking BMI. Supported by more than 50 international medical experts, the report suggests classifying obesity into "clinical" and "pre-clinical" types for better diagnosis and treatment. The shift underscores a growing consensus: BMI alone may not tell the full story of your health.

While BMI is simple to calculate and universally accessible, it is far from perfect. It does not consider muscle mass, bone density, or fat distribution, leading to misleading conclusions in some cases. For example, athletes with a high muscle mass may be considered overweight, whereas individuals with normal BMI might carry unhealthy amounts of visceral fat.

A landmark study in JAMA Network Open studied more than 155,000 postmenopausal women and found that women with a normal BMI but a waist size over 35 inches were more likely to die from heart disease or cancer compared with their counterparts whose waists are smaller. That makes a great case for how BMI can be insufficient and fat distribution must be factored into account.

Not all body fat is equal. Subcutaneous fat, which lies just beneath the skin, is relatively harmless. The real health danger lies in visceral fat—fat that surrounds internal organs. Unlike subcutaneous fat, visceral fat is metabolically active, releasing stress hormones like cortisol and inflammatory substances that raise blood pressure, blood sugar, and cholesterol levels. These effects significantly increase the risk of conditions such as heart disease, type 2 diabetes, and certain cancers.

BMI Isn't Always the Best Measure of Body Composition — Here's What to Use Instead

Since BMI is not the most reliable measure, scientists and doctors have sought other means to measure body composition more accurately.

1. Waist Circumference

A simple tape measure can provide valuable insight into your health. Measure your waist at the level of your belly button, ensuring the tape is parallel to the ground. For women, a waist measurement under 35 inches is considered healthy, while for men, the goal is under 40 inches.

2. Waist-to-Hip Ratio

This is the ratio of your waist circumference to that of your hips. To calculate it, divide your waist measurement by your hip measurement. According to the National Center for Biotechnology Information, a ratio under 0.8 for women and 0.9 for men is considered healthy.

3. Body Roundness Index (BRI)

A newer method that seems to be receiving more attention involves the Body Roundness Index or BRI: height, weight, and girth are placed together to represent a more advanced view of what body composition says. Research presented in JAMA Network Open offers evidence that this BRI predicts mortality risk greater than BMI in some cases- a promising weapon for public health.

Also Read: Using BMI To Classify People As Obese Is Flawed Say Experts

Ways To Cut Off Unhealthy Fat

The good news is that visceral fat responds well to lifestyle changes. Here are three evidence-based strategies:

Time-Restricted Eating

Adopting an eating window of 12 hours—such as from 7 a.m. to 7 p.m.—can significantly reduce visceral fat, according to a study published in Nutrition Research Reviews. This approach not only helps control caloric intake but also reduces late-night snacking, a known risk factor for abdominal obesity.

Limit Alcohol Intake

Excessive alcohol consumption is associated with increased belly fat. A 2017 study published in Public Health Nutrition revealed that alcohol increases the levels of insulin and encourages the storage of fat in the abdominal area. Limiting alcohol to occasional indulgence helps avoid weight gain in this region.

High-Intensity Interval Training (HIIT)

HIIT involves repeated episodes of high-intensity exercise separated by periods of rest. A review in *Sports Medicine* concluded that HIIT is very effective in reducing visceral and total body fat. It can be noted that adding just 20 minutes of HIIT two times a week can make all the difference.

The reliance on BMI as a sole indicator of health is increasingly being challenged. While it remains a convenient screening tool, its limitations necessitate a broader approach that considers factors like fat distribution, waist circumference, and new metrics such as BRI.

In the simplest of words, health is multi-dimensional, and shifting perspectives from considering weight solely to broader measures of body composition will get people a much clearer understanding of where their health risks are so that they can take the action required for a better quality of life. Through adjustment to diet, exercise, or perhaps through innovative metrics like BRI, health is well within reach of the individual.

This dynamic conversation raises the point about personalized health screenings, which helps everyone get more relevant tools fitting their unique lives and circumstances. As body composition research is enhanced, so do the futures look brighter and brighter for the times of measurement when it comes to health.

Definition and diagnostic criteria of clinical obesity. The Lancet Diabetes & Endocrinology.

Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women. JAMA Netw Open. 2019

Waist-Hip Ratio. NIH.

Physiological responses to food intake throughout the day. Nutr Res Rev. 2014

Association between abdominal obesity and alcohol drinking pattern in normal-weight, middle-aged adults. Public Health Nutr. 2017

While exercise is good for the body and mind, it can have special benefits for the liver — a key organ that filters blood, breaks down food, stores energy, and keeps the human body in balance.

In recent years, there has been a significant increase in young patients presenting with poor liver health and related conditions, such as fatty liver and liver fibrosis, among others.

A recent study published in The Lancet Gastroenterology & Hepatology journal showed that the Metabolically Dysfunctional-Associated Steatotic Liver Disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), affected 1.3 billion people around the globe in 2023.

India has also shown a sharp rise in MASLD prevalence, up 23.19 per cent from 1990 to 2023. India’s age-standardized MASLD prevalence rate rose from 10,191 per 100,000 in 1990 to 12,555 per 100,000 in 2023.

The findings show that the spike is increasingly driven by rising metabolic risk factors, including high blood sugar and obesity.

Amid the growing burden, hepatologist Dr Cyriac Abby Philips noted that “the best friend of the liver is muscle”. In a post on social media platform X, Dr Philips, popularly known as Liverdoc, added that “liver listens to your muscles” and shared nine exercises, all backed by clinical trials, that can be included in a daily routine to help boost liver health.

Brisk walking:

According to Dr Philips, brisk walking is the most accessible liver medicine. He noted that "150 min per week cuts liver fat by more than 30 per cent on MRI”. Citing a UK Biobank study of 91,000 people, he added that every extra 1,000 daily steps can lower the risk of developing fatty liver by about 12 per cent.

Moderate-intensity cardio (MICT):

This includes steady jogging, cycling, or swimming at a "can talk, can't sing" pace. Dr Philips stated that 30–45 minutes of MICT exercises for 3–5 days every week for 12 weeks can help reduce liver fat by 2–4 per cent (absolute). It can also significantly lower liver inflammation (enzyme levels), even without weight loss.

High-intensity interval training (HIIT)

This includes short hard bursts, like burpees, jumping jacks, etc. He recommended four minutes of these exercises “at 85–95 per cent max heart rate”.

Repeating the exercise 4 times a day can “cut liver fat by 16–37 per cent, improve heart function,” in 12 weeks, the Liverdoc said. He added that the exercise regimen “matches steady cardio in half the time”.

Sprint interval training (SIT)

SITs are shorter and harder under 15-minute sessions of squat punches, knee hovers, and chair squats. “Six weeks of these can reduce intrahepatic triglycerides by 12 per cent and visceral fat by 17 per cent in men with fatty liver (MASLD),” said Dr Philips, adding that it gives the “biggest liver benefits for the smallest time spent”.

Resistance/strength training

This includes weights or bodyweight, such as squats, presses, rows, and pulldowns. Dr Philips recommended 3 sets of these exercises three times a week for about 40–45 min.

It can “reduce liver fat independent of weight loss, uniquely lowers liver enzyme, and is the single most important exercise for cirrhosis patients to prevent muscle loss (sarcopenia),” he said.

Combined aerobic + resistance

The Liverdoc stated that this combination is the gold standard for exercises. He noted that “network meta-analyses rank this combination as the number one for improving triglycerides, LDL, and total cholesterol in patients with fatty liver (MASLD) - better than either alone”.

Yoga (Hatha/ Surya Namaskar)

Dr Philips noted that classical yoga is not useful for liver health as it is not aerobic and vouched for the modernized versions.

“Eight to 12 weeks or 3 sessions/week of asanas like Surya Namaskar, Ardha Matsyendrasana, Paschimottanasana, Naukasana can help improve liver tests, insulin resistance, and fatty liver grade - especially in patients with type 2 diabetes plus fatty liver disease,” he said.

Pilates and core work

“Eight weeks of pilates can help reduce body weight, body fat, liver enzymes, and liver fat on ultrasound,” said Liverdoc. He called it a joint-friendly option for people who can't run or lift heavy.

Tai Chi / Qigong

The Chinese exercise is a low-impact mind-body movement. About 30–60 min of these three times a week can help “improve glucose control, insulin sensitivity, and balance/ stability, muscle tone," Dr. Philips said.

He noted that this form of exercise is “gentle enough for older patients, those with early decompensated cirrhosis, or people with poor cardiorespiratory fitness”.

Exercise In Cirrhosis

Dr Philips said that even advanced liver disease can respond well to exercise treatment.

Citing randomized trials, he stated that “combined aerobic plus resistance training cuts serious events (death, major complications) from 12.3 per cent to 5.6 per cent”. It also “prevents the muscle wasting that drives death events in cirrhosis patients”.

“Make physical activity your number one preference to maintain liver health and reduce liver disease,” Dr Philips said.

For many working professionals, going to the gym often feels like a luxury. Their days begin early and end late—rushing for buses and metros, juggling deadlines, presentations, meetings, and endless reports.

So when they are diagnosed with conditions like diabetes or high blood pressure, the most practical and affordable option left is walking. Another common step is cutting down on sugar in tea and coffee. While these are good starting points, these may not be enough.

Calling them "most frustrating", Dr. Sudhir Kumar, Neurologist at Apollo Hospital, Hyderabad noted that such "patients are losing a battle they think they are winning".

"Every day, I see patients with obesity, Type 2 Diabetes, or hypertension who tell me: 'I walk every morning, Doctor'. 'I do all the household work.' 'I have stopped adding sugar to my tea'," said Dr Kumar, in a post on social media platform X.

He also cited these as "dangerous health misconceptions", wherein the patients feel they have done their part, but "their blood work and body composition tell a different story".

Popularly known as the Hyderabad doctor on X, the noted neurologist shared some evidence-based reality of why "walking and quitting sugar" may not be enough.

Several studies have pointed out that walking or undertaking household chores is better than a sedentary behavior. However, neither can be a "substitute for strength training", Dr. Kumar said.

Although walking can burn a few calories, "strength training builds the 'engine' that burns glucose even while you sleep".

"If you are not lifting weights or doing resistance training at least twice a week, your insulin resistance will likely persist, regardless of your step count", he said.

Speaking to HealthandMe, Dr. Manisha Arora, Director - Internal Medicine at the CK Birla Hospital, Delhi, explained that cutting sugar and walking are good first steps, but they do not solve the problem of diabetes and high blood pressure.

"Insulin resistance, inflammation, and loss of muscle all contribute to these diseases. Light walking may help, but the intensity and duration of exercise are also important," he added.

What Is Strength Training?

Strength training exercises force muscles to contract against an external force, such as body weight, dumbbells, or bands. Common examples include

• squats,
• lunges,
• step-ups,
• push-ups,
• planks.

Strength training helps

• Decrease insulin resistance
• Lower blood pressure
• Improve cognitive function
• Reduce systemic inflammation
• Protect against neurodegenerative diseases like Alzheimer’s.

Focus On Protein Leverage

Dr. Kumar further mentioned the diet trap that most people fall into, that is., cutting out sweets and sugar, while loading up the plate with carbohydrate-rich foods such as rice, roti, and poha — 80 percent — and zero protein content.

"Refined carbohydrates (even without added sugar) spike insulin similarly to sugar," he said, calling "no sugar as the bare minimum".

The doctor noted that "a protein-deficient diet can lead to muscle loss and increase hunger".

To lower blood sugar levels, the experts urged to cut down on other foods, such as

• refined carbohydrates,
• processed foods,
• low-fiber foods.

"Focus on protein leverage. Prioritize 1.2g to 1.5g of protein per kg of body weight. When you hit your protein goals, your craving for carbs naturally drops," Dr. Kumar said.

To see the real change in blood sugar and BP levels, he advised people to "add two days of resistance training (bodyweight, bands, or weights)", instead of "just walking",.

The neurologist also recommended "starting the meal with protein paneer, eggs, sprouts, lean meat, and to eat carbs last, and in smaller portions".

In addition, a diet high in protein and fiber from whole grains, fruits, and nuts can also help control blood sugar levels.

"The most successful approach to controlling blood sugar results from combining aerobic exercise with strength training, along with balanced nutrition," said Dr Arora.

We often assume that having a “normal weight” automatically means being healthy. While body weight is an important parameter, it represents only a small part of overall health. True health is far more complex than what a number on the weighing scale can convey.

Understanding The Limitations Of BMI

Body Mass Index (BMI) is widely used to classify individuals based on their weight relative to height. However, it does not differentiate between fat and muscle. As a result, someone may fall within the normal BMI range yet still have high body fat and low muscle mass, a condition known as “normal weight obesity.” Such individuals may appear healthy but remain at risk for metabolic disorders.

Why Is Body Composition Important?

Body composition analysis offers deeper insight by evaluating fat, muscle mass, and their distribution in the body. A combination of low muscle mass and excess body fat, especially around internal organs, can increase disease risk, even when overall weight appears normal.

The role of fat distribution:

All body fat is not the same. Where fat is stored matters significantly. The waist-to-height ratio is now considered a more reliable indicator than BMI, as it reflects fat distribution. A ratio above 0.5 is associated with a higher risk of conditions such as type 2 diabetes, cardiovascular diseases, and even increased mortality.

Looking beyond numbers:

Health cannot be defined by numbers alone. Factors like physical activity, nutrition, stress levels, and sleep quality play an equally critical role. Even individuals with a normal weight can experience poor metabolic health due to inadequate sleep or chronic stress.

The bigger perspective:

Good health is not just about appearance or weight, it is the result of multiple factors working together. It reflects a balance between internal processes and external lifestyle choices.

In essence, being of normal weight does not necessarily mean being healthy. To truly stay well, it is important to look beyond weight and consider the broader picture of health.