ProtectionFeb 17 2023

Doctor challenges BMI reading that pushed up life insurance premium

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Doctor challenges BMI reading that pushed up life insurance premium
[Pexels/Thirdman]

A doctor has challenged an insurer on its decision to increase his life insurance premium by 25 per cent, arguing that Body Mass Index is an inaccurate measure of risk when underwriting policies for black customers.

For decades, UK life insurers have used BMI as a universal metric to calculate the risk, and therefore the cost, of life insurance policies they underwrite.

In this case, a British born doctor of Ghanaian descent was looking for life and serious illness cover.

I was stunned when I was told that my BMI indicated that I was clinically obese. All my other health parameters were normal.Aviva policyholder

His adviser, director of Hanbury Wealth Mandy Dale, recommended using Aviva - as the only insurance company in the market which offers relevant life cover on a serious illness basis, Aviva's policy allows premiums to attract tax relief.

The client, who wishes to remain anonymous, was quoted a standard term premium of £215.41 per month.

But this was bumped by 25 per cent and increased to £270.06 per month after his BMI readings were taken at the nurse screening he attended as part of the application process.

With a 22-year term, the difference between these two premiums is just under £15,000 over the course of the policy.

His BMI was 31, according to the reading. The World Health Organisation classifies those with a BMI of 25-29.9 as overweight, and those with a BMI greater than 30 as obese.

The client told FTAdviser: "As an NHS consultant who exercises regularly, I was stunned when I was told that my BMI indicated that I was clinically obese. All my other health parameters were normal.

"I was faced with a 25 per cent increase in my life insurance premiums, an unfair extra financial burden to protect my family."

The doctor argued that BMI is flawed, because it fails to accurately represent those customers with lower body fat and higher muscle mass.

BMI does not account for lean body mass and may have the propensity to underestimate body fat in South Asian groups and overestimate body fat in black groups.European Journal of Public Health

This has traditionally impacted sportspeople's access to cover, according to product manager at Protection Guru, Adam Higgs.

But Dale's client argued it can also impact those of African descent. A European Journal of Public Health study from 2021 highlighted this.

It concluded that BMI does not account for lean body mass and "may have the propensity to underestimate body fat in South Asian groups and overestimate body fat in black groups".

'We are aware it is not perfect'

Dale decided to compile her client's findings, which also included a handful of British Medical Journal articles from 2021, in an effort to get them to review their decision.

"We were shocked with the offer," she said. "He goes to the gym on a daily basis and takes ‘health living’ very seriously."

In its first response, Aviva said it makes no adjustment for an applicant’s ethnicity in its BMI calculation.

The insurer went on to say: "Like most measures assessing potential future risk, we are aware it is not perfect, and so we take a more pragmatic approach to our decisions – we do not apply a premium rating for those applicants within the 'overweight' BMI bracket of 25-29.9 despite statistical evidence of increased risk.

"Instead our premium increases come in at a BMI of 30 and above. We are content that the available evidence shows BMIs of this level do associate with increased risk in all demographics and so we would not be able to overturn this decision."

Dale was not happy with this reply, so she went back to the insurer again.

This time, she highlighted what she felt was the "lack of attention" it had paid to the studies she had referenced linking the relationship between race and BMI.

There are scenarios where BMI is less well correlated, for example where an individual has a muscular physique. In our experience this is far less common than BMI evidencing overweight or obesity.Aviva

She also asked her client to re-weigh himself, and sent the new weight to Aviva.

The new weight managed to tip Dale's client out of the obesity category, which prompted Aviva to agree to remove the 25 per cent weighting on his monthly premium payment.

But the new weight was only accepted because Dale's client was a doctor.

The insurer said in its second response: "We are willing to accept the weight provided given the customer's occupation within healthcare.

"Ordinarily, the weight taken at medical would be the one we would use and we wouldn’t accept an alternative from the customer in such close proximity."

Dale said that while she ultimately won and secured her client a cheaper premium, "nothing has changed" within Aviva's processes.

"What would they have done if the client wasn’t a doctor? Probably have kept the 25 per cent loading. Is this fair? Doesn’t feel fair," she said.

Aviva's response

Aviva told FTAdviser in a statement that BMI is a “well-established method commonly used across the insurance industry”.

The insurer went on to say that for the majority of people, BMI is a good indicator to determine whether an individual is a healthy weight. 

A spokesperson for the insurer added: "BMI is used in clinical practice across all demographics and at a population level is correlated with health risks as identified in research over the past 50 years in thousands of medical research papers."

Aviva cited government figures, which found 64 per cent of adults in England are either overweight or obese.

Other measurements such as muscle mass, body fat content, and visceral fat are far better markers.Adam Higgs, Protection Guru

“There are scenarios where BMI is less well correlated, for example where an individual has a muscular physique. In our experience this is far less common than BMI evidencing overweight or obesity, but we are always happy to review any underwriting decision, taking into account additional new information which supports that an individual is lower risk, as was the case with this application.”

The insurer was clear that it does not discriminate against individuals applying for insurance based on ethnicity, because it does not ask questions about a customer’s ethnicity when they apply for insurance cover.

What does the industry think?

Director of MoneysWorth, Andrew Wilkinson, said BMI has been grumbled about for decades and understandably so.

For many individual cases, he said it is not accurate for calculating risk, but that it’s seen as the least bad thing the industry's got to measure mass population risk.

Wilkinson's worry, however, is that if customers started listing their race on insurance applications they could be discriminated against in other ways.

For example, insurers might start linking the higher risk of diabetes at a younger age in black people to risk on an insurance policy.

Some doctors used by insurers have been trying to practically address the inconsistences BMI presents.

Adam Higgs at Protection Guru said he knew a doctor who, when asked to carry out insurance medicals on clients with a muscular physique, would send photos to the insurer as well. 

“It does seem that other measurements such as muscle mass, body fat content, and visceral fat are far better markers,” Higgs explained.

“However most people will not have the tools to measure these factors themselves, whereas height and weight, most people can do.”

One adviser also flagged the issue of black women’s BMIs being higher than white women’s due to the difference in fat distribution on their chest and hips.

“Regardless of race, a woman with a large chest will have a higher BMI than a woman with a smaller chest,” director at Cura, Alan Knowles, explained.  

“Does this really increase their cardiovascular risk to the same degree that being overweight and having a large stomach would?”

He said some insurers do ask for dress size or waist size to mitigate this, but in reality he said it makes little difference to the terms of a policy offered.

ruby.hinchliffe@ft.com