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With your height in inches, and your weight in pounds, use the BMI Calculator below to determine if your body mass index is less than 30 or greater than 30. Use the drop-down above to select your answer.

BMI Calculator
Height
(inches)
Weight for
BMI = 30
58 143
59 148
60 153
61 158
62 164
63 169
64 174
65 180
66 186
67 191
68 230
69 237
70 243
71 250
72 258
73 265
74 272
75 279
76 287
77 295

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