Earlier quoted context omitted.
Your heart does not care if it's supporting fat or muscle it must pump blood for both. Further skin and colorectal cancer are both surface area and don't care about fat vs. mussel. Metabolically muscle is worse as it needs more oxygen and fuel. Which is one of the reasons body builders can often die young from a heart attack.
Your heart is going to care about how much you weigh but not how tall you are. Those cancers are going to be mostly a function of height, not caring about weight for most people. Neither of those is a reason to care about the ratio that BMI represents.
Gaining weight increases skin, which is why skin reduction surgery happens for people that lose lot's of weight. GIS for skin folds.
Weight / height ^2 is a proxy for both it's far from perfect, but it's also really easy to collect.