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  #1   ^
Old Mon, Jul-20-20, 02:29
Demi's Avatar
Demi Demi is offline
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Default Why BMI is no longer fit for purpose

Why BMI is no longer fit for purpose – and how you should measure your health instead

The pandemic has made us more aware of our weight than ever, yet the technical measurement remains a crude and outdated calculation


https://www.telegraph.co.uk/health-...health-instead/

Quote:
Following his serious spat with Covid-19, our Falstaffian Prime Minister has woken up to the health implications of carrying a few extra pounds. Boris Johnson recently noted that the UK was “significantly fatter” than other European nations and that we would be “more resistant to diseases like Covid if we can tackle obesity”.

Despite the mixed messages of half-priced Big Macs in the #eatouttohelpout initiative, a raft of weight-loss proposals is currently under review. These include wider availability of fitness programmes, bariatric surgery (gastric bands) and stricter labelling of calorie content. What’s almost certain is that the metric to measure their success will be the default solution: the Body Mass Index (or BMI).

The formula for BMI — weight in kilograms divided by the square of height in meters — was invented in the early 19th century by Belgian mathematician Lambert Adolphe Jacques Quetelet as a swift measurement of obesity. It is, however, still used regularly today by medical professionals to determine whether a person has a healthy amount of body fat. For most adults, according to the NHS website, an ideal BMI is between 18.5 to 24.9.

The coronavirus pandemic got me thinking about my own BMI. I am 52, have had two children, and am healthy. I have a personal trainer twice a week, swim when I can, and try not to eat carbs with my evening meals (the glass of wine - or two - stays: one has to live). But there’s no doubt I have a few ‘life miles’ on the clock. There’s the hint of a double chin. More irksome still is the round stomach encouraged by medications prescribed for insomnia and depression in the mid-2010s — coupled with a sedentary lifestyle during that period.

Slim for most of my life, I don’t enjoy self-denial. But in the interests of research, I have just put my height and weight measurements into an online calculator. I’m not going to share the precise numbers, but not only am I firmly in the “overweight” category; I am barely a bagel away from “obese”.

Now, is this fair, when I’m pretty sure I could out-squat most of the skinnies I know? It is really helpful that a crude mathematical calculation remains the best way to measure health?

Dr Margaret Ashwell thinks not. A biochemist, and president of the Association for Nutrition, she has been arguing for years that BMI is not ideal. “Though it can be useful to measure general obesity, BMI measures both muscle and fat, so does not distinguish between over-muscled, and overweight people,” she says. For decades, Dr Ashwell has illustrated this with the poster from the 80s film Twins: Arnold Schwarzenegger and Danny de Vito apparently (at that time) had the same BMI. Since then, there have been reports of muscular athletes such as the cyclist, Chris Hoy (27.2) falling well into “overweight” on the BMI scale.

The most important measurement, says Dr Ashwell, is the waist-to-height ratio, which is a person’s waist circumference divided by their height. “BMI is like the Titanic,” she says. “It only allows you to see the tip of the iceberg when it’s too late and does not distinguish between individuals with different types of fat distribution.”

Visceral fat — the fat you gain around your middle/ waist, wrapping around your organs — is significantly more dangerous than the subcutaneous fat that ‘pear shaped people’ have on their thighs and bottoms. “It’s long been known that central obesity raises the risk of heart disease, type 2 diabetes, and strokes,” says Dr Ashwell. “And one in three people who have a ‘normal’ BMI could have too high a percentage of visceral fat.”

In Dr Ashwell’s straightforward “string test”, you measure your height with string, fold it in half and check that it can fit comfortably round your waist. “The ‘OK’ region is 0.4 - 0.5,” says Dr Ashwell. “Below 0.4, and between 0.5 and 0.6 the advice is to ‘take care’. Above 0.6 is ‘take action.” How much gentler than curved graphs screaming OBESE! at you. (The choice of BMI of 25 for “overweight” was based on insurance data, but the choice of 30 for “obese” and 40 for “morbidly obese” was, says Dr Ashwell “merely pragmatic. The researchers just saw them nice, easy, linear numbers.”)

I take this opportunity to bring up my reasonably fit figure, but problematic tummy. “There is a separate area of research that relates fitness and fatness to your health risk,” says Dr Ashwell. “Certainly, being fit can counteract being fat to a certain extent.”

In 2010, a study of 35,000 people from the Journal of the American Medical Association suggested that walking fast was linked to living longer. Those who walked at 2.6 feet per second (a mile in 33 minutes) were likely to hit their average life expectancy. With every speed increase of four inches, their chance of dying in the next decade fell by 12 per cent. Separate research in 2018 correlated having a stronger grip with greater, longevity. And, last year, Stefanos Kales, a professor at Harvard Medical School studied a group of firefighters. He discovered a link between firefighter’s ability to do press-ups, and their cardiac health. “The results show a strong association between push-up capacity and decreased risk of cardiovascular disease,” he said.

Dr Michael Joyner is a physiologist who researches exercise at America’s prestigious Mayo Clinic. “Fitness can absolve a multitude of problems,” he says. “And push-ups are another marker in a consistent story about whole-body exercise capability and mortality.” According to Dr Joyner, only 20 to 30 per cent of adults can do a single push-up. “But almost anyone could get to 30 or 40 push-ups if they worked at it (as long as they don’t have a shoulder problem, or are really obese.) But one marker of fitness becomes a correlation to another marker.” He explains this as a product of “conscientiousness. Conscientiousness means that healthy behaviours tend to come together,” he says. “So those who are likely not to smoke are also likely to vaccinate their children, wear-seat belts, and wear face-masks, and eat healthily. This tends to come with education.”

The lockdown era — and its immediate aftermath — has been a double-edged sword, says Dr Joyner. “We’ve long known that 'active commuting' — cycling or running to work, or even the habitual 500m walk to the station — is great for general fitness,” he says. “People who live in New York City are leaner than those who live in the suburbs, for example. This period is challenging because people have been working from home, and not commuting. On the other hand, many have found more time to start fitness programmes.”

Dr Margaret Ashwell also sees a Covid link to her approach. “As well as putting you at risk of chronic health conditions, central obesity can also impair the immune system, and respiratory function. This might be why people from the BAME communities (who are prone to central obesity) might suffer severe symptoms from infectious diseases such as Covid-19.”

Dr Joyner believes the BMI metric has to change — perhaps to an “exercise stress test” where a person runs on a treadmill while their breathing, blood pressure, and heart-rate is measured. Dr Ashwell would prefer universal adoption of the waist-to-height ratio. But both completely agree with the government’s refocus on fitness management in maintaining future health. Says Michael Joyner: “fitness is within our control. It’s an issue of practice, rather than destiny.”
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  #2   ^
Old Mon, Jul-20-20, 08:15
Ms Arielle's Avatar
Ms Arielle Ms Arielle is offline
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Default

Hate Hate HATE BMI method.

It says my son is very underweight. Very fine bones and very tall, bone structure of grandma who married very very tall grandpa.

When my sister and I stand side by side, same height my hands are bigger, shoulders wider, hips wider.....far bigger and heavier bone structure, yet the same height.

A friend is of what looks like native pacific islander.... He is built like a brick. ..... and could out manuver his team of 8th grade soccer players.

Hard on his sons who register in the obese range. School is required to notify parents. I remember the day I popped over to pick up my son. The son was distraught. Overwhelmed with distress as he told me the numbers. Very emotionally damaging to this child.

Pinch an inch is better, but subjective.
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