BMI bullshit

[trixtah]

[one of the many many reasons I like saluqi so much is the way she has of pithily summarising almost anything with a perfect phrase. Handy when you're around someone like me, who rabbits on and on and on...]

Getting to the point, a couple of people on my friendslist have talked about BMI this week, and commodorified posted a great link to a Flickr slideshow of Illustrated BMI Categories. It graphically shows how meaningless BMI is when it comes to assessing how healthy and attractive people can seem, even with an "excessive" BMI. It's one of my particular bugbears, since my BMI is "high" too.

If it's not obvious, that's a pic of me, complete with messy book pile in the background (btw, I don't need to hear that I'm "fine", or not - I'm quite self-conscious about this pic, but I don't have a problem with my size). I'm not sucking in any parts of my anatomy for the pic! I have a BMI of 28, which makes me "overweight", and not far from "obese" (which starts at 30). I am 39, 5'6" (1.68m) and weigh about 78kg at present. I normally hover around 80kg. This apparently puts me at more risk from diabetes and heart disease. Whatever. I've had three or four days off sick in the last 2 years (2 for a gastro thingie). My blood pressure is around 115/60 (or lower). Everything else physically is completely robust (touch wood). And even if I looked like the normal conception of fat (well, maybe I do), how much is there really a correlation with this stupid BMI thing, or fatness, and actual health?

I personally feel that body fat percentage might be a better gauge of how fat or not one might be - it seems like a better metric to use for any correlations with regard to health (since visceral fat - around the heart and organs - would probably have impacts. General body fat can make your hormones work differently as well). However, body fat percentage is hard to assess without doing an autopsy (no thanks!), and I have no idea how much research has been done that shows actual correlations between fat percentage and, say, heart disease.

It seems to me the BMI is a crappy instrument that doesn't account for anything, and it can have impacts on people's lives beyond the supposed health risks. For example, I had a checkup by a corporate doctor before going permanent in my job. He pointed out to me that my BMI indicated I was "overweight" and he needed to note that on his report. I asked him if it actually seemed that I was "overweight", and what, if any, impact it would have on my job - he replied that that was what the figures said, and it needed to be on the report. He couldn't tell me what BMI figure would actually be an issue for getting the position. I actually wasn't worried that it would have an impact on the hiring process - I mean, hello, I work at a desk all day - but what was the point? I assume they do the same test with air traffic controllers - but do they do cardiograms and the like which might show real problems? My understanding was that I got the same test that ATCs do... and so it would prove precisely nothing. I believe that health insurance in the US requires medical checks that include BMI - do premiums go up? Would I get knocked back from a job if my BMI exceeded a certain amount, even if I was capable of doing the physical tasks (for example, I can most definitely do the strength tests for the police - running is another matter, heh. Short Irish legs.).

I feel like getting very feministy about the patriarchal cabal that comes up with stupid figures to try and control all of us - was BMI invented by insurance companies to enhance their profits, for example - but I'm sure you can all take that part as read. :-) But do check out the Flickr slideshow; it's extremely illuminating.

Comments

[buddleia.livejournal.com]

I saw that BMI Flickr thing, it was cool. I do understand that a general indication of weight issues is needed, something which takes into consideration more than just height/weight/age, but BMI is not considered by anyone to be particularly helpful. Still, it's used for everything, and by people whose medical knowledge is less than even mine. I am probably considered morbidly obese by my BMI, but it is surely more useful to note that I have (for instance) a family history of high cholesterol, mental illness and glaucoma?

Also, HI HOT BIRD HI!I LIKE YOUR TATTOO!

[trixtah.livejournal.com]

Yeah, I'm definitely with you on there being a need for a general indication of weight stuff, thus the ramble on body fat percentage (which would again need to be altered for age/ethnicity, etc, if there were a simple way of actually finding it)... but it's so true that the actual family medical background should have much more importance when it comes to talking about health risk. I'm much more likely to die a slow and painful death from cancer, myself, than develop diabetes (none at all in my family).

*koffblush* As to tattoos, well, baybeh, how about you drop by some time and check out my ...etchings. ;-)

[thette.livejournal.com]

BMI might have some use when you go above 35. You'll find reports that say "being morbidly obese" (BMI 40+, I think, could be 35+) "is linked to" a variety of risks and diseases. Then, they'll go on with such-and-such percent of the population "is overweight or obese", OMG TEH HORRORS! Most people who are "overweight" look not much different than you do. They're almost always a bit padded and not the waddling bags of fat the journalists and scientists want you to think about.

I think my sarcasm meter broke. I need to re-set it with an honest compliment. You're butchy hot!

[trixtah.livejournal.com]

Yeah, it gyps me that the diet industry now have a clobbering stick with the BMI thing, and that what I'd consider "average" (ie. me) is "overweight". Too right with the annoying portrayal of "waddling bags of fat" (hee!). Yeah, I can see it being a bit more useful at the extreme edges of the scale - it's really the fact that what is considered to be "just right" is so narrow.

As for compliments, *blush*. Thanks!

[epi-lj.livejournal.com]

I dunno; I'm way out toward and past the extreme. I'm not sure that the way BMI is used these days in medical practices is totally okay for people like me and that it's only really a problem when it's applied to much smaller people.

If it's a factor, then it's a factor. Being male reduces my lifespan *far* more than being fat is purported to. Would it be reasonable to refuse to look at and care for my health until I get full hormone therapy and SRS surgery? (Is there any more evidence that infinitessimally small number of fat people who manage to become thin and stay that way long-term are actually healthier than there is that my life expectancy would go up if I had hormone therapy and SRS surgery?) Even if I could be slightly healthier by being thin and there were some mystical and magical way to make me that way, say by cutting out the part of my intestinal tract that allows me to process nutrients such that I become incontinent and can't eat more than a couple of tablespoons of food without throwing up, is it still reasonable to use that as a reason to discriminate, to deny decent health care, to refuse people jobs or promotions that they're absolutely qualified for, to create bonus structures at companies that exclude me, etc.?

Is the only problem with the BMI and how it's used today really that it fingers both of us rather than just me?

[trixtah.livejournal.com]

No, I do think the scale itself is a problem. Even at the "extremes", as you so amply point out, there will be problems with a "one scale fits all" mindset.

I had one person I had a brief involvement with who was very fat. I don't have a problem with size, but I did find myself having a problem with the fact a 30-year-old woman refused to walk 150 metres down a 10 degree slope because it was too hard for her - and she was not seeking medical care. I recognised that she had internalised the "I'm fat so I'm never going to be fit" thing, but I'm sure she had been given that message loud and clear from all kinds of people throughout her life. I tried encouraging her to go to a doctor to get whatever might be fixed, fixed, but given your experience, I'm (now) not surprised why she was adamant in her refusal.

The thing was, my last girlfriend was/is fatter, and has no problems with managing an extremely busy life... because her current doctor treats her health problems and not her weight. She did get browbeaten into an attempted gastric bypass a decade ago, and it luckily failed (after nearly killing her). Her heart got damaged by the surgery (and resulting infection), and not any goddamned weight "issues" she had previously. It makes me angry thinking of it.

[micheinnz.livejournal.com]

And let's not mention that the BMI category "goalposts" were all reset 5 points lower about 10 years back.

[trixtah.livejournal.com]

What a surprise. Not.

[pretentiousgit.livejournal.com]

My BMI has been somewhere between Overweight and Obese for most of my life, as I'm 5'3/5'4 and somewhere between 145 and 158 pounds. On the other hand, I'm usually involved in physical labour and come from a genetic background composed solidly of short, no-nonsense square ladies. All of my relatives are built in (several) stone, so is it any surprise that I should be the same? Not really.

But I still feel sort of crappy when the meter doesn't say "135" or "129" or whatever.

[trixtah.livejournal.com]

Huh, I think of that kind of weight range as a nice healthy one myself. It's most definitely to do with one's inheritance - and if those no-nonsense square ladies are doing their threescore and ten plus, what's the problem?

But, yes indeed, it's bloody hard not to buy into the fact that we should actually be X (lighter). I get a bit focussed on muscle tone by way of displacement, but even that's crock. I try to keep in mind the fact I'm capable and healthy... and most of the time it keeps those stupid voices at bay. I'm hoping to achieve the totally zen state of not giving a shit at all one day.

[reynardo.livejournal.com]

When my BMI was down in the normal range, I was horridly underweight and depressed and should have been taken away for a stern talking-to. (Breastfeeding and Post Natal Depression made me soooo skinny).

But that lady in the photo up there is HOT!

Ahem. Enough drooling. BTW, Trixtah, I'll be back down in Canberra next we'end. Shall we?

[trixtah.livejournal.com]

Yeah, breastfeeding is draining (not that I've tried, but I've seen the effects). I had one ex in particular who was always really small - at her "ideal" weight, but she constantly battled with blood sugar swings, lurgies and everything else that came along. Now she's in her mid-40s and is a bit more solid, she's so much more robust in every way. Everyone has an "ideal weight", but it's not often much to do with what the powers that be tell us is ideal.

Heh, thank you for the kind words. Yes, I'll be around next weekend, although occupied Sat morning and evening. We might be able to round up saluqi and faxon too, if we can synchronise our calendars!

[saluqi.livejournal.com]

Perhaps find out what she meant by "shall we?" first ;-)

*GDR*

[trixtah.livejournal.com]

*running after you thwapping you with something thwappy*

Silly me for assuming, though. I'll endeavour to check whether it's dinner or coffee or something that is actually on the agenda! ;-D

[epi-lj.livejournal.com]

One of the things that I've always wondered about, in terms of effects of not just BMI, but general attitudes about weight these days, is how much of the health effects that they track are due to fat people not being able to get adequate medical care. I mean, one big factor in the extension of lifespan over the past century has been improvement in medicine. But as a fat person, it's next to impossible to get decent medical care. In places withoug socialized medicine, of course, it can be much more difficult to get or afford insurance, but even in places with it, a lot of doctors will just dismiss anything you present with as being because you're fat. I've heard some really ridiculous stories, and I've also experienced some bad ones myself. And I have to admit that I don't go to the doctor for my regular checkups, despite knowing how important they are. I don't even *have* a regular doctor right now -- my last one pulled a "don't call us, we'll call you," fade-style breakup and I haven't had the courage to go to one again. Given how dramatically disease treatment is improved by early detection, if fat people don't go to the doctor at all or if they do they can't get a proper diagnosis or have to fight tooth and nail to get one, how does that affect their health and longevity?

Then you also add in all the added life stress that being fat can bring in today's society and for those who cave to it, you can add in the (known and documented) deleterious health effects of yo-yo dieting, and overall, I'm frankly shocked that the statistics showing differences in longevity for fat people show as small a gap as they do, even if there isn't any real health effect.

Me, the last time I did get a checkup, every last statistic they could pull from me -- blood sugar levels, cholesterol levels, resting heart rate, blood pressure, whatever -- was excellent. But the doctor still told me that I was wildly unhealthy because of my weight and had to really take drastic measures or I'd drop dead any second. He chastised me for not getting enough exercise and eating poorly -- WITHOUT EVEN ASKING ABOUT MY EXERCISE OR DIET HABITS. I pointed out that I was eating quite well and gave him a run-down of everything I'd eaten that week and that I got two hours of reasonbly vigorous exercise every weekday and up to six hours of weekend days. (Note that that's not the case anymore, but it was then.) Not only did he dismiss it with a clear implication that I was lying, but he simply said that as long as I was fat, it obviously was not enough. I said that I didn't have the time for any more exercise in my day -- that between working full-time and often putting in overtime and two hours of exercise a day, that left little enough to have a life as it was, and he just kept repeating that I needed to do more. I asked what he ate and how much exercise he did and he ignored it. In general, it was a very frustrating interview.

[trixtah.livejournal.com]

That fucking sucks. And yes, the yo-yo thing, and reluctance to take care of oneself if no-one thinks you're worth taking care of are much higher risks, IMO.

Imagine looking at all that evidence about your good health, and then dismissing it because of some stupid preconception about what "healthy weight" really looks like (which varies by individual).

How do we identify risk factors without trying to shove people into little boxes because of our preconceptions? A Polynesian man who weighs over 150kg is quite healthy if he's eating a traditional diet. If he's eating a more Westernised diet with lots of white sugar and white flour, he's much more likely to be at risk of developing diabetes.

I was reading a book recently that goes into how medical professionals are increasingly relying on "algorithms" to diagnose people, rather than assessing the full picture of what they are being presented with. Your doctor is a prime example of that mentality. Your tests completely backed up your statements about your exercise (and imagine not asking about your diet, if he thought it was a problem!), so he was ignoring scientific evidence because of the stupid algorithm (fat = unhealthy) that he had stuck in his head. That really shits me.

[cheshire-bitten.livejournal.com]

The thing is, I implemented some of those algorithms, and you know the one question they didn't ask, weight because it is statistical insignificant once you control for blood suger, blood pressure, and cholesterol were considered.

grumble

[trixtah.livejournal.com]

HAH. So it really just boils down to stupid prejudice. Well, we knew that, but that just makes it obvious.

[not-in-denial.livejournal.com]

I have brainfog so I'm just going to comment with a wolf-whistle and go, "Haaaaaawt!" and then go back to sleep.

[trixtah.livejournal.com]

Heh, thanks! :-)

[stormkpr.livejournal.com]

I don't have anything to add other than -- very well said! I always like reading your entries.

[trixtah.livejournal.com]

Thanks! Rants R us! :-)

[kightp.livejournal.com]

The BMI and the way it's used - and misused - is so meaningless as to be insane.

If you want some interesting reading on the subject of "obesity" and its purported health risks, I can recommend the Junk Food Science blog (http://www.junkfoodscience.blogspot.com/). She often casts a skeptical scientist's eye at the way the popular press reports human health studies, and goes to the primary source material to tell us what the studies *really* found ... which is often not at all what we're led to believe.

[trixtah.livejournal.com]

Yeah, I really wonder why they keep pushing it at us. Well, no, I don't - there's a hell of a lot of money to be made by putting people in fear of their health for no good reason.

Thanks for the pointer! It looks like a good read - I do like a nice, objective, well-informed POV (I can take care of the less-informed rants myself).

[the-s-guy.livejournal.com]

This is one reason why, on the occasions I feel like eating more healthily than usual and am lazy enough to let something like Jenny Craig do all the food prep and menus for me, I regularly tell them to take a flying leap when they try to tell me what I should be doing lifestylewise.

I am perfectly capable of managing my own weight and fitness levels, given sufficient supplies of reasonably nontoxic food (and I really must get more into cooking one of these years). Diet company employees are not my doctor or my gym, have much less experience of being me than I do, and have no business trying to guilt me into anything. Fortunately, weight loss is _not_ my #1 concern, so I have no qualms about telling them where to stick it.

One of their many failings, to drift back on to topic, is their use of BMI. Any place which decides on that as a metric automatically fails the medical expertise test, in my opinion. This includes people who fancy themselves doctors.

(They also have a number of other fairly dodgy practices, mainly psychological ones, which have failed to endear them to me.)

Yes, bodyfat would be better. Ish. But yeah, tricky to check, given variable bone densities and sizes, organ sizes, and even fat location. We'd probably need to stick people in a full medical scanner - CT, ultrasound etc - to get an idea about how much fat a person had and where they had it.

And personally, I will decide when I'm healthy. When I can perform a number of basic, mildly strenuous tasks and exercises without getting completely winded, that's a good point to stop and re-evaluate.

[trixtah.livejournal.com]

Yeah, I got clobbered by that the first time I went to a gym here, when I was told unconvincingly that "some of the larger girls can be really fit" when I said I was not interested in weight loss. So, I didn't get her as a personal trainer.

As for your expertise test with regard to an organisation's use of the BMI for a metric, I think I'm getting to be with you there. It certainly seems to be a negative correlation between use of the thing, and real-world knowledge.

And personally, I will decide when I'm healthy. When I can perform a number of basic, mildly strenuous tasks and exercises without getting completely winded, that's a good point to stop and re-evaluate.

Word.

[micheinnz.livejournal.com]

BMI is crappy for two reasons: the "squared" in the equation is only useful for two-dimensional beings, and, well, we're not; and BMI by itself doesn't take things like muscle mass vs fat mass into account. Very muscular athletes can have a high BMI (and therefore be "obese") because fat weighs more than muscle by volume.

My BMI is around 40, which is enough for one of my doctors to suggest Xenical (as if!). She's the only one who's said anything about it, though, and the Fulton Hogan doctor didn't seem concerned about my ability to do very physical work.

[trixtah.livejournal.com]

Are you serious??? Xenical??? Jesus, I bet the gastric bypass is next.

And, yes, those are precisely the kinds of concrete reasons I dislike the thing being used. On a broader note, once certain types get any kind of measuring stick, valid or not, they don't hesitate to start clobbering people with it.

Oh, and...

[micheinnz.livejournal.com]

Nice ink, btw.

[saluqi.livejournal.com]

I think it's a typically human thing to respond to a person's individual proportions by blowing the whole thing way, way out of proportion.

I don't think fat percentage (as opposed to weight) is irrelevant. I think it can be too high and it can be too low but I don't think it's my business to get in other people's faces about it. And yes, people like you, in my brain, are nothing like overweight. You look perfectly healthy, and I happen to know that you eat better than most people and you exercise more than most too.

But even if you could accurately measure fat, there are plenty of things people do that aren't ideal and extreme lows and highs of fat are only one.

Here in Australia, there are heaps of people who drink at dangerous levels, and that isn't stigmatised anything like weight, even tho' it's socially and economically very expensive. Fat doesn't make people come home from the pub and slap their wives around, or go poofta bashing in packs, or call in sick every Monday.

[trixtah.livejournal.com]

Yeah, I think a proper metric could be useful for an input (but not a diagnostic, alone). Speed the day when they come up with something that's actually scientifically valid.

Too right with other risky behaviours that aren't stigmatised in the same way. I should probably change my fulminations into one against unfettered capitalism, because of course the common trend there is what makes money. Booze consumption makes money. The diet industry makes probably just as much money. There's no profit in saying that probably the majority of people are fine with respect to weight and health. Eh.

[ilikerivers.livejournal.com]

The BMI is useless as it doesn't take into account muscle volume or body size/type or fitness level. At uni we had an acronym for BMI that a lecturer told us that highlighted it's uselessness but I can't remember it now. I saw the BMI slide-show the other day, it was pretty interesting. I'm classified as 'normal' on the BMI but I consider myself underweight.

You are gorgeous and you look very fit and toned, I don't understand how your figure could be classified by any scales as 'overweight.'

I'm also a fan of your ink.

[trixtah.livejournal.com]

Hah, I'd love to know what the translation of the acronym was. "Bollocks Mongering Idiots?"

Thank you - I also don't understand how someone like me, who is quite average, is termed "overweight". It's total crap.

[ironed_orchid]

BMI is such crap.

[trixtah.livejournal.com]

Sure bloody is.

[cheshire-bitten.livejournal.com]

I've read a range of stuff which suggests that overweight people have the lowest death rate of anyone, but everyone still uses it.

/rant.

Will you accept. oh-my-god hot?

[trixtah.livejournal.com]

I'm sure people who are overweight are generally healthier than those who are underweight by similar amounts. It makes sense.

Yay rants, and thank you for compliments! :-)

[kk1raven.livejournal.com]

Fitness is what matters to your health, not fatness. Your BMI goes up when you're more fit, not down, since more muscle makes you heavier. Any measure that rewards you for being unfit and punishes you for being fit is obviously not useful for measuring health.

[trixtah.livejournal.com]

Yep, that's certainly how it works for me. When I'm more blobby, my BMI tends to go down a bit. Such a stupid metric.

[filkferengi]

*hands you a whole OED full of awesome WORD[s]*


:)

[trixtah.livejournal.com]

Thanks!

*drooling over the thought of a whole OED to MYSELF!* :-D

BMI

[(Anonymous)]

BMI is inaccurate not only because it doesn't take into consideration muscle vs fat % but BMI also doesn't work for people of extreme heights. Somebody over 7 feet of even a relatively light body mass may be calculated to have a very high BMI.
The following formula works much better than BMI...

hypothetical mass (hm)= real mass (rm) times (hypothetical height (hh)/real height (rh))^3

Note the power of three is used because because the volume of an object is a cubic relation (height *width*depth) for example, if you doubled the size of a cube it's volume would increase 8 folds (2*2*2=8) right? The same concept also applies to humans...