BMI: The Mismeasure of Weight and the Mistreatment of Obesity

Yves here. The entire field of weight management is dodgy due among other things to the extremely weak understanding of diet and nutrition, in part due to it being an unsexy backwater, in part due to the difficulty of designing and implementing good studies (for starters, getting participants to keep accurate records over long periods of time. How many will ‘fess up to having an undue fondness for deep fried or sugary foods?)

As this article points out, even measures like BMI, as in body mass index, often produce misleading results. For instance, bodybuilders and football players can have BMI of over 30, yet not have excessive body fat. From Business Insider:

Waist size may actually be one of the most important factors in measuring a person’s overall health, Insider previously reported. You may have a high BMI, but if the circumference of your waist is below 35 inches as a woman and 40 inches as a man, you’re more likely to have a healthier weight.

“A waist circumference greater than 35 inches in women and greater than 40 inches in men could not only determine overweight status but put a hard-and-fast number on one’s health,” dietitian Michelle Routhenstein, MS, RD, CDE, CDN, told Healthline.

“Waist circumference above these numbers indicates excessive belly fat, a dangerous type of fat surrounding vital organs, which increases one’s risk of diabetes, high cholesterol, high blood pressure, and the metabolic syndrome,” she added.

By Julie Appleby, Senior Correspondent for Kaiser Health News, who previously worked at the San Francisco Chronicle and the Contra Costa Times in Walnut Creek, California. Originally published at Kaiser Health News

People who seek medical treatment for obesity or an eating disorder do so with the hope their health plan will pay for part of it. But whether it’s covered often comes down to a measure invented almost 200 years ago by a Belgian mathematician as part of his quest to use statistics to define the “average man.”

That work, done in the 1830s by Adolphe Quetelet, appealed to life insurance companies, which created “ideal” weight tables after the turn of the century. By the 1970s and 1980s, the measurement, now dubbed body mass index, was adopted to screen for and track obesity.

Now it’s everywhere, using an equation — essentially a ratio of mass to height — to categorize patients as overweight, underweight, or at a “healthy weight.” It’s appealingly simple, with a scale that designates adults who score between 18.5 and 24.9 as within a healthy range.

But critics — and they are widespread these days — say it was never meant as a health diagnostic tool. “BMI does not come from science or medicine,” said Dr. Fatima Stanford, an obesity medicine specialist and the equity director of the endocrine division at Massachusetts General Hospital.

She and other experts said BMI can be useful in tracking population-wide weight trends, but it falls short by failing to account for differences among ethnic groups, and it can target some people, including athletes, as overweight or obese because it does not distinguish between muscle mass and fat.

Still, BMI has become a standard tool to determine who is most at risk of the health consequences of excess weight — and who qualifies for often-expensive treatments. Despite the heavy debate surrounding BMI, the consensus is that people who are overweight or obese are at greater risk for a host of health problems, including diabetes, liver problems, osteoarthritis, high blood pressure, sleep apnea, and cardiovascular problems.

The BMI measure is commonly included in the prescribing directions for weight loss drugs. Some of the newest and most effective drugs, such as Wegovy, limit use to patients who have a BMI of 30 or higher — the obesity threshold — or a lower level of 27, if the patient has at least one weight-related medical condition, such as diabetes. Doctors can prescribe the medications to patients who don’t meet those label requirements, but insurers might not cover any of the cost.

While most insurers, including Medicare, cover some forms of bariatric surgery for weight loss, they might require a patient to have a BMI of at least 35, along with other health conditions, such as high blood pressure or diabetes, to qualify.

With medications, it can be even trickier. Medicare, for example, does not cover most prescription weight loss drugs, although it will cover behavioral health treatments and obesity screening. Coverage for weight loss medications varies among private health plans.

“It’s very frustrating because everything we do in obesity medicine is based on these cutoffs,” said Stanford.

Critics say that BMI can err on both ends of the scale, mistakenly labeling some larger people as unhealthy and people who weigh less as healthy, even if they need medical treatment.

For eating disorders, insurers often use BMI to make coverage decisions and can limit treatment to only those who rank as underweight, missing others who need help, said Serena Nangia, communications director for Project Heal, a nonprofit that helps patients get treatment, whether they are uninsured or have been denied care through their health plan.

“Because there’s such a focus on BMI numbers, we are missing people who could have gotten help earlier, even if they are at a medium BMI,” Nangia said. “If they are not underweight, they are not taken seriously, and their behaviors are overlooked.”

Stanford said she, too, often battles insurance companies over who qualifies for overweight treatment based on BMI definitions, especially some of the newer, pricier weight loss medications, which can cost more than $1,500 a month.

“I’ve had patients doing well on medication and their BMI gets below a certain level, and then the insurance company wants to take them off the medication,” Stanford said, adding she challenges those decisions. “Sometimes I win, sometimes I lose.”

While perhaps useful as a screening tool, BMI alone is not a good arbiter of health, said Stanford and many other experts.

“The health of a person with a 29 BMI might be worse than one with a 50 if that person with the 29 has high cholesterol, diabetes, sleep apnea, or a laundry list of things,” said Stanford, “while the person with a 50 just has high blood pressure. Which one is sicker? I would say the person with more metabolic disease.”

Additionally, BMI can overestimate obesity for tall people and underestimate it for short ones, experts say. And it does not account for gender and ethnic differences.

Case in point: “Black women who are between 31 and 33 BMI tend to have better health status even at that above-30 level” than other women and men, Stanford said.

Meanwhile, several studies, including the long-running Nurses’ Health Study, found that Asian people had a greater risk of developing diabetes as they gained weight, compared with whites and certain ethnic groups. As a result, countries such as China and Japan have set lower BMI overweight and obesity thresholds for people of Asian descent.

Experts generally agree that BMI should not be the only measure to assess patients’ health and weight.

“It does have limitations,” said David Creel, a psychologist and registered dietitian at Cleveland Clinic’s Bariatric and Metabolic Institute. “It doesn’t tell us anything about the difference between muscle and fat weight,” he said, noting that many athletes might score in the overweight category, or even land in the obesity range due to muscle bulk.

Instead of relying on BMI, physicians and patients should consider other factors in the weight equation. One is being aware of where weight is distributed. Studies have shown that health risks increase if a person carries excess weight in the midsection. “If someone has thick legs and most of their weight is in the lower body, it’s not nearly as harmful as if they have it around their midsection, especially their organs,” said Creel.

Stanford agrees, saying midsection weight “is a much better proxy for health than BMI itself,” with the potential for developing conditions like fatty liver disease or diabetes “directly correlated with waist size.”

Patients and their doctors can use a simple tool to assess this risk: the tape measure. Measuring just above the hipbone, women should stay at 35 inches or less; men, 40 inches or less, researchers advise.

New ways to define and diagnose obesity are in the works, including a panel of international experts convened by the prestigious Lancet Commission, said Stanford, a member of the group. Any new criteria ultimately approved might not only help inform physicians and patients, but also affect insurance coverage and public health interventions.

Stanford has also studied a way to recalibrate BMI to reflect gender and ethnic differences. It incorporates various groups’ risk factors for conditions such as diabetes, high blood pressure, and high cholesterol.

Based on her research, she said, the BMI cutoff would trend lower for men as well as Hispanic and white women. It would shift to slightly higher cutoffs for Black women. (Hispanic people can be of any race or combination of races.)

“We do not plan to eliminate the BMI, but we plan to devise other strategies to evaluate the health associated with weight status,” said Stanford.

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  1. t

    Measuring just above the hipbone, women should stay at 35 inches or less; men, 40 inches or less, researchers advise

    How is this different? You’re still assuming a standard person. Weight-height ratios are still better, like your waist size should not exceed half your height.

  2. Mike

    I think a standard body fat % test eliminates most of the issues here. It ultimately gives you a sum total % but you can quickly put together an idea of where the fat is distributed around your body and decide for yourself. You also have to decide whether your % is within an acceptable range based on how you feel and your general body type, ectomorph vs endomorph (which exists on a scale).

    I will disagree with this: “and it can target some people, including athletes, as overweight or obese because it does not distinguish between muscle mass and fat.” A lot of these athletes are probably not healthy… I’ve been there. About 6 years ago I was about 20lbs heavier and had 5% body fat. I looked/performed like an elite level athlete, I know since I trained with buddies that were. I would say none of us were overly healthy. We all had injuries, I felt worse (eating all day long) and everyone was on some sort of performance enhancing drug. If you are someone with enough muscle mass to tip the BMI scale you are certainly fitting the description I just painted. Also that is probably a small enough percentage of the population to not worry about and they should just focus on the overweight folks and coming up with a better metric than BMI for them, since there are a lot of them.

    Either way key points here are this is another topic in our overly complicated lives where you have to become knowledgeable enough to be your own advocate because a standard doctor knows jack about healthy lifestyles. And on the medicine side they know very little also… queue in the articles this week about the cholesterol debate and how statin prescription has been off base for 3 decades. But drug companies don’t care since they have made billions.

    What is greatly underrated in modern medicine is a person learning how to roughly experiment on themselves and have a general idea on trends knowing we are just an N=1. This is a skill that takes a lot of practice but can be rewarding and not time consuming at all once it is figured out.

    1. Yves Smith Post author

      No, bodyfat tests are extremely problematic. They were done with water displacement studies using all of 8 corpses. “Standard” bodyfat tests regularly produce negative bodyfat measures in athletic black men.

      The electrical impedance (the ones sometimes integrated into scales) are unreliable because the readings are very much influenced by recent salt consumption.

      The government of Quebec spent $2 million Canadian investigating bodyfat measures when the police sued over the use of bodyfat measures they argued were misleading and were forcing some incorrectly out of jobs. Quebec ascertained the only reliable test was a 10 site measurement with calipers….which to be administered accurately, also had to be done by someone who had made over 4000 measurements.

      And there is the issue of weight/fat not necessarily reflecting overall health. One of my brothers is morbidly obese. He does not have diabetes or even insulin resistance. His heart is fine despite his bulk. He does have somewhat elevated blood pressure but my mother and grandmother had that at normal body weight, and a mild case of gout.

      1. Mike

        Interesting… I guess to be clear I meant the body fat test with 10 caliper measurements. 4000 measurements is a lot but I don’t think that would be unreasonable for a Nurse to be trained on if a medical practice was serious about addressing body fat? If a single practice has dozens of patients a day they could get there quickly. But all of that is moot if body fat % is not an overall effective metric.

        I would defer to my previous comment and say a person has to find metrics that relate to their specific conditions and find a way to track them. Biosecurity state concerns aside I think wearables in the future will help facilitate a lot of various tests from heart rhythm, blood pressure, blood markers and more but will require a big shift with the Doctor to Patient relationship, I’m excited about what they could provide. Also there is a lot of room for somebody to track more qualitative measures like “how you feel,” once again everyone has to be there own advocate, unfortunatley.

      2. Stephen

        There is a fun US Navy approach which involves feeding various data into an algorithm and then spews out an answer. No actual examination or special scales required. I suspect it is just as (or more) problematic. But it is great when it gives you the answer you want!

      3. O.Lengai

        He [Yves’ brother] does not have diabetes or even insulin sensitivity.

        This is a confused and confusing statement. Insulin resistance or loss of insulin sensitivity is a pathological state that usually accompanies metabolic syndrome, prediabetes and type II diabetes.

        To say that a person is insulin sensitive means that the cells in the person’s body correctly respond to the insulin that is secreted by the pancreas, ie the cells are sensitive to the hormone insulin. Insulin sensitivity is associated with optimal glucose control and metabolic health.

        On the other hand, to say that a person is insulin resistant means that the cells in the person’s body do not respond effectively to the hormone insulin. More insulin resistance means a larger bolus of insulin is required to obtain a cellular response to insulin. Insulin resistance plays a major role in the development of metabolic syndrome, pre-diabetes and type II diabetes.

        In most cases, obesity is associated with pathology insulin resistance. In a small subset of the population, obesity is not associated with insulin resistance and pathology. Which category a person falls into has to do with fat carrying capacity and the number of adipocytes in the body.

        Paradoxically, having a small number of adipocytes makes a person vulnerable to pathology associated with obesity, whereas having a large number of adipocytes is protective of the pathology associated with obesity. Due to time and space constraints, I will not go into the reasons for this here.

        The gold standard test to determine whether a person is insulin sensitive or insulin resistant is the Kraft oral glucose tolerance test (OGTT). Has your brother had an OGTT? If not, given that you say he is obese, it is highly unlikely that anyone definitively knows whether he is insulin sensitive or insulin resistant

        1. Yves Smith Post author

          Sorry, I drafted in haste since I wrote this after having woken up with only 3 hours of sleep to get some posts up. And I do not draft comments as carefully as posts proper. I will correct the text.

          My brother has no signs of pre-diabetes, as in he is not insulin resistant. He gets a full bloodwork every year.

          The fault was in my drafting, and not in my brother’s condition. His doctors monitor him carefully for signs of diabetes or progression towards diabetes but he has none so far.

          This study confirms my brother’s status: “…but substantial numbers of overweight/obese individuals remain insulin-sensitive.” It appears your confidence that obesity must produce insulin resistance is misplaced.

          1. O.Lengai

            It appears your confidence that obesity must produce insulin resistance is misplaced.

            Nowhere did I claim or imply that obesity must produce or lead to insulin resistance. On the contrary, I specifically noted that:

            In most cases, obesity is associated with pathology [of] insulin resistance. In a small subset of the population, obesity is not associated with insulin resistance and pathology.

            My conclusion is in no way discordant with what Gerard Reaven actually wrote in his article that you (rather selectively) quote above:

            The more overweight/obese the person, the more likely they are to be insulin-resistant and at increased risk of cardiovascular disease, but substantial numbers of overweight/obese individuals remain insulin-sensitive, and not all insulin-resistant persons are obese. (emphasis added)

            Commonly offered blood tests like fasting blood glucose level and HbA1c provide rather poor proxy measures of insulin resistance. HOMA-IR approximates insulin resistance. To accurately determine an individual’s degree of insulin resistance requires a Kraft oral glucose tolerance test. This is a four hour procedure where the subject ingests 75g of glucose and has blood samples taken every half hour for three hours after that. Putting aside the question of whether insurance will cover it in the US, few doctors are familiar with or offer this test.

            That said, it is entirely possible that your brother falls into that minority of the population that has a high fat threshold, and are able to accumulate large amounts of adipose tissue without signs of insulin resistance. Generally, it is found that people of South and East Asian descent have a much lower fat threshold than people of African or European descent, in that signs of insulin resistance and metabolic disease manifest more rapidly in South and East Asian populations.

            1. Yves Smith Post author

              Sorry for jumping on you again.

              My brother was very fit and thin when he was young so this may have also been helpful. He’s only had the fasting test but hie readings have never been over 115 and are usually 100-110. He also does not have much of a taste for sweets. He might eat a dessert once a week and does not eat sugary breakfast bakeries, and he rarely eats prepared foods. So he’s not eating a high blood sugar-inducing diet out of his eating preferences.

      4. O.Lengai

        No, bodyfat tests are extremely problematic. They were done with water displacement studies using all of 8 corpses. “Standard” bodyfat tests regularly produce negative bodyfat measures in athletic black men.

        The reason these tests are ‘problematic’ is that they do not measure the proportion of body fat directly. Instead they measure proxy markers for body fat and then rely on numerical models or calculations to convert these markers to a number, which we then agree to interpret as a proximate measure of body fat composition.

        No test based on proxy markers can be accurate to within more than a few percent. This is why some athletic individuals with, say 5% body fat, may come up with negative reading – it does not mean that the test is completely worthless, just that the body fat percentage of the individual is lower than the sensitivity of the test that’s been used to estimate it.

        The current gold standard test of body composition is the DEXA scan which is considered one of the most accurate tests you could do to determine body fat and muscle distribution. Nobody (however athletic or white, black, or brown) would come out of a DEXA scan test with a negative fat reading.

        So if you want to know whether an individual has, say 3.25% body fat as opposed to 3.75% body fat, you should use a DEXA scan. Most of the population, who lie in the 15%-50% body fat range, do not require a test of such high sensitivity to estimate their adiposity.

        Finally, a body composition test based on proxy markers may not be completely worthless. For example, such a test may be useful in providing an indication of changes in body composition in a single individual over time. These tests are also cheaper, can be carried out at home, and do not involve the exposure to radiation that comes with a gold standard DEXA scan.

        1. Yves Smith Post author

          Sorry, you do not provide links and other sources strongly disagree with your assertions about DEXA. For instance:

          Like all other body fat estimation techniques, DEXA has numerous sources of error. There can be inconsistent results between different machines from different manufacturers, and even different results between machines from the same manufacturer. Software upgrades can change the algorithms that the device uses to calculate body composition. Different hardware and software configurations can result in different interpolations of soft tissue over bone, and different treatment of pixels of which a small portion is bone. The type of X-ray beam (fan beam or pencil beam) can also be a source of error; DEXA machines with fan beams can suffer from beam magnification (also known as parallax error). A final source of error is the same error that all 2-compartment models also have: the hydration of fat-free mass. In fact, a 5% variation in fat-free mass hydration can change your DEXA-determined body fat percentage by nearly 3%. This can be a problem when comparing different ethnicities or body types where fat-free mass hydration can vary. It can also be a problem when trying to measure change over time.

          DEXA vs. 4-Compartment Models

          A number of studies have compared DEXA to 4-compartment models. When looking at group averages, DEXA does pretty well, with errors of 1-2%. However, like with all other body fat testing techniques, individual error rates can be much higher. The error rates vary by what study you look at and which DEXA machine was used; error rates range from 4% in one study to up to 8-10% in another study. Also, the accuracy of DEXA can be affected by sex, size, fatness, and disease state of subjects.

          There are also issues when trying to use DEXA for tracking change over time. In one study, researchers wrapped lard around the legs of subjects to simulate weight gain. However, this changed the apparent bone mineral content, questioning the ability of DEXA to accurately assess body composition during weight change. In another study on bodybuilders, DEXA was reasonably accurate when looking at the group change in body fat percentage, but the individual error rate was as high as 4%. Thus, you could decrease your body fat percentage by 4% yet DEXA might show no change, or DEXA might show a 4% change when you didn’t really have a change. Another study showed DEXA to overestimate decreases in percent body fat, while it underestimated increases in percent body fat. In fact, the overestimations got as high as 5%. Finally, here’s a chart from a study that compared changes in body fat over time using DEXA to using a 4-compartment model.

          The X-axis of this chart shows the change in % body fat for DEXA, while the Y-axis shows the change for the 4-compartment model. You can see there was very little agreement between the methods. For example, one person showed an increase in body fat percentage by 5% with the 4-compartment model, but a decrease by 5% according to DEXA. Another person had nearly a 10% loss of body fat according to the 4-compartment model, but only a 3% decrease according to DEXA. These results question the reliability of DEXA for measuring change over time in individuals.

          DEXA: The Verdict

          Despite the fact that DEXA represents a 3-compartment model, its error rates are no better than hydrostatic weighing, and in some cases is worse. Like other techniques, DEXA does well when looking at group averages, but not so well when looking at individuals. Individual error rates tend to hover around 5%, although some studies have shown error rates as high as 10%. When looking at change over time in individuals, error rates have hovered around 5% in some research, although other research has indicated DEXA to perform much more poorly. For these reasons, I do not recommend DEXA for tracking change over time in individuals. If you do use DEXA for tracking change over time, I recommend very long time periods between measurements (a minimum of 3-6 months), as you will need a minimum of a 5% change in body fat to reliably detect a true change in body fat in most people.

          The original text has embedded links.

          As indicated in our text, hydrostatic weighing is much less accurate than the 10-site caliper approach.

          See also:

  3. SocalJimObjects

    Shouldn’t waist size be adjusted for height as well? A smaller person with a waist circumference of 40 inches might be more obese than a tall person with similar waist size?

    According to BMI, I was once obese and yet my waist measurement peaked at 37.

  4. Stephen

    I guess no single metric will ever be perfect and I see how BMI is far from that. Useful as a first order guide but then to be supplemented by other metrics and, presumably a proper examination by a physician. Which I think is what the article says. Although, increasingly as a society we seem to dislike physicians having discretion or judgment but prefer to create formulaic approaches for them to follow. I guess it reduces risk but it can mean less importance given to individual circumstances.

    Yves makes a very sensible point that we do not understand diet and nutrition very well. This feels correct. I linked late last night to a very long study that a commenter had suggested and it challenged my own prior beliefs that calories are the ultimate determinant. For example, although we are typically more obese today than in the past the article claimed that there is not so much evidence that proportionally more calories are being consumed systematically, nor that activity levels have fallen so much since the start of the last century. Not sure I fully buy that perspective but it was interesting.

    My own belief is that the mix of food that we eat today has an impact, particularly heavily processed food that turns to sugar rapidly in the bloodstream and creates an insulin burst leading to rapid storage. This has been borne out by my own experience of weight loss when I minimized processed carbs and substituted high fibre and high protein foods that make you feel fuller for longer and also satiate the body’s needs for nutrition.

    I stumbled on that particular approach rather than applying any specific intelligence but then I found the attached video by Giles Yeo that ex post rationalized it for me. However, he still argues I think that ultimately calories matter for weight gain or loss but they are just not the metric to target because the body may actually self regulate protein intake, irrespective of calories consumed. From what I read last night that view itself may not be definitive though. There may be additional effects on weight independent of calories consumed that we just do not understand.

    1. marieann

      Per packaged foods are mostly rubbish. I belong to a weight support group…most of us are overweight but we manage to keep from gaining…and that is a very hard thing today. We all find that the best way to loose or maintain is to eat meals made at home and stay away from restaurants. When we make our own meals we know the ingredients and the calorie counts of those ingredients….we also know the fat and carbohydrate counts of all the foods we eat.
      It should not be this hard to not gain weight….we are the same humans as the humans in the 1950’s and they were all skinny(by today’s standard) obesity was rare.
      The problem lies in the food we have to eat not in everyone turning into “greedy pigs”
      It costs me over $150/year to belong to this group…how did this become the new normal

      1. Stephen

        I agree. Historically, the growth of obesity in western countries seems very much to track the growth of pre packaged / ultra processed food. Correlation does not provide proof, of course, but it is indicative.

    2. O.Lengai

      My own belief is that the mix of food that we eat today has an impact, particularly heavily processed food that turns to sugar rapidly in the bloodstream and creates an insulin burst leading to rapid storage. This has been borne out by my own experience of weight loss when I minimized processed carbs and substituted high fibre and high protein foods that make you feel fuller for longer and also satiate the body’s needs for nutrition.

      You are correct about sugar and foods that convert to sugar in the digestive tract leading to spikes in blood insulin levels. Generally, and especially when compared to carbohydrates, protein does not elicit a large insulin response. However, the body cannot store excess dietary amino acids and one way it disposes of these is through conversion to glucose, a process called gluconeogenisis. In this way protein can elevate blood sugar levels.

      The macro-nutrient with the lowest insulin response is fat. It most probably follows from this observation that one way for us to maintain low insulin levels, and to maintain insulin sensitivity, is to consume a of our calories from fat than from protein (let alone carbohydrates and sugar).

      To anyone who understands that hyperinsulinaemia and insulin resistance are key factors in the development the metabolic syndrome and associated pathologies, it comes as no surprise that the 70 year demonisation of dietary fat, and particularly saturated fat, by the PMC has been followed by an explosion in metabolic syndrome, obesity, pre-diabetes and diabetes. Witness the explosion in these conditions since the McGovern Commission issued its report in 1977.

  5. KLG

    “A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.”

    Summarized here for 1.4M individuals of one “racial” group. I had a student who graduated in the top-10 in his class at West Point. He was a power lifter who could also run 6-minute miles for as long as he wanted. His BMI was in the “obese” range.

  6. Polar Socialist

    I’ve dabbled a lot in data curating on a medical research, and it has always been “common sense” among all the involved that BMI was just a convenient way to quickly classify a large cohort of people to check for any correlation. And then go deeper, if that superficial analysis gave any reason to.
    Nowadays the research seems to have moved towards more personal, and people are using way more nuanced models to understand their data.

    1. digi_owl

      Yeah, i think BMI was first and foremost used as a GP shorthand for seeing if it was worth taking a more detailed look or not. But then social media and the teen mags got hold of it, and off to the races it once again went.

  7. digi_owl

    One reason the field is such a mess is that Big Snack (food it ain’t) has conspired to hide blame, much like Big Oil and climate change.

    Thus we have spent decades fretting about fat, while starch (sugar, white bread, etc etc etc) have gone below the radar.

    Thing is that if you poke at human biology and what plants etc produce, we find that the human body is really more adapted to processing fat than processing starch. This for example in how it can turn fat into sugar to maintain brain activity, something that in more recent years have turned into another fad diet.

    But here is the rub, i don’t think it is either or. It is that when you have a diet rich on both fat and starch, that is when things go awry. As that allows the body to direct the starch directly to the brain, while fat is set aside for potential lean times.

    Sorry, had this thing nagging at the back of my brain for a while.

    1. Objective Ace

      It’s not even fat per se that causes things to go awry (See the French Paradox), It’s specifically fat from processed foods (or arguably the processed foods themselves) as OL alludes too. I recommend Max Lugavere’s Genius Foods books if anyone is looking for a super thorough dive into the matter

  8. PlutoniumKun

    A colleague of mine was once advised by his doctor that he had a common medical condition whereby his bellybutton had become excessively detached from proximity to his spine. His prescription was for an hours walk every day and to cut down his beer consumption.

    I think that about as useful a rule of thumb as any is whether or not you need a mirror to clearly see your belt buckle.

    Incidentally, on the statement in the article that Asian people are more prone to diabetes, my understanding is that its the opposite – Europeans (something to do with gene relating to lactose tolerance) are abnormally resistant to the impact of excess glucose in their system, but as most research was in the US/Europe it became assumed that Europeans were the ‘default’. It’s a while ago, but I recall hearing an interview with an endocrinologist who predicted major health problems in Asia and Africa over the coming decades due to the adoption of a more western (or specifically American) influenced diet.

  9. Lexx

    I went looking for a now very old 60 Minutes episode (didn’t find) where they covered the question of whether BMI was a useful measure of health. One of the people they talked with was a man who had been told he was obese according to his BMI, but he was also by every other measure very healthy and rigorously athletic. He was just built barrel-chested and stocky with very muscular legs. The conclusion was that BMI was one measure and not a very good one. I thought the question had been answered and the science had moved on to something better, but we all know that’s not how things work where there’s money to be made.

    Yesterday I walked into CVS to buy a blood glucose meter and test strips because I wanted better carbohydrate tolerance numbers. I had placed myself on a high protein, low carb diet but I was just guessing that 60 mg. a day would result in slow weight loss and I wanted to hedge my bet. It’s a common ballpark figure. Winter and Christmas goodies were coming up. I wanted to know precisely how many grams of carbs my body could handle, and I knew that the guy who is usually behind the counter is a diabetic and could recommend the meter he preferred, which he graciously did… it’s just that he forget to offer me a lancet device, so I’ll be driving back to get it today*.

    On Monday I’ll get up and take the first reading, eat a “carb rich breakfast”, wait an hour and take the second reading, and an hour after that take the third. All will be recorded in a journal. I’m convinced that my problem is carbs, what has probably been a mild lifelong poor ability to burn them, and it’s getting worse with age. And that the only way to definitively determine what best works for me is by tracking my blood glucose. I’m not considered a diabetic but I will be without a course correction. Diabetes on both sides of the family, especially my mother’s, and a few hypoglycemics. Also I’m tall with a tendency to wear a lot of black (mostly out of fashion laziness) and that hides a weight problem because of distribution. So I don’t look fat, but I am and worse, I’ve felt a little sicker every year. Really wasn’t looking forward to winter.

    There is a more definitive way of testing; it has to be medically administered and it is miserable; that’s the bottle of glucose a day tests. Every morning reporting to a lab and basically doing what I’m about to do but under the watch of nurses to make sure you don’t leave and don’t sneak any food or drink. Yes, the patient’s honesty is being questioned and they want to be sure of the numbers. Yes, I’ve done this once and it’s disgusting tasting; you have to drink down every drop. Better to gather numbers on my own; I trust me.

    There are no useful blanket theories about weight that cover every individual, every ethnicity, every body type; there are only individual numbers and customized solutions.

    I’ve been listening to this doctor on youtube for a while. Her channel goes back years on the subjects of diabetes, weight loss, and eating high protein and low carb.

  10. polar donkey

    I exercise regularly. I’m 5’10”, around 190 lbs. Waste is 33″. My BMI usually in 26-27 range. I notice if my weight drops to 185 or lower my blood pressure is very good. Over 190 it gets worse. Weight changes depending on exercise doing. If I’m not lifting weights as often, I drop weight quickly. When I lift weights, it jumps back to 190 quickly. I don’t think BMI is very accurate measure of health. I’m 48 years old, take no prescription drugs. Been regularly exercising for 25 years. No soda, no alcohol, no smoking, but I do like sweets. Being healthy and mobile later in life is a big goal for me. To reach that goal, you have to exercise. The earlier you start the better. The one thing I wish I would have known more is proper weight lifting technique. Lower back took too much abuse from me. Now I lift much smarter and my back is a 100x better.

  11. BadRobot

    I just look in a full length mirror after or before my shower. It’s pretty obvious if one is carrying some extra fat.

  12. Mikerw0

    BMI is a farce. A while back my doctor used it to tell me he thought I needed to lose weight. Maybe about 10 or so pounds. He never asked a single question about my diet, which is rich in diverse vegetables, fruit, beans and lentils (we’re vegetarians), or how I exercise. Not a single lifestyle question. I am lucky, I have careful about managing my mass my entire adult life, I strength train p and I’m an avid endurance cyclist into my 60s. I told him I have been this way for decades and it is too cheap to say lose weight without telling me how.

    I got a new doctor.

    1. Oh

      Good you changed doctors. From your description (i.e. vegetarian, strength training and biking) I don’t know why weight should be a factor. You’re doing well IMHO. Many doctors dont know about diet nor exercise and only parrot what they read.

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