On BMI and Rules vs. Guidelines

Reader Samantha dropped me an e-mail asking about my opinions of BMI. She is the 35-year-old mother of a 5-month-old infant, recently went in for a check-up, and was told that she was overweight based on the current BMI scale. Her own feelings about what constituted a healthy weight for her body were shattered when she was informed that she needed to be 20 pounds lighter than her own typical weight in order to fall within the “normal” range. And she was frustrated.

I can completely relate to her frustration. Over the past two years, I’ve been having all sorts of digestive and reproductive health problems. None of the docs have had any idea what was up, despite round after round of tests. At some point in there – about a year ago, I think – a blood test came back that had me right on the border of being pre-diabetic. Still nowhere close to being actually diabetic, and that test turned out to be an anomaly. Yet I was told that I should probably lose five pounds to kick me back into the “normal” BMI range. It was all I could do not to laugh in the doc’s face. Really? REALLY? I’m not diabetic, there’s no possible link between my health problems and my weight, I’m five pounds over “normal,” and you’re still gonna harp on BMI right now?

Now before I really dig into this post, a few caveats. I’m not a doctor, as you all know. I’ve studied human physiology very briefly, but have no experience in the health services or medical professions. Everything contained within this post represents my set of opinions which are based on my personal observations and readings. I don’t know everything about this topic and don’t claim to, but I’ve had experience with it on a very personal level and have formed views accordingly. Samantha asked for my views, and once I began writing my response to her I realized that the topic was worth bringing to this forum. My hope, as always, is to generate a lively, varied, respectful discussion – NOT to assert myself as a weight, health, BMI, or public policy expert. Got it? OK, moving on.

I do not think that BMI is a nefarious tool of purest evil. There ARE preventable health problems linked to obesity and I understand how a physician might deem it important and necessary to keep patients mindful of weight. On a daily basis, doctors are faced with hundreds of health problems that aren’t preventable, and I think they may harp on obesity because they feel it’s important to practice preventative medicine whenever they can. Also, broken as it is, BMI is one of the only tools we have that provides parameters for understanding when overall weight may begin to impact other areas of bodily function. The idea of having rough guidelines for healthy weight makes some sense to me, especially if those guidelines have been backed up by broad, deep research, and leave room for individual variation.

But in my experience – as supported by my anecdote above – BMI is treated more as a rule than a guideline. Doctors see you’re over a certain number and it’s a done deal: You need to change. I’m sure much of that is related to the high volume of patients that medical doctors are forced to help, how HMOs are organized and run, and other factors that make medical providers feel totally boxed-in. But it’s still harmful and infuriating to the patients. To tell the 35-year-old mother of a 5-month-old to get cracking on that weight loss seems utterly laughable to me. To tell a woman who is five pounds over the magic limit that shaving off a few will cure what ails her seems downright preposterous to me.

BMI is supposed to be more informative and tailored that straight weight, but I’m not sure it truly is. Cross-referencing height and weight gives a bit more information, but it’s still not enough for real insight. Certainly not enough to merit application of a broad, health-related label to a highly unique human being. In my (albeit layperson) opinion, no group of impersonal numbers will give the complete picture of an individual’s health. Not the way an in-depth conversation will.

Do I have a solution? No. I imagine that reexamining the way BMI is calculated to include factors like activity level, fat percentage, bone density, and other key influencers would help somewhat. So would training docs to really TALK with patients about their lifestyles, choices, and overall health before slapping weight-related labels upon them or advising dietary changes. (Which would mean lightening doctor workloads, a potentially impossible demand.) But I really don’t know if either of those would create actual helpful, influential, effective guidelines for linking weight and health, or just circle back to being oppressive, exclusive, rigid, shaming rules.

My understanding is that BMI is a set of guidelines designed to give a rough idea of when your weight may begin to negatively impact your overall health. But like all guidelines, there will be loads of personal variation. Loads. And that’s the piece of the puzzle that ends up missing in a lot of doctor-patient discussions of weight and health.

That’s my opinion anyway. What are your thoughts on BMI as a measure of health? If you think it provides an incomplete picture, how would you change it? Do you think such standards should be abandoned altogether, or do they provide some beneficial structure when implemented as loose guidelines instead of strict rules? I’d really like to hear from some of the medical pros that I KNOW are reading, since your perspective on this matter may shed some light on the benefits of the BMI system that those of us who feel frustrated may not know about.

Image courtesy Beating Down the Dashboard.

  • http://catspajamas-dogstuxedos.blogspot.com/ coffeeaddict

    You must be joking?! The doctor told you you were overweight? Has he counted in the fact that you exercise more than an average person and that the extra weight might actually be muscle tissue which is heavier and not body fat which is lighter?
    BMI is just an approximation, meant to give you a general idea which end of the spectrum you are. Seriously, let’s stop looking at number and see the bigger picture, huh?

  • cora

    Like you said, it’s a tool to measure certain aspects of your health. And I refuse to make a tool into a goal. I keep an eye on it, just to be sure, but my pants can also tell me when my physique (and more often, my psyche) needs some tweaking or more TLC.
    Numbers cannot define you, but your lifestyle can.

  • http://zonkered.net Amanda

    I think as a rough guideline, BMI is useful. It’s not perfect. It doesn’t take in effect that healthy people with a lot of muscle (Arnold Schwarzenegger is apparently morbidly obese) will weigh more while being healthy, and it doesn’t take into effect a lot of other things you’ve already mentioned. The problem is when people treat it as the be-all, end-all measure of health. It’s not that.

    I started Weight Watchers two months ago and should hopefully be at a 20 lbs lost at this week’s meeting. My high BMI before I started was one of the reasons, but in the scheme of things a far less important one than a desire to feel better, look better in my clothes, and be more confident in myself.

  • morfydd

    I don’t have a problem with the idea of the BMI, but the guidelines seem so low as to be misleading.

    In my case: At one point I got dumped, couldn’t eat, and started obsessively exercising. I dropped to a size 4 that was all muscle, and was really way too thin, but according to the charts I was overweight. My response, which I think was healthy, was to say the charts were stupid. My *unhealthy* response was to then continue saying the charts were stupid as I started gaining weight again, until one day I turned around and realized, “hey, I’m actually fat! When did that happen?”

    If BMI hadn’t been so laughably off-base at the low end, I think I would have paid attention to it as my weight was creeping up again, and it would have been useful for me.

  • http://www.befabulousdaily.us Cynthia

    Everything that I’ve read indicates that BMI only correlates closely with health problems when you get over a BMI of 35 or so. Below that, you plot other health indicators vs. BMI and you basically get a giant scatter with no obvious correlation. Same is true of waist size and other quick-fix diagnostics that are so popular. Bloodwork indicators, on the other hand, correlate much more closely with actual health problems. So BMI? Whatevs, unless you’re really big and even then it’s not a perfect correlation by any means.

    Hell, up until 1993 when the diet industry lobbied the CDC to change the BMI definitions, a BMI up to 27 was normal! So in 1992 at my current weight, I was “normal”, in 2011 I am “overweight”. I exercise daily (sometimes twice, but one of those is just a walk) and my blood tests (blood pressure, sugar, cholesterol etc) were so good last year that my new doc wouldn’t even repeat them this year (so sad about the loss of my good former doc). So she went from telling me that my bloodwork was so good that she wasn’t even going to bother to recheck me, to telling me that my BMI was in the “overweight” zone (by about 10 pounds) at which time I filled her in on my history as a long-term major weight loss maintainer and politely told her to stuff it. I’m giving her one more chance, and if she pulls BMI out again at this year’s checkup (or refuses to test my thyroid, which I’m wondering about lately) she’s fired.

  • Bobbini

    The most important thing to remember about BMI is that it was developed as a measure of populations–not individuals. So applying the BMI cut-off points (which moved down in 1998, by the way) to an individual is not useful. Measuring an individual’s health, as you said, is much more complicated.

    • http://www.alreadypretty.com Sal

      I had no idea that BMI was formulated to discuss trends among populations!

      • Courtney Landes

        The BMI formula was developed by a Belgian mathematician between 1830-1850. It was based primarily on a population of soldiers. I consider its modern use as an individual health measure to be junk science. There are several studies over the past few years showing that it is not a reliable indicator of health risks, but the damned thing just won’t die.

        If a doctor wants to talk to me about the health implications of my body fat percentage, my blood lipid levels, or even my waist-to-hip ratio, no problem. As soon as they start harping on BMI, I quit listening.

        • http://cheapandchicinchicago.blogspot.com/ Piper Alexander

          I remember reading that it was created to be used for health insurance pricing.

          Weight is not an indicator of health, and therefore, neither is BMI. Pretty much the only issues directly related to obesity are issues with joints related to carrying extra weight. One can be healthy, i.e. exercise/clean eating, and still be “overweight”, just like one can be unhealthy and have a “normal” BMI.

      • http://corpgoth.blogspot.com/ Trystan

        Yep, there’s a ton of info about how the BMI was developed on Wikipedia – http://en.wikipedia.org/wiki/Body_mass_index

        Tho’ my fave. analysis is here – http://www.maa.org/devlin/devlin_05_09.html

        BMI was created for broad population statistics, not individual weight & health. The specific point determining “overweight” & “obese” has changed over time too. But it’s become shorthand for doctors & an easy way for them to not have to actually talk to people about weight issues.

    • http://clg1213.blogspot.com cheryl

      Just what I came to mention. I think it is helpful to keep this in mind when considering how much to worry about it. I’m more muscular than normal so I consider that when looking at it. My BF is a very in shape military guy and winds up quite high thanks to a ton of muscle.

      I wouldn’t say to ignore it, but just use it as one element in evaluating your health and goals.

    • rb

      Yes, saying everyone should fit into the BMI is the same as saying every person will live to be age 78, just because that’s the average. There is no accounting for variation when you use a single point of reference.

  • http://georgescastle.tumblr.com Satchirel

    Yes, I agree BMI really is everything but the optimal measure for health… though very easily accessible. Only because someone has a BMI of lets say 30 doesn’t mean he’s any more unhealthy than someone with BMI 20 and who smokes all day long and drinks alcohol… just with the difference that for the first case you’re being most likely partially ostracized from society while in the latter you count as “cool”…

  • Kat

    I have had bad experiences with BMI – I find when I do a lot of exercise I build up more muscle mass and it tips me over from one classification to another, whereas when I’m more sedentary I seem to go back down, even though my clothes feel tighter and I feel less healthy. So when I exercise more, I get more lectures from doctors and told to watch my weight or else they might take my birth control away (despite the fact that I’m still not anywhere near the recommended limits, BMI-wise.) I don’t know if this is just my doctors, but it’s infuriating that when I try to take care of myself and all my other vitals (blood pressure etc) are good, I get nagged because of this one number that doesn’t seem to correlate that well to my health at all!

  • Veronica

    I have personally never had any doctor tell me I ‘need’ to lose weight, never been referenced/implied either. My sil told me that her doctor told her she was obese and needed to lose weight. She probably did but to flat out tell her like that I found offensive. I think that doctors have lost (if they ever had it) their bedside manner. How many doctors really even know their patients?

  • http://www.befabulousdaily.us Cynthia

    Also, BMI was never designed to be a health indicator. It’s a population statistic invented, some 200 years ago to generally describe the size characteristics of human populations. To apply it to individuals as an indicator or a rule is an example of the “ecological fallacy”, see this recent article by Pattie Thomas about causation, correlation, etc in health studies:

    http://www.psychologytoday.com/blog/i-take-space/201107/lesson-in-cause-and-effect

    Divisions along the BMI scale are completely arbitrary and made by policy-making bodies often with the influence of diet and pharma lobbyists. I wouldn’t take it even as seriously as a measure of health as you have here, but that’s just my take from what I’ve read. Get your bloodwork done (if you have insurance, natch) and take those numbers seriously, by all means.

    There have been some great studies recently suggesting that regular exercise will affect your bloodwork indicators positively even if you don’t lose any weight, so — do some activity you enjoy and don’t worry about BMI (unless your weight isn’t stable, if you’re experiencing rapid gain or loss that is something to worry about).

    • Miss T

      Even blood work “normal ranges” are based on population studies. EVERYTHING, all the tests, weight, BMI, etc. have to be evaluated together. That’s what practicing medicine is: the ability to evaluate and interpret the big picture. Over the past 20 years or so, there’s been this push for all of us to “take responsibility for our own health” and this obsession with test numbers, BMI, etc. taken out of context by lay people is the result. Sure, we can all see that a number is out of the range of normal, but unless we’ve been to medical school, we don’t necessarily know what the clinical significance of that lab abnormality or BMI number is for ourselves and our overall health and personal risk factors. I also think that doctors may be overly eager to tell people to lose weight when it IS just 5 or 10 pounds to lose because making the necessary lifestyle changes early, in order to lose a SMALL amount of weight, is a lot easier than when the harmful lifestyle changes have been in effect for years and it’s 30 pounds or more to lose — then it’s REALLY hard to effect any change at all. In my own personal experience, I’ve never been told to lose weight by the doctor, though I have expressed to the doctor that I’d LIKE to lose a few pounds. Turned out that my cholesterol was very high at the same time, and her response was that if I deal with the cholesterol issue through diet/exercise, the pounds OF FAT will take care of themselves. On a slightly unrelated tangent, years ago at work (I work in clinical research) someone at a meeting about a drug that affected metabolism, someone passed around a plastic model of a pound of fat. It was HUGE! Seeing “fat” out of context like that (i.e., not hidden under skin, not ephemized as “curves”) was vaguely shocking and really hit home for me in terms of needing to stop thinking of losing weight as a lower number on the scale, but as losing FAT, regardless of what the scale says.

  • Hetty

    BMI is ok. But I would’t worry about 5 pounds, either way. BMI doesn’t account for a lot of stuff. Like the fact that I am overly blessed, much like Christina Hendricks from Mad Men. BMI will never take into account that weight. That being said I do pay attention to my BMI score because I am obese and do have weight related health problems. But no matter how much I lose I will never be able to lose the extra weight from “The Girls”. BMI is a flawed tool. But it is a nice general guideline.

    As a side note, I’ve lost 10 pounds in the last 2 weeks after over a decade of staying the same weight!

  • Heather

    While right now, I am beyond overweight and looking to fix it, I have always been heavy for my size. In my younger days I had to be measured to pass my military fitness exams becuase I was too heavy despite my measurements falling way within the parameters for someone of a healthy weight. BMI is the most popular gauge of a persons “healthy weight” but it’s not right for everyone.

  • Rhiannon

    Great post – I think that your point on how BMI is often used as a rule, not a guideline, is something that people need to be aware of. Especially since the science behind BMI is sketchy at best.

    Other measurements that are just as easily calculated, especially body fat % and waist-to-hip ratios, are far more indicative of overall health, and are far more suitable and tangible tools for preventative medicine.

  • http://www.modalcorpus.blogspot.com Natalie

    BMI is something that I am quite outspoken about – and let me also preface this by saying I am not a doctor or a medical professional of any kind, but I am a statistician and a student of development.

    To paraphrase this article:
    http://the-f-word.org/blog/index.php/2009/07/22/the-history-of-bmi-and-why-we-still-use-it/

    BMI was never ever intended for use as a measurement of body fat and is in fact fairly useless as such. It was originally designed as a way of measuring the proportions of the human body, and when applied to weight ranges, designed to be used at a population level as a measure of development.

    So I steadfastly ignore it. As long as my clothes fit, I can run up the stairs at work, walk up a collossal hill without getting out of breath and I eat healthily, I say yah boo sucks to anything that tells me that in order to be healthy I must look skeletal (because that is how I look at my so called healthy weight).

  • http://iwonderandiwander.wordpress.com Kris

    I feel very lucky that my doc has never suggested that I lose weight. I am definitely in the overweight category by BMI, but my blood pressure, cholesterol, and such are all good. She does ask about healthy behavior, like nutrition and exercise, but not once has she suggested that I should lose weight. That said, my BMI number gives me pause now and then. I have come to grips with the fact that I will never be thin (partly due to my build and partly from my own priorities), but knowing that I don’t exercise as much as I feel I should paired with my BMI, makes me want to make some changes.

    • Dee

      I can relate to all of these comments. My Doctor, while he means well, pissed me off at my last visit. Yes, I am overweight but I had lost 15 lbs (with weight watchers) and had kept it off since the last visit (6 months previous). Instead of giving me any praise for keeping the weight off he went on and on about what could I do to lose more weight. I was nearly in tears and am prepared for next visit to tell him “Look, I know I am overweight and what I should do to get healthier, just drop it!!” I suppse its their job to tell us but we KNOW we are overweight and how we got there! I am glad to hear that BMI numbers are not the “be all and end all”.

  • http://enbouton.blogspot.com Frankincensy

    I’m not going to make any general comments on BMI, but when thinking about my own weight I prefer to define “healthy” based on actual indicators of health (mood, energy levels, blood pressure, heart rate, sleep patterns, nutritional status, and so on). I would much rather pursue a weight that is genuinely healthy *for me* than use the BMI as a guide. This doesn’t translate as “I ignore whatever my doctor tells me about my weight”, more like “if my doctor told me I was iron-deficient and had dangerously low blood pressure, I would be a lot more concerned than if she just told me I had an underweight BMI”.

    To look at it from another perspective, my body seems to be programmed to stay thin no matter what I eat or how active I am. No doctor has ever told me to eat less or exercise more, and it took me a fairly long time to realise that my eating and exercise habits were probably impacting my health anyway. These days I do try to eat and exercise with my health in mind, not for weight control but because I just feel better that way.

  • Anonymous

    I am 11 pounds over “average” BMI, yet I have 25% body fat. No matter what I try, I only seem to keep the same BMI, but go down in body fat. For instance, when I started exercising, I was 11 lbs over BMI and was 41% body fat. I exercise HEAVILY at least 8 hours a week, mixing the appropriate amount of cardio and strength training, and resting one day a week. I also eat less than 1500 calories a day, with a carefully measured portion of lean meats and green veggies.

  • http://elegantmusings.com Casey

    Wow… Loving all the comments! I basically stopped paying attention to BMI years ago when I realized that all my exercising made me seem closer to the high end–due simply to my muscle mass! (I exercise fairly often and tend to focus on toning and building lean muscle.) I really am a firm believer that doctors need to simply ask their patients a few more questions about exercise habits, diet, etc. for the yearly checkup, rather than rely fully on “averages” like the BMI charts. I’ve been going to a military clinic for the past three years, and perhaps this is just indicative of the Air Force medical clinic (haven’t been to ones on any other non-AF bases), and they always ask basic questions about that–every time I go in.

    I agree with the commenter who said that blood work should be used more often as an indication of any real health problems. My dad is considered very overweight, yet works out (even more than I do!), eats incredibly healthily, and has amazing blood work results. Which always gives his doctor fits because judging by my dad’s weight and appearance, he shouldn’t be that healthy. Just goes to show you that judging a book by it’s cover–in any situation–can be wrong. I understand there is a problem with people being unhealthy in this country, but at the same time I can’t help but wonder if we’re making people more neurotic and prone to unhealthy lifestyles (yo-yo dieting, eating disorders, etc.) by just slapping the BMI “you’re overweight!” label on them without digging deeper…

    Just my two cents!

  • T.

    Interesting discussion. I don’t have anything to add to the BMI comments, but I will say that within the first year of giving birth to my first child, my doctor told me that my ideal weight would be the one I had when I was a teenager. I was shocked. Not only did his doctor have no idea what I weighed as a teenager, but also, I thought it was very irresponsible to tell a woman in her 30s who had recently given birth that her ideal weight was the one she had in her teens. So I can relate to your readers feelings! In my experience, the first year after childbirth is a time of tremendous body changes (especially if you are breastfeeding). In my opinion, if BMI was the only health concern Samantha’s doctor harped on, she can safely ignore him/her for now.

  • http://modernmrsdarcy.com Anne @ Modern Mrs Darcy

    I have no professional experience here, just a hobby nutritionist and fitness junkie.

    I don’t think BMI is a great diagnostic tool, by any means. It speaks to averages, and I think it’s dangerous to tell one specific person they need to lose weight (20 pounds is a lot of weight, too!) based on her BMI.

    I’m tempted to equivocate a little because I’ve read that denial is a major problem for many very overweight people–maybe BMI could be helpful here? But just maybe.

    BMI is used because it’s easy. But for myself, I pay much more attention to how I feel in general, and I have my body fat checked every couple of months. (And that’s only because I’m trying to improve my body composition after my own baby.)

  • http://Midwesternmodernmomma.blogspot.com Jen

    Wow. I guess I am blessed to have the doctor I have. Our family physician has talked to me about weight, but in a more wholistic way. She has approached my health as a long-term goal and has been helpful in finding me options to loose weight when needed, and when it has crept back up has never scolded me once. She is the family doctor for my MIL & FIL as well, so knows my husband’s family medical history quite well. Her work with me, my spouse, and our son has always been to mitigate what could possibly be in our health futures, and never to scold or critique our bodies. In fact, I don’t know if she has even mentioned BMI to us before. Honestly, (and this is just my opinion, not researched medical fact) I think that if you eat healthy foods, are active and feel healthy you shouldn’t worry about it. We have way too many stressors in our life to beat ourselves up over as it is!

  • Donna C.

    You know, I love your blog more every single day. I’m so happy when you address thought-provoking topics like this one, because I am interested to hear what others say. Right now, I am a high-BMI plus-sized woman. However, to get within what is considered “normal” for my height, the charts say I have to get back to the weight I was in high school – 35 years ago! There’s no way I would even want to go back to that weight, and not a chance I could maintain it for more than a day! I know in my head what is a reasonable, and most importantly, maintainable weight for me, but I also know my doctor will not agree.

  • http://www.tenaciouslyyours.com Kat

    Ah, BMI. What a favorite frenemy of mine.

    I think BMI is “good” in the most general of terms. As you illustrated, it’s an 11/10 way for physicians and individuals to identify when weight could possibly begin to impair bodily functions and overall health.

    That being said, as a vetran of being perenially “overweight” according to the BMI charts (despite the fact that I’m 5’5″, weigh ~150 lbs, run 40 miles a week and wear a size six), I think that an overall assessment of body composition (water-fat-muscle) is more effective and accurate. Obviously an individual who carries more fat than muscle or vice versa is going to encounter a different picture of health.

    Thank you for opening up this discussion – reading the other comments on this one has been truly fascinating!

  • Jill

    I’m with Natalie above. There are just too many factors to consider when calculating BMI. My trainer’s BMI qualifies him as “obese” and I can count his ab muscles. I also have a friend who runs marathons and is technically overweight by BMI standards. While I do have some padding and am well endowed, I am also a weight lifter, so my numbers are extremely skewed as well- I can’t rely on BMI or the scale for progress.

    The only numbers I take seriously go along with Blood Sugar, cholesterol, and triglycerides.

  • http://twobirdsboutique.blogspot.com/ two birds

    i was just discussing this the other day with a coworker. there are so many factors that can make these numbers misleading. for instance, a friend of mine is shorter than average, but he lifts weights like crazy, ergo, his weight is higher. therefore his bmi is very high…very misleading. i think if it’s done with the forceps or the water tank, it’s much more clear…however, it still shouldn’t be a deciding factor for many health decisions. great post!

  • Sara

    I’m at the unhealthiest point in my life with a body fat percentage pushing a third – and I fall within the normal BMI weight range. Whilst my triathlete best friend is within is considered overweight according to her BMI. BMI is such a generalized scale that it is practically useless due to the great differences of body make up.

  • http://nikkilevenduski@yahoo.com Nikki

    My son was 9 lbs 6 oz when he was born. As an infant and toddler he was in the 98-99th percentile for his weight and off the charts for his length/height. Now he is a perfectly healthy little boy. He eats well (it is not uncommon for him to ask for seconds of salad or go straight to the garden and pick some peas for a snack). He is very active (karate, baseball, football, plus swimming, jumping on the trampoline and wrestling with his friends). But every year I get a letter from the school that says his BMI is in the 95th percentile and that puts him at risk for future problems related to obesity. I used to get angry. Now I just ignore it – the school nurse is mandated by the gov’t to use BMI to alert parents that there may be a problem. BMI is fine when used as a starting point, but we all need to look past it to get a true vision of whether there is a problem or not.

    • Annie

      I think that this is one of the biggest problems with BMI. Because it is designed for whole populations it is very good at telling us that, for example, in the US there is an obesity issue. But it is not a reliable measure for individuals. I know that we also have issues in general with body image and eating disorders. I have friends whose petite kindergartner brought home her BMI from school and asked her mom if she was fat! I have a problem with that. As a general rule, 5 year olds should not be worrying about being fat!

  • http://www.theneverythingchanged.com Heather

    As others have mentioned, BMI is being used in a way that it wasn’t designed for. There are other measurement systems, my personal favorite (a am not a clinican of any sort) is the waist-to-hip.

    http://www.livestrong.com/article/113959-alternatives-bmi/ – is about a variety of different messurements

    http://www.msnbc.msn.com/id/14483512/ns/health-fitness/t/bye-bye-bmi-tape-may-measure-obesity-better/ – is about waist-to-hip.

    • Andrea

      I too think the waist-to-hip ratio is a good measure (when used in combination with other metrics).

      I do have a complaint though about how rigidly it is sometimes used: I was recently being poked, prodded and tested in order to acquire life insurance, and one of the measurements was the waist measurement. The nurse insisted that the guidelines stated the waist MUST be measured at the level of one’s belly button. I explained to her that I am very long-waisted (I’m 5’10″ with a loooonnng body) and my natural waist is actually about two inches above my belly button (this is very clear if you look at my body and note that my belly button is at a place on my body that is clearly below the flare of my hips). But no, she insisted that the rules were rules and she had to measure my “waist” at my belly button (even though that is most certainly my hips). This meant that the measurement was actually 3 inches larger than my actual waist. While it was still considered within the “healthy” range for a waist measurement, I’m still infuriated that it was not a measurement of my waist at all! It just seems so…ridiculous.

      I think this is yet another example of the medical profession bastardizing evidence-based research, and trying to widely apply rules without taking into consideration that we aren’t all made from the same mold!

  • Miss T
  • Katharine

    My thoughts on BMI are mostly unprintable, but “dangerous” and “junk science” and “tool of the weight-loss snake-oil industry” would be a start.

    I also give you this. http://everydaypaleo.com/2011/06/22/attention-scale-addicts-part-2/

    • Laurinda

      That is a great link, amazing how different the same 155 lbs weight can look.

  • http://www.stumbleintostyle.blogspot.com EvaNadine

    BMI measurement is a single tool — one of MANY that should be used in conjunction with one another, not a tool to b used alone. No single tool or measurement is able to give you the whole story.

    I remember a few years ago, when my company offered a “Get Fit” program. In order to join, we were all required to get a physical from our doctor, including bloodwork. They wanted to be sure we were healthy enough to participate. The last requirement for participation was having the company official measure your BMI. One of my coworkers, who is *insanely* healthy and in shape was placed in the “obese” category, according to his BMI. Why? Because he is covered, head to toe, in huge, solid, bulging muscles. As muscle weighs more than fat, his weight placed him in the “obese” category, though the man is far from it. Had he used only the BMI measurement as his guideline, he would have actually declined in his health and fitness.

  • Mary

    Hi Sal,
    I am a registered nurse and do have a professional health background. Recently we had a wellness assessment done at work by a health center attached to world renown teaching hospital. I was in the normal range for my BMI but I was off the charts for my body fat content. WTH??? I eat healthy…avoid fast food and while I could step up the exercise, I am by no means a couch potato. What am I…a bag of bone full of fat? Those tests are tools and can be motivators, but we can’t use the results to feel bad about ourselves. The point is to feel healthier and as long as we work towards that goal, the BMI is just a number.

  • http://hal.cyondays.com Loren

    I am not a doctor, nutritionist or even a frequent exerciser. But I’ve always fallen into the ‘healthy’ BMI category for my height and I know plenty of ladies who fall in the ‘obese’ category that could out run/out cycle/out yoga me any day of the week. Our bodies are not all built the same I don’t think it’s fair to put us all onto the same chart.
    The BMI wouldn’t be so bad if there wasn’t ALWAYS a chart hanging right next to the scale in every doctors office I’ve ever been in.

  • Diana

    I agree with you that BMI provides a very incomplete picture of one’s overall health as it correlates to weight. Like you, I read as slightly overweight on the BMI scale, but I think I am perfectly healthy. There’s not much evidence, however, that being anything but “obese” on the BMI scale really correlates to any health problems, and again, everyone’s body is different and everyone’s body has a different ideal weight.

    I do not own a scale; I know that I am the analretentive type who would obsess over the number on the scale every day, so I avoid the temptation. I feel basically the same way about BMI – since it’s so easily quantifiable yet still has some perceived medical or scientific cache, however overstated that may be, I think a lot of women obsess over it just as much as about weight. I guess what I am trying to say is that since BMI is an easily quantifiable number, both doctors and patients find it easy to rely on without digging deeper.

    As an aside, I think if a doctor behaves like your reader’s doctor did, it’s time to find a new doctor, one that will take into account the needs of the individual patient.

  • http://departmentofcolor.blogspot.com Ms. M

    I think your doctor is being lazy and practicing “cookbook medicine”. He/she is probably an expert in something, but I don’t see any evidence of expertise in healthy weight ratios.

    Having said that, I don’t think most people need an expert to tell them when it’s time to lose a few pounds (or a lot of pounds, for that matter). I know when I’m overweight. When I’m overweight or out of shape, I see unwanted bulges and I feel heavy and tire easily.

    If I had an eating disorder, I might not be able to see that. But then again, eating disorders are not that hard to spot either. And the people who are qualified to treat them are experts in that field– not some hurried or lazy family doctor who relies excessively on numbers.

  • http://www.thebombshellmanifesto.blogspot.com Lindsey Niles (@lindseyniles)

    Great, great post. As someone who’s dealt with an eating disorder, the BMI alternatively terrifies me and entertains me. The way people act about it is ridiculous. It’s so great to see someone who’s in the public eye (or, well, the blogger public, which is way better, IMO) to not be so concerned, and to be able to take a step back and see the big picture. You’re really inspiring and I’m definitely going to be coming back. Thank you for this post.

    The Bombshell Manifesto

  • http://notdeadyetstyle.blogspot.com/ Patti @ NotDeadYet Style

    Great article, Sal. I had a discussion with my doc about BMI and she said: it’s just one of many metrics she looks at, specifically a *change* in one direction or another, over a period of time. It’s certainly incomplete on its own.

    Have a great Tuesday, eat something wonderful!

  • Maggie May

    I would note that many people here are complaining that their doctors mention they need to lose weight. I think many doctors never did this at all and there is now a shift to viewing being overweight as an independent risk factor for health problems. Sure some people are overweight due to having high ratio of muscle to fat but…. um… I am thinking this is not the main reason people weigh more than the appropriate range for their height or build (whether you use BMI or other measures). I would prefer doctors say something to their patients rather than nothing. Bedside manners vary, of course, on this topic and all others. I would not expect any doctor to mention a 5 lb swing one way or another unless it represented a trend for the patient (in either direction).

  • Anonymous

    As far as I’m concerned, BMI stands for Bite Me Idiot when used by doctors trying to get folks to lose weight. I’m in the healthy category, but barely. As a size 4/small. Bah.

  • http://www.stylinstacy.com Stacy

    I can hardly believe your doctor told you to lose weight..you clearly don’t need to! BMI is just one indicator of a healthy weight range, and hopefully people don’t get too wrapped up in it. If you take care of yourself, eating healthy and exercising, then you should be able to know when you need to lose weight. I know for me, it doesn’t take many days of skipping exercising and overindulging for the weight to start reappearing. Oh how I long for the quick metabolism of my earlier years.

  • http://readinginskirts.wordpress.com Mia

    I see a lot of folks here talking about themselves and their friends who are healthy and fit people, and who end up on the obese side of the BMI scale. I have the opposite situation: I’m lazy and rarely exercise–I do try to eat a varied and healthy diet with little fast food, but could probably stand to amp things up–and my BMI has always floated within the healthy range. I feel like that sort of measurement encourages me to think, “oh, I’m in the healthy range, I must be healthy, everything’s fine, la la la,” which is so dangerous. I’m not that healthy, I’m really not; I know this from my own habits. So it’s definitely not great in that factor.

    • Rachel W.

      Same here. I’m fairly sedentary and don’t eat as well as I should, but I’ve always been within five pounds, either way, of the dead center of the ‘normal’ BMI range. I was 125 when I was working out three times a week in college. I was 120 when I was pale, unhappy, and living off of toast, coffee, and stress last year. I was 130 when I was sleeping endless amounts during bouts of wintertime depression. All of these keep me within the ‘normal’ range, but not all of those are at all healthy.

      I sometimes worry that because I have a ‘normal’ BMI, my physician isn’t asking me the questions they should be. I go to the doctor, have my weight taken, get congratulated on being ‘healthy,’ and that’s pretty much it for diagnostic questions about my well-being. My weight is ‘acceptable’ and I’m having my period, thus my health is obviously stable.

      Of course, my health is my responsibility (and I need to speak up for myself more), but I do wonder: if the numbers said I was over- or under-weight, would my doctor pay more attention to really asking me how I was doing?

      • Addie

        Unfortunately, it is more likely that the doctor would praise you for your “dramatic” weight loss if you were underweight on the BMI scale. I was 5’6″ and 110 lbs, which is around a 17 on the scale, and the doctor that I was seeing was extremely enthusiastic about my “fitness” despite the fact that my hair and fingernails were falling out. I was told at that appointment that my eating disorder was nothing to worry about because I looked so good.

        It took several initial visits with doctors who couldn’t understand what the problem was before I got one who paid attention and went into treatment.

  • Laurinda

    The real risk for heart disease is related to HDL and blood triglyceride (fat) levels. Keep your HDL high, blood trigs low, and don’t worry so much about BMI.
    http://www.yourmedicaldetective.com/public/523.cfm

  • http://www.kitchencountereconomics.com Toby Wollin

    Whoa. ‘Lose 5 pounds and you win the golden ticket’? I get a bit testy on this sort of thing because for years (like close to 20), I was told year after year after year that my thyroid was ‘low normal’. And I had all sorts of problems with weight, my periods, that creepy crawly feeling and so on. And even after I told my practitioner about my mom, who had all sorts of ‘low normal thyroid/runaway cholesterol and high blood pressure’ issues that went unresolved until someone finally took a look at dealt with her ‘low normal thyroid’, nothing got done about that. Until – until I could no longer sleep at night and would fall asleep at my desk (not too dangerous) and at the wheel of my car (major whoa). The hormone thing is really funky and delicate and at first they thought I was in perimenopause but finally did a full thyroid panel and found out that basically my thyroid had gone off the rails, which was causing my pituitary gland to go into ‘danger, danger Will Robinson’ territory. But all those years, because they looked at my test number and looked at the chart, it was all ‘low normal’. In the end, it all comes down to ‘how do YOU feel?” Do you feel good? Do you get good sleep? Is your digestive system working well? Do you get plenty of veggies and fruit? Any tingly feelings? Do you feel strong? Can you take a long walk or bike ride or carry bags of groceries up the stairs and still feel good? I gauge everything on whether or not I feel good. Five pounds either way is not going to make this huge difference (even on the waistband test) if you don’t feel good. It will, however, take your practitioner off the hook at having to really look at you in a 360 degree way. They can check that box off the list and go on their merry way.

  • http://www.roobeedoo.blogspot.com Roobeedoo

    I recently took part in an EU-funded study of workplace stress and eating behaviours, and as part of it I had to have my weight and body fat measured as well as keeping an infinitely-detailed food diary, wearing an activity monitor, and noting my mood every hour of the day. The upshot was that I am borderline underweight, just scraping into the “normal” BMI range, with very low levels of abdominal fat… and yet they said I was eating three times as much as I should be for my activity level! If I took the “3 times too much food” message to heart, I believe I would be in serious (anorexic) trouble as I am really pretty thin. I do agree that I would benefit from taking more exercise, for the sake of health and fitness, but how easy it would be to take the wrong message from these numbers! What’s that quote about “Lies, damned lies and statistics”?!
    By the way…you look pretty fine from here! Maybe some gentle exercise would be of benefit but don’t go crash-dieting – that’s a sure way to end up with messed up blood sugars!

  • Lain

    Ooohh, this topic gets my blood boiling. A little history that may not seem relevant… Five years ago, I had a very bad injury. Initial visit to an orthopedic surgeon said nothing was broken, pulled, etc. However, three months later, I was still in near constant pain. I spent a year practically bedridden. I was overweight to begin with – the pain and lack of movement, put me at 250 pounds, at 5’5”. I went to 10 different specialists over a year and was diagnosed with a multitude of problems – including a rare form of arthritis that required infusions to treat. I kept insisting the injury was the cause and no one would listen. Someone suggested I visit my PCP and try to see if he could sort through the multitude of random diagnoses.

    He told me I was fat. And it was all in my head. And “if I just lost 20 pounds” I would not hurt any more. He also suggested a low carb diet. I bawled on the way home from that visit. (incidentally, he also suggested a low carb diet to my underweight husband who went in for an ingrown toenail about a week later – we dumped him immediately and reported him to our insurance).

    Thankfully, I tried one more doctor and found out it was a dislocated SI joint! Three months of physical therapy later and I was fine! Then, I lost 70 pounds! I’ve been stuck at 180 for the last 2 years, but I am now 28% body fat, down from 31% last year. My new PCP does not lecture me about still being over my BMI.

    • rb

      I’m so sorry about your injury. I have an unstable SI joint which resulted in SI issues each time I was pregnant (not the more common sciatica) and it was excruciating! At one point my OB suggested I use a walker. It was only my vanity that prevented me from doing so. I’m glad you’re feeling better.

  • http://www.roobeedoo.blogspot.com Roobeedoo

    Oh no! I just read an earlier comment about you exercising more than most – please scrub my comment about you maybe benefitting from gentle exercise! You are in fact doing everything I am not! LOL

    • http://www.alreadypretty.com Sal

      I appreciate it. I generally do four to seven hours of cardio, an hour of weights, and an hour of stretching every week. And no doctor has ever asked me about my exercise regimen in any discussion of weight or BMI.

  • http://cohabitatingcloset.blogspot.com/ Anne

    Seriously, YOU need to lose weight? You look great, and I can’t think 5 pounds really makes much of a difference.

    I do agree with your point about doctors needing to spend a little more time with patients on this. I had a gynecologist who would, basically, tell me I’m fat in my yearly check-up, tell me to lose weight, and leave it at that because she was so overbooked. Meanwhile, my PCP doctor, who has the time, would go over BMI with me, but also talk about my eating and exercising habits. This conversation usually happens when we go over my yearly physical results, including blood tests, which say that I’m completely healthy, despite being overweight. My sugar is under control, my cholesterol is in a healthy range, and my blood pressure is normal, despite a family history of problems in all of these areas. Yes, I would like to lose weight so that I can stay healthy and not develop problems that I probably have a predisposition for, but it’s not as black and white as some doctors make it. Having a higher BMI doesn’t always mean that you’re unhealthy.

  • tagatha
    • Maven

      Oh good, I was coming over here to post that link.

  • Samantha

    Two months (and the loss of 4 or 5 more pounds) later, I’m still angry about this, but I think the reasons why have changed. Mostly, I have worked really hard for the last 10 years or so to have a healthy attitude about my body. I’m short, curvy, and muscular. I exercise at least 3-5 times a week, and while I do like “bad for me” food, I typically eat a fairly healthy, semi-vegetarian diet. What destroyed me was the off-hand way in which my doctor, after hearing all of this, and doing a physical to determine that I was, in fact, healthy (she said as much), then went on to say “Oh, but your BMI range isn’t so great.” It was as though the entire 20-30 minutes previous had not happened. I have never paid attention to BMI, preferring, as someone said already, to pay attention to how I feel and how my clothes fit. But when a medical professional negates that, it’s really confusing and upsetting.

    I’m eating and working out in the way I feel to be appropriate to my lifestyle, and I would be thrilled to lose 10-15 lbs. (I think 20 would be too much) if it means that I am fitter and healthier. But it’s the blind adherence to a number without taking into account the human being that still steams me.

    Thanks for the post, Sal! It’s good to hear what other people think about this.

    • http://www.alreadypretty.com Sal

      You bet, lady. I’m still furious on your behalf.

  • Andrea

    Thank you for this great post! As women we can get far too hung up on the number on the scale, as well as the (sometimes unwarranted) negative feedback we get from healthcare professionals. If you are honest with yourself, you know if you’re healthy or not. And BMI, frankly, is a bit of a crock.

    It seems so ridiculous to me to look at BMI in isolation and not take other factors, such as lipid levels, blood pressure and body composition into consideration.

    I am at the very upper-end of a “normal” BMI, but as someone who works out five times a week, eats a largely organic, vegetarian diet and does not partake in sugar or refined flour, I would laugh in a doctor’s face if he/she tried to tell me I as unhealthy based solely on the BMI factor.

  • Rachel

    A few years ago I had some problems with my back. When it finally started to affect my ability to care for my child I went to the Dr. to get help. Being a nurse I kind of figure what kinds of tests I would be under going but was surprised when the dr. spent less than 5 mins with me said she couldn’t find any reason I would be having back pain and suggested that the issue might be from my ‘large breasts’ and that I should consider losing weight and/or getting a breast reduction.
    2 years later and a knee injury I was back at the dr’s(different one) trying to figure out what was going on. Come to find out I actually have a genetic problem that makes my joints hyper flexable and prone to injury and I need to be very careful when working our or engaging in strenuous activity as I could dislocate a joint fairly easily.
    My pain had absolutely nothing to do with my weight, despite what everyone had been trying to tell me.

  • http://createdforhisglory5.blogspot.com/ peggy

    BMI Categories:

    Underweight = <18.5
    Normal weight = 18.5–24.9
    Overweight = 25–29.9
    Obesity = BMI of 30 or greater

    I am 20.4.. but what does that mean really? Is that weight healthy (muscle) weight or is it flab? How does a calculator know the difference?

    • Samantha

      Ooh. That is a really good point.

      Incidentally, mine is, and has been for years, 25. So at the bottom of the scale anyway.

  • Aziraphale

    I’m not sure how useful BMI measurements are. As several people have indicated, BMI only correlates with health problems once you get above a certain number (35?), but it seems to me that if your BMI is that very high, it should be patently obvious that you need to lose some weight, should it not?

    It seems to me that we should pay less attention to body shape and more attention to healthy behaviours. For example, I used to run with a woman who was naturally plump. She ate healthy food, rarely indulging in junk, and exercised regularly. She wasn’t a smoker or a heavy drinker. Her skin glowed, her hair was shiny, and overall she LOOKED a picture of health. It really bugged her that she was heavy, but I thought she looked great. Clearly she was meant to be that shape, and although she had more body fat than me, I’ve no doubt she was healthier.

  • Kristina

    My understanding is that BMI is just a basic tool that’s easy for people to figure out because height and weight are easily accessible facts. Fat percentage calculations involve either a specialized “scale” with questionable accuracy, or the skilled use of calipers or a special water tank. But a doctor also has her eyes and hands, which for a trained person are fairly good diagnostic devices, too.

    Personally, I appreciate a physician who’s willing to deliver blunt, but constructive advice regarding my health. My doctor is a good one for nagging me at an appointment for a sprained ankle about routine tests and vaccinations I haven’t scheduled yet (even for my kids!), etc. Usually, I end up taking care of scheduling those before I leave her office. If I were clinically obese, I expect she would be on my case for that, and as someone charged with overseeing my general health, I don’t think it would be ethical for her to do otherwise.

  • Ariana

    BMI as a diagnostic tool is fairly irrelevant, doctors that are interested in meaningful data related to metabolism use a waist/hip ratio and blood glucose tests. You can be overweight and healthy, but in general if your waist hip ratio is unhealthy (which can occur within a “normal” weight range) it indicates at minimum cortisol issues which can lead to a host of other potentially serious health conditions. You can be quite overweight and still have a good waist/hip ratio, healthy blood work, and normal glucose results.

    The focus should be on relevant data that can suggest a disease or pre-disease state not on a number that provides little real information. The focus on BMI is not helpful for anyone, the patient or the provider. I am not a doctor but am in the health care field and working towards becoming a PA.

  • Jessica, RN, BSN

    BMI as a measure of health is totally inadequate.
    BMI as related to increasing risk of health problems is statistically supported.
    However. Obviously there are many situations in which your (or my, or my husband’s or your next door neighbor’s) “overweight” category BMI is grossly misleading.
    If you have an ideal blood pressure, lipid levels, resting heart rate, a moderate level of stress, good coping skills and support system in place, if you avoid tobacco, and you get some activity every day and eat your fruits, veggies, whole grains and lean protein, then an overweight BMI really tells you nothing except that there are people who are your height who weigh less than you. That does not make them happier or healthier. It does not make them prettier or more capable or more stylish. And it certainly doesn’t make them more likely to get a job or be in a better relationship.
    If you’ve got all that, really, who cares if your BMI is technically overweight?

  • http://mrsdragon.net MrsDragon

    I hate BMI, it’s junk science. Giving people something to quantify so that they can feel like they have a guidepost. I like quantifiable metrics more than the average bear, so I get this, I do, but it’s pretty much meaningless. For my height, the “normal” weight range is something like 125-155 lbs. In highschool, I weighed 155lbs. I’ve been up and down over the years, getting up to 170, and most recently back down to 145. I love this weight–I feel better, fit into clothes better, etc. But I’m still out of shape and still not exercising and despite the fact that my BMI is now “better”, I’m not any healthier.

  • Halo

    If any of you get a chance to have a DEXA scan (I participated in a research study and got one free), you should. It’s really interesting to see an actual calculation of both bone density and body mass broken into muscle and fat.

    I’m technically obese by BMI, but my DEXA revealed an off-the-charts dense skeleton and a lot higher muscle-to-fat ratio than my doctors predicted. My primary care doctor was shocked. Like many obese/overweight people, my blood pressure, cholesterol and triglycerides, hemaglobin A1C/blood sugar, etc. are all perfectly normal, and I’d been getting lectures about how that’s only because I’m still young.

    I definitely need to lose more weight, particularly because I’m apple-shaped and the health problems associated with extra abdominal fat take time to manifest. But it’s good to know that my health is better than most doctors would assume, and I can just continue my exercise and incremental weight loss and feel positive about it.

  • http://dhoogbruin.com Diana

    Last March I went to the doctor for a terrible upper respiratory infection. This particular virus was so bad that it landed my (“normal” BMI) roommate in the hospital with double pneumonia but I (“obese” BMI) escaped with some mucinex and codeine and two weeks of rest. The entirety of my visit was spent discussing my eating habits and exercise habits even though I had lost my voice and speaking made me cough so much my chest rattled and my eyes would stream tears. I also had a fever of 103 when they checked me in. I was told I needed to eat less and move more. On my paperwork, my diagnosis was “Obese BMI” followed by a list of weight loss resources and then on a second page there were three lines “URI” followed by my two prescriptions.

    When discussion of or concern about a patient’s BMI takes the focus away from a patient’s well-being as a whole person then it’s a problem, and In my experience it is currently an enormous problem in the medical community.

    I have a fab new doctor and I lodged a complaint but not everyone is in the position to do either of those things and they honestly shouldn’t have to.

  • Kate K

    Oh BMI. *sigh* I’m well versed in it from my days on Weight Watchers. Last year, I was stuck at the same old weight–it had been months since I had lost. I was about 10 lbs above my healthy BMI weight (as a 5’10″ woman) so I just had to keep trying and struggling and stressing. I was running and working on weight training and I was really feeling good about my body. But, according to WW, that wasn’t enough. So I kept trying and failing. Finally, I became desperate so I was trying to lose weight in really unhealthy ways. It was a scary time and I remember thinking that this one little number can’t be the end all be all of how I see myself.

    So, I quit Weight Watchers and here I sit, at about 15 lbs over my healthy BMI rate. On paper, I’m overweight. However, I can also run 2 miles without stopping, my diet is more balanced than it ever was, I have a much better body image and I’m not stressed. *That* is so much more important than a number.

    (Sidenote: Weight Watchers isn’t a bad company. It helped me understand food and nutrition and portion control and it helped me safely lose about 35 pounds. Ultimately though, I had to decide how long it could help me.)

  • Holly

    I propose a new evaluation criteria. It’s a simple rule that your belly should not hold your shirt out farther than your chest. It easily takes in the fact that some women are more shapely, and some are more muscular. There are some studies that point to women’s belly weight is more heath-affecting than legs and behinds. So it works with that trend too. Plus you can evaluate yourself, so it is cheap. Obviously does not apply to those in pregnancy or post pregnancy. And works for guys too as they should have less belly to maintain health than women.

    • Miss T

      I think you are really on to something there! Yes, it is belly fat that’s dangerous.

  • Leah

    http://en.wikipedia.org/wiki/Body_mass_index

    I bring to your attention this passage in the BMI wikipedia entry:
    “BMI has become controversial because many people, including physicians, have come to rely on its apparent numerical authority for medical diagnosis, but that was never the BMI’s purpose; it is meant to be used as a simple means of classifying sedentary (physically inactive) individuals with an average body composition.”

    BMI is not a medical test. It is a statistical one. I think a better marker of health would be to ask someone if they exercise till they break a sweat at least 3 times a week. Also the slew of other markers that doctors ask about are probably more useful at predicting disease than BMI. Family history? Sugar intake? Tobacco? Alcohol? I can’t fathom how BMI became the authoritative marker of future illness and disease – perhaps our need to put a number on something as nebulous as good health.

    A doctor would probably see my BMI and tell me the same thing as you. I’d laugh at them and drop to the ground and do 50 pushups right there, just to prove a point.

  • Jennifer

    I have to totally agree about the bmi being a guideline, one that we can sometimes throw out the window. Being a petite Asian woman, I’ve always fallen under the ‘normal’ bmi – according to that scale, I should gain 15 lbs, in spite of being very happy with my weight where it is!

  • Victoria

    You toggled what used to be a hot button for me: BMI vs reality vs a doctor’s assumption. Then I realized that doctor’s run down a check list. That was followed by learning that the checklist is created by committee. (with all that committee work implies – science is not as important as doctor-patient politics.)

    Here’s a little PSA, a person’s genetic history says more about whether someone will have hypertension (high blood pressure), diabetes and various other weight related illnesses than a person’s actual weight. I know this because I have instances of hypertension, diabetes, cholesterol, and cancer on both sides of my family. For me, it’s not a question of if I”ll get one (or more) of the above, it’s when. The odds are against me.

    I’m a pretty proactive person. As part of my annual physical, I don’t rely on BMI. I make the doctor test for all of the weight related diseases via blood draw. I know for a fact that despite pushing 300 lbs, I’m healthy on all counts. My doctor has watched my weight go up and down in a 30 lb range, but my blood numbers do not change over time or much with my weight. (I’ve been getting annual blood test/physicals for the last 20 years so my baseline is pretty extensive.)

    As for the pre-diabetic…. a small change to your diet will go a lot to getting you back into the normal range without any weight loss. (any of the following work great: whole grains, fresh fruits/veggies, lean meats, less processed/pre-packaged foods, smaller portions of sweets, drinking more water) I speak from experience in watching my parents and siblings cope with these things. Adding 10 minutes of exertion to your day also helps if you’re mostly sedentary. That 10 minutes could be a quick walk, dancing to your favorite tunes, free weights while watching TV and so on. DIY yoga via the internet. No gym required. No workout tapes necessary.

    There are a ton of free web sites that address stuff like this, but really it all comes down to “eat well, and be physically active” …and ignore BMI. Researchers are now finding out that too low a BMI can be more harmful than a too high BMI.

    For the record, I’m trying to loose weight, but that’s only because I want to go sky diving and the harnesses have weight limits for personal safety. Otherwise, I wouldn’t bother.

  • http://aworkingmomscloset.blogspot.com Melissa

    Personally, I HATE the BMI measurement and I hate the weight measurement.

    I haven’t read through all the comments and I’m fairly certain someone else has probably pointed this out, but muscle weighs more than fat. Fat is what isn’t good for you. If the main consideration for the healthy range of BMI is weight, how on earth can that take into account whether that weight is from fat (bad) or muscle (good)? Someone might have a TON of muscle but their BMI would say that they need to lose weight. Would a doctor truly ask someone to lose muscle in order to have a lower BMI? That doesn’t seem like a healthy idea.

    I base my size on my fat percentage. If it goes up, then I need to lose weight. If my fat percentage is okay, then I really don’t care how much I weigh because the higher the weight is, the more muscle I have on me and I’m happy about that.

  • Cait

    Ugh, the BMI. Having the most basic background in medicine/health, physiology and statistics, I agree with what everyone else has said about it being a population metric and thus difficult to correlate with real individuals.

    When I was 18, I played high school rugby and was also on the school’s swim team, as well as teaching swimming and skiing lessons on weekends. Thus, I was exercising quite a bit and my family doctor told me that my BMI fell in the “yellow” range (on the verge of being overweight). The bottom line is that for athletes, who tend to have compact, muscular bodies, the BMI is a relatively useless indication because it doesn’t differentiate between muscle and fat. A good doctor should a). understand the difference between weight from muscle and weight from fat and b). be able to combine the results of several different tests to get the full picture of their patient.

  • http://www.dailyjohaiku.blogspot.com Daily Jo Haiku

    What a timely topic. I was just at the doctor’s office today and we were discussing this very issue.

    Despite being an athlete who just completed her first marathon, I, too, am 5 lbs outside of my “normal” BMI category, ranking me in the “overweight” category. The doctor, however, thinks it’s ridiculous. BMI is based on a certain idealized body type. People who have an atheltic body type (i.e., put on muscle quickly, wider, thicker bone structure) are unfairy penalized under the BMI scale. The BMI one of many different measurements of health, just like your cholesterol, your body fat percentage, and so forth, So if your other determinants are OK or good, and only your BMI is off, you’re probably a healthy individual.

  • Becky

    A problem with BMI I haven’t seen anyone else mention yet is that the ratios assume people are two-dimensional; it essentially caculates a number that represents 2D area, not 3D volume. Which renders it an even more bogus measurement.

    This means that people who are on the ends of the bell curve in height are *even* more at risk of BMI info being completely meaningless for them. All other things being equal (muscularity, frame size, etc. – which obviously is untrue) a short person will skew toward smaller BMI numbers (“underweight” when they aren’t) and a tall person will skew toward larger BMI numbers (“overweight” when they aren’t).

    As others have mentioned, BMI is only useful on a population scale. For individuals, it’s meaningless. I think that a doctor can get a better idea of whether a person’s weight level is healthy or unhealthy by spending five minutes talking with them about their habits, and history, and how they feel in general than they would get from this ridiculous number.

    Count me among those whose BMI falls smack in the “normal” range but because I’m sedentary and I have a small frame, I know I should be exercising more to convert my fat into muscle mass. Regardless of the fact that doing so might make me “overweight.”

  • http://corpgoth.blogspot.com/ Trystan

    Ah yes, the magical BMI number. The one time I dieted & got down to the “healthy” BMI for my height, I looked like a lollipop — my head appeared too big for my body. Ugly! And it was entirely impossible to maintain for more than a few months. That was a terrible experiment & screwed up my metabolism for years.

    There are so many other measurements, as readers have pointed out, that give more specific, relevant, & accurate definitions of health when taken together. I may be considered overweight, but my cholesterol levels are pretty dang good, for example!

  • http://n/a vampfan30

    I have no clue what my BMI is, but according to all of the things that I have seen, I should be 20 pounds heavier to qualify as a “normal” weight. If I was 20 pounds heavier, I would look & feel like total crap. I am 4 ft.10 & very small boned, if I followed basically ANY of their guide lines, I would be miserable.

    The best guideline that I can follow is how I feel on a day to day basis, not what my scale says or some fat counter thing or BMI measurements. If I eat good & take care of myself, I feel right & that is more important to me than any number – on the scale, on a fat counter, or on the label of my jeans.

  • http://www.meganmaedaily.com/ Megan Mae

    I’ve been “underweight” according to BMI for most of my whole life. I’m still borderline even after gaining 15 lbs. BMI doesn’t account for muscle mass, bone or body structure or even how you carry the weight (better on bum than belly in terms of “health”). I think it’s a crock to put everyone inside of parameters that do not reflect the individual at all.

  • http://www.geekthreads.blogspot.com Audi

    Great post, and great comments! I think BMI is one tool among many that each individual can use to assess his or her overall health; it should by no means be used in the black and white way that some physicians apply it. As a few people have mentioned, BMI is based on statistical averages and does not apply the same way to each individual within the population. The biggest flaw with the measure is that it doesn’t take fat percentage into account, so people with high muscle mass can end up in the overweight or even obese range. Health can’t be defined solely by numbers; it needs to be assessed holistically.

  • Lady Harriet

    I had a bad experience with being told to lose weight at my last doctor visit. Mostly due to scheduling difficulties, I hadn’t had a physical in about 3 1/2 years. (I’d been away at college in another state, and the last doctor I’d seen was a pediatrician, so I hadn’t gotten around to picking a new one yet.) I’m 5′ 4″ and while in college had lost ~40 lbs, going from about 235 to 195. I was seeing a physician’s assistant, since the appointment was easier to make and I’m not planning to stay in this area long-term, so finding a new doctor didn’t make sense. I expected that she would at least be pleased at my weight loss, considering that people are expected to gain weight in college, rather than lose it. I realize that I’m still overweight, but all I got was a request to lose more weight. She looked at my chart and said “Well, you were 160 once, you should go back to that.” When I weighed 160 I was twelve years old and two inches shorter than I am currently. I tried to convince her of this, so she finally relented and told me I ought to at least be at 180. This really didn’t inspire me to lose more weight.

    Despite being overweight, my cholesterol and blood sugar are fine, and my blood pressure is on the low end of normal. My father is skinny, but has a whole host of health problems (high blood pressure, heart disease, diabetes, &c.). Fortunately, I take after my mother who is overweight (more so than I am) but much healthier overall. I realize that I do need to lose more weight, but I eat healthily and get at least a moderate amount of exercise. (I could probably do with more.)

    In the past, a previous doctor sent me to a nutritionist because she assumed that since I was an overweight teenager I must be eating badly. The nutritionist was very nice and knowledgeable, and determined that I was in fact eating well, but the original assumption by my doctor upset me.

  • ismay

    The point of BMI being a tool population-wide, and not meaningful as a single data point for a single individual is important. I would also look at it as a measure of trend. If your BMI is increasing, and its already higher than recommended, its probably not a good thing.

    I think it is helpful to think of it as one of many points on a spectrum of health indicators. If fitness and blood levels of key things (LDL, HDL, glucose, others) are great, I would not be concerned about a modestly high BMI (unless it is drifting further upward). But if several aspects including BMI are elevated, and functional fitness is also poor (how far you can run, walk, how much you can lift), I would consider making some changes and working toward a broadly considered goal of better health (not just lower BMI).

    Weight is a relative thing. 20 lb above upper BMI guideline may be reason for concern on someone 5 feet tall, but a relatively minor difference on someone 6 foot tall.

    There are even some health studies that being “overweight” (NOT obese) is associated with (not causality, as with all epi studies) longer life than being “normal” weight!

    For me, being tall, quite fit, of average build, BMI correlates quite well with whether I feel a bit overweight or OK. But I am happy with my appearance at the upper range of “normal” BMI (say 23-25) and look skinny if I get much lower than that, even though that would still be well within normal…

  • Kylara7

    BMI was intended as a population measure, a way to track the overall obesity trends in large groups of people rather than a definitive health quantifier for any one individual in that population. If a couple of people in the large group are carrying too much weight, that doesn’t skew the BMI of the entire population too much; likewise the underweight folks, because there is allegedly a much bigger group of people who are in between the two extremes. However, if the national (or state or regional) BMI is growing over time (trend tracking), then there may be something going on in the entire population.

    I agree that BMI can be counterproductive for individual folks and doesn’t take into account body composition or amount of body fat vs. muscle. Heavily-muscled athletes, for instance, may have “overweight” to “obese” level BMIs simply because they weigh a lot more for their height. Likewise, a very sedentary person with a lot of body fat but not a lot of muscle might have a BMI in the normal range but is not healthy.

  • http://nosignposts.blogspot.com The Waves

    Great post, Sal, and greetings from the other side of the BMI discussion. When I was applying for a green card, my doctor in Finland actually had to explain to the US authorities in my medical paperwork why my BMI was too low, why I wasn’t “normal” – even if all of my tests came back as good as can be, and even though I was in good health in every way. He ended up writing down “genetic disposition”. The whole thing seemed rather Kafka-esque to me.

    I agree with many other commentators who have said that it seems stupid that our health can supposedly be judged on the basis of one number. What we are missing in Western medicine is the ability to see a human being as a complex whole.

  • http://www.justatitch.com Amy — Just A Titch

    I’m overweight but even when I’m healthy, I weigh considerably more because I’m a muscular person. BMI doesn’t take that into consideration.

    The good news is that (hopefully) soon, doctors should be using a new way to measure things called the BAI: http://www.huffingtonpost.com/2011/03/04/new-obesity-scale-_n_831416.html

  • nsv

    Sal, I have to compliment you on gathering the nicest, most respectful and courteous bunch of people around to comment on your blog – especially on such a contentious topic. There have been a couple of voices among them from the size acceptance community, but if you want to see some very interesting ongoing posts on bmi and all things related, go to Psychology Today’s series – see http://www.psychologytoday.com/blog/brave-girl-eating/201107/health-not-weight-shifting-the-conversation.

    As a very fat woman, I alert my doctors that I want them to tell me when my weight is responsible for a specific problem I’m having or about to have, but not to indulge in general fear-mongering or stigmatizing. (Well, I say it in a nicer way…) I am quite aware that I am fat, having been in my body and this culture my whole life, and I don’t need my doctor to repeat what everyone else is saying; if it were a problem that was easy to solve, believe me, I would have solved it by now. I don’t let my doctors weigh me either – if my weight goes up or down, I’ll tell them, because that can be a symptom of something serious. Being responsible for my health means that I work together with my doctor to figure out what’s best for me. I interview doctors before I hire them, because I have very little money and sometimes no health insurance, so I prefer to make the investment up front to get someone who’s a good fit for me. This is a lot of work and privilege plays no small part of it. But part of having pride in yourself is doing what YOU think is best for you, after doing your research and considering your lived experience. Health care is a lot like fashion choices, in that way. ;-)

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  • http://ribcagefiligree.tumblr.com Ryann S.

    Hahah! Those are my feet! And my scale!

    • http://www.alreadypretty.com Sal

      Ryann! YAY! I nabbed your photo from We Heart It – I’ll change the link to your Tumblr!

      • http://ribcagefiligree.tumblr.com Ryann S.

        The photograph has ended up all over the place! It’s been absolutely crazy to see it spread around!

  • Jen F

    While you’re right, it’s just a number, would you prefer that your doctor says something at 5 pounds over or never says anything and you find yourself overweight having to lose a lot more weight to be healthy. I knew I wasn’t thin but I shunned the scale for a long time in grad school only to find myself 35 pounds heavier than when I started. The doctor never said a word to me.

  • Katy Cooper

    When I was more seriously overweight and my doctor brought it up, she brought it up in the gentlest way possible, mentioning that she was concerned because it was going up year to year. I know it was gentle because I’m very sensitive about it, and I didn’t get that upset. (Mentioning what my weight was, just the statement of the number, could upset me; I’m not kidding when I say I’m very sensitive.) I don’t think she’s ever mentioned BMI–she tends to focus on my cholesterol and blood sugar. I managed to lose a lot of weight and then gained some of it back. It’s stabilized at the new weight, and she hasn’t mentioned it.

    There were days when I wished I could get down to my lowest weight, but I realized recently that in order to do that, I would have to give up my writing–watching my intake that closely takes a lot of focus. I’m not willing to cut back on my writing in order to lose 20 lbs. when I’m healthy where I am. I told my doctor that, and she agreed.

  • Lydia

    Today my doctor read a letter from a doctor that saw me as a teenager (while he was checking some records), and he read that as a teen I needed more exercise, and was ‘flabby.’ I was shocked, because as a teen, I was considered scrawny by most — though I recall I did wear really baggy clothes because I was shy. I felt really upset for a long time after my appointment today, because though I am sure this doctor meant well at the time, it brought back all the issues of being a teenager, and hiding my self behind clothes, though my gym class bmi rating was considered fine. How come the doctor didn’t notice I was shy, and hiding behind clothes?

    Today, I exercise way more than I ever did as a youth, and though I weigh more than I did over 17 years ago, I eat and am healthier than I was before.

    I am at the point where I am much more outspoken with healthcare proffessionals than I was in the past because it seems as though they just blurt out reccomendations without asking questions. I stand my ground, and calmly though firmly ‘fight back’ with doctors (when I am not too shocked to respond). I learned this lesson the hard way, when my husband was in emergency and then in hospital for an extended stay — he is better now, but I learned that doctors are so used to their pedestals, they speak without thinking — a human failing at times, especially when they don’t realize how scared and worried patients can be. I am grateful for all doctors have done and know that without them we would be lost, but I have to remind them to retrieve their lost ‘bedside’ manners.

  • http://www.coxhomestead.org Amanda

    Just wanted to say that your doctor’s “five pounds” remark seems off-base. You don’t look like you need to lose any weight at all.

    As someone who also deals with chronic reproductive parts stuff (I’ve got endometriosis and have had extremely painful ovarian cysts in the past), my doctor told me as well that losing some weight and exercising more would help my condition. Admittedly, I’m not as firm as I could be and need to work out more to increase my strength and stamina but, at the same time, I’m 5′ 8″ and weigh 136 lbs!! I’m hardly at a weight which would exacerbate my conditions!

    A lot of great comments and interesting discussion. You’ve got sharp readers. :)

  • GingerR

    Sadly gaining weight during pregnancy is something I’m familar with. While the young mother might not feel like dieting while getting used to her new baby, after 5 months she’d probably lost as much weight as she was going to lose without effort after giving birth.

    If you don’t take it off it will increase. Then you have another baby and the extra 20 pounds turns into 40 pounds. We won’t talk about what happens with 3 children! Menopause is good for another 10 pounds. The cards are stacked against us.

    I think it may not be what she wants to hear, but it’s better to take it off when it’s just 20 pounds than to get 30 years down the road and have it be 100 pounds and have suffered health problems.

    My husband has high-end blood sugar and losing 10 pounds helped.

    • Samantha

      I absolutely appreciate what you said, as it was a big fear of mine upon deciding to get pregnant, but you’ve missed the point.

      At the time of that check-up, according to the doctor’s scale, I was 10 lbs away from being back at my pre-baby weight. The doctor asked about my diet (good), my exercise habits (I was an active athlete for 17 years, and I exercise at least three times a week, cardio, strength, and stretching), did all of the other usual physical things, and then said “Well, based on what I can see here, you’re healthy, but your BMI says that you are overweight. I’d like to run some tests (which were fine, by the way).” When I asked her what a good target weight for me would be, the number she gave me was 20-25 lbs. lighter than my pre-baby weight, at which I have been happy, healthy, and comfortable in my own skin for the past 3 or 4 years, after adopting a more healthy lifestyle post-college. It was literally as though she did her own diagnostics, and then negated them based on what the number told her, even though that number does not take into account my frame or my muscle, both of which are larger/more than average for my height.

      I absolutely have no intention of allowing baby weight to creep up on me; I took up running after my daughter was born, and I’m loving it. That’s not the issue. The issue that I’m an individual, and not a statistic.

  • http://cgherini@gmail.com CG

    this site is amazing. It’s illustrated pics of different BMIs. Shows you how stupid and unreliable this technology of measurement really is.

    http://www.flickr.com/photos/77367764@N00/sets/72157602199008819/

    • Glamdoc

      Perfect! Great link!

  • http://almostadultlife.blogspot.com Elizabeth

    What a great post, very sensible. It’s taken me a long time to get over the number on the scale and my BMI, which has never really reflected my healthiness, I think. Doctors and nutritionists always take a look at my BMI and say “Oh, you’re fine,” when I ask how to improve my diet and exercise habits. Actually, I just have a small frame, which makes BMI less accurate. As I understand it, the further you are from the average person, the less it applies to you. I can feel out-of-shape, have no energy, and see places that could shed a couple pounds, all while my BMI says I’m almost underweight, which I don’t think is quite right. Now I just measure my diet/exercise progress in terms of inches and how I feel; I hear your waist measurement is a useful tool as well.

  • Oddball

    You have digestive and menstrual problems and this doctor thinks losing 5 lbs is the solution? I know they’re human too, but that is the dumbest advice I have heard from the medical profession since “distilled water is bad for you”. Clean H2O is going to somehow leach minerals out of your body? Silly, as is the Body Mass Index, the Food Guide Pyramid and prescribing pills for restless legs syndrome. I would research your concerns for as long as you can unless you are in a lot of pain. Ovarian cysts, food allergies and drinking too little water could be all you need to check out. You know your own body better than anyone else.

  • Shaye

    For reasons that other people have already mentioned, I think BMI is total BS. I don’t care that “it works for some people,” and tool that has so many exceptions as a measure of health is worthless.

    In high school, my BMI would have been in the “overweight” range (or sometimes, the high side of normal). That’s also around the time my gym teacher pulled me aside and asked me, in all seriousness, if I was anorexic. (Okay, so her intervention skills could use some work.) I was totally confused because I weighed so much more than my classmates. But you know what? It was all in my hips and thighs. I look at pictures of myself now and realize that, without any particular effort on my part, the rest of me was practically skeletal.

    Now that I’m in my 30s, a “healthy” weight according to the BMI is totally unrealistic. I could never maintain that weight even if I could again achieve it. If I tried, I really would be starving myself.

    Look, I’m not gonna lie and say that I do a great job of maintaining an exercise routine, or that I couldn’t stand to lose weight. But I’m also not going to assume the sky is falling if I can’t, simply because some number that has never been right for me tells me so.

  • http://sidewalkchic.com joann, sidewalk chic

    Really interesting post, and one that opens up a lot of pent-up frustration for myself. I’ve recently been told by my doctor that my “ideal weight” is one that’s essentially my high school weight, which was 15-20lbs ago. What’s laughable about that is that when I was in high school, my pediatrician told me I needed to gain more weight in order to be healthy, and this was a time when I had a diet that could probably be considered disordered eating.

    I try to be healthy — I have a good balanced diet now and I try to keep active. I think BMI should just be guidelines at best — it’s just unfortunate that it can be strict in some cases with health insurance and other programs.

  • http://www.jenfordphotography.com Jen

    Wow. I an’t get over the fact that you were advised to lose 5 pounds!!! From WHERE? Ugh.

    From what I gather from your blog, you live a very healthy lifestyle. I think that’s way more important than BMI measurements.

    The last time I went for a physical, I was told by my doctor that I fit into the proper, if a little higher, BMI for my age/size/height whatever. I started running after that, and probably gained weight. I never bother to check that stuff, personally. The only things I can concern myself with are eating well and exercising. All within reason, all within moderation.

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  • Glamdoc

    Not much to say here that hasn´t been way more eloquently put by all of the commenters above. Lots of interesting viewpoints, and lots of valuable information I didn´t know! And how could I? Med school isn´t perfect, there´s no way one can learn all there is to know about the body in six years. You learn as you go, and you learn from your patients.

    Ms M – cookbook routine, nicely put! I´m honestly shocked that so many of you have had this sort of feedback from your gp. Maybe it´s the insurance issue, maybe your US docs have to take classes, I dunno. But I know that I, for one, don´t apply the BMI scale that anally. I find that it´s a good tool, but it´s only a guideline, and the whole being must be taken into consideration. If you´re at a high BMI but have a perfect blood pressure, statistically you ARE at risk for developing higher blood pressure later on (and cardiac disease, diabetes, stroke, etc), and I see proof of this in the ER every day. But it´s just statistics. Family history, build, excercise, nutrition, waist/hip ratio, bloodwork, smoking, should all be taken into consideration. That said, I heard that the WHO are considering raising the upper limit to account for some of the above (but don´t remember where I got that from, hope I´m right).

    I have never told a patient to lose weight because of their BMI. Never. But maybe I´m a slacker, and don´t want to trigger feelings of inadequacy. Which can definitely be detrimental to health, both mental and physical. Support is key, like with the person who commented above that she DIDN`T get kudos for keeping the weight off – fail!
    I have been both way below and above the recommended BMI (due to both carelessness and disordered eating patterns), and I can see and feel for myself that I am healthier when I´m somewhere around the middle. For the time being I am a 22, due to long work hours and pre-wedding stress, and I feel fit and healthy and energetic. At the same time, the scale creeps upwards since I´ve taken up running. And that´s ok.

    I can see lots of you have some beef with the BMI, and rightfully so, but applied carefully and mindfully, in the right hands, I think it´s a good tool.

  • Glamdoc

    And Sal, I´m sure you won´t because you´re a sensible woman but please DON´T drop those 5 pounds!

  • MelD

    I hope I’m adding my opinion to that of many in saying I am sick to death of constant reference to BMI as a golden rule. It takes far too few things into consideration, and if I were within “normal” BMI figures, I’d be painfully thin and probably feel dreadful. My build is fairly heavy for my lack of height, if I compare wrists with friends of the same height, they are almost twice as wide, so why should I come within the same “healthy” range of weight?!!
    Surely it is most important to feel healthy and comfortable, whatever the numbers say? Although my BMI is supposedly excessively high (34, I think ), I am healthy, have no signs of high cholesterol or diabetes or any other weight-related complaints, enjoy exercise of various kinds (horse-riding, yoga, gym-class, cycling, walking…) and also like wearing fashionable clothes, where most of the time I fit into the largest sizes without any trouble (a US 18 or so), and that at age 46. All this and the way I lead my life and treat my fellow human beings, how I enjoy my closest relationships and myself are all far more important to me…

  • GIPA

    As a mid-level provider, I rarely take the time to calculate a BMI. My own BMI was consistently “overweight” at a time when I was a varsity gymnast and had minimal body fat. It’s overused and misused in medical practice, and an overall look at an individual’s diet, exercise, build, labs, tobacco/alcohol habits, personal and family history is much more useful and productive. I should point out that I am in a GI practice, and so weight management is primarily something I discuss with people when it is directly contributing to the reason I am seeing them. For example, someone with severe reflux who has a lot of abdominal obesity should try to loose weight, because this directly contributes to the problem. This doesn’t mean I don’t evaluate and treat them aside from their weight, but to leave it out of the conversation isn’t good medicine.

    When I realize I must discuss weight with a patient, there are a few things I do to try to minimize the chances of being insensitive/insulting. First, I explain the issue at hand, so they understand all the contributing factors, including weight. I discuss all the treatment options, and include weight loss among them. We discuss their diet (this is pertinent for many reasons in a GI practice, so I discuss diet with normal and underweight patients also). I don’t focus on the number on the scale, rather on healthy habits and healthy changes. I compliment and encourage patients who are already working on weight loss and other healthy life changes. I ask inactive patients if they can think of a way to be more active, rather than lecturing them, and try to get people to own their health a bit.

    On a similar vein, I don’t harass my smokers either, but just remind them that they should consider quitting and offer help. There are studies out there that suggest that a healthcare provider mentioning the need for quitting smoking or weight loss increases the chances people will do so. Personally, I didn’t start exercising regularly until my doctor reminded me that I should and gave me that nudge to go do something about it.

    The thing is, some people are going to be offended when you mention weight, no matter how you preface or frame it. Other people are surprised when I bring up weight loss, and will say, “I’ve always known I should loose weight, but my doctor never talks about it” and are glad to have a non-critical conversation because it is an overwhelming and difficult task. Providers need to be sensitive to their patients and pick the appropriate time to discuss it, but at the same time patients need to realize that what is being said is not meant to offend. Yes, some providers are tactless, and medical school should include some “how to talk about sensitive issues” training. Some will obsess on numbers that are not necessarily meaningful. Saying nothing about a medical condition that has so many lousy health consequences, just to not offend someone, is also lousy medicine. How much to say, and how to say it, depends on the patient, and providers should take the time to ask the right questions before doling out advice. It’s hard in a 15-20 minute time slot, but it’s part of good patient care.

    • http://www.alreadypretty.com Sal

      Thank you so much for taking the time to respond, GIPA. This is really enlightening, and I sincerely wish you could be my doctor.

      • http://www.amidprivilege.com Lisa

        Yes, I agree, this is the kind of thinking that’s required. No philosophical iron in the fire, pragmatic, but smart.

  • http://www.amidprivilege.com Lisa

    I’ve been lean all my life – even skinny, as a kid. As a result, those times when I’ve been heavy, i.e. 50 lb weight gain pregnancies, I just ignored those who told me I was getting too big. But that’s because weight isn’t my area of insecurity. I have other ones, of course, where I also react very strongly to criticism, real or not. I think doctors need to be more sensitive around this stuff, and think about how what they say will be received.

  • Silvia

    I’m aware that this comment might be lost, considering the lateness of it, but I really think it should be said. It bugs me that while people do mention that BMI is one tool among many, none have mentioned why it’s so heavily used and why, in some cases, it does matter.

    Current medicine is not based on anecdotical information, but evidency based. This means it needs something to be measured in a lot of people and measured in the same way. Also, that a lot of information is only useful to the mayority but innacurate in a good chunk of the population. While in recent years most papers in endocrinology and reproductive health use a complete array of measures, BMI is still the most used. It easy to measure, most medical charts include weight and height and thousands of studies use it. So when a doctor uses it, it’s because he can make predictions based on it, not because he considers it a good tool. I’ve seen gyms and everything from nutritionists to random people place more importance on it than actual doctors.

    For example of when it does count, Polycystic ovary syndrome affects up to 10% of the female population. Besides acne and insulin resistance, one of the most common alterations is infertility. There’s plenty of evidence that 5% weight loss marks the difference between getting pregnant and not, and it appears that in the overweight range (yes, even with a BMI of 26 which is most other things a very healthy woman) it marks the difference between actually giving birth and not (a woman with PCOS has twice the risk of abortion). Working at a fertility clinic I’ve seen reactions that go from rage to elated when understanding what a difference those few pounds made.

    Waist to hip ratio appears to be more accurate in predicting cardiovascular risk and other issues but sadly the infomation widely available (and more valid) uses BMI.

    Tl, dr? BMI has it uses and, while is not a tool for everything, it does not mean it’s BS or that it has to be completely ignored.

    (Also, sorry if the wording is a bit odd, I’m more used towriting in spanish. Also while I’m not an expert on weight, I am a doctor and I did my thesis on PCOS)

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  • http://sara-star-studio.blogspot.com sarasuperid

    Thank you!

    I have a few health problems, none of them are remotely linked to physical fitness levels or BMI. But some folks around me think if I lost a few pounds it would cure all that ails me! I about 15 pounds overweight, so a little bit of exercise and a change in diet might help, but frankly, I am more concerned with self care for my chronic problems that are not weight related than dealing with my unrelated weight issue of 15 pounds.

  • http://stingystitcher.blogspot.com Annie

    I’m a med student, so I’m glad to hear you talking about this. I’ll try and make sure that, if this is involved in the field I enter, I will absolutely remember it.

    In my opinion, BMI has never been more than a guideline, a general rule. It’s annoying to see that even doctors, who should be well-informed that there is almost never a “magic number” or threshold, are being such sticklers. It is perfectly normal to deviate a little from the norm.

  • http://labellarosa3@gmail.com Liz

    My mom would be overweight according to her BMI as she is a competitive rock climber and buff as everything, but she is probably the healthiest person I ever met.

    I am overweight, and I recognize this. However, when I was only 12 (5′ 6″ and 170 lbs.), I did have an “overweight” BMI, although not by much. The doctor helpfully explained how overweight I was to me, accompanied by a chart of the average 12-year-old girl’s weight and how much I was different from all the normal, thin, healthy and pretty girls. The f’d me up pretty bad – I had already developed earlier than everyone else I knew, and sitting in the doctor’s office alone staring at a piece of paper that validates your status as fat ugly freak wasn’t helping at all.

    I mean, on kids? Really?

  • JuliR

    I know it’s super late but I wanted to get on the pedestal too! I recently had an actual BMI test done where they take your weight, height, put you on some machine that calculates your actual muscle mass then subtract everything you need from everything you don’t and tell you, in pounds, the safest amount of weight you can lose.

    I’m 5’5 and 176. The max weight, for my height, according to BMI is 141. That makes me 35 pounds overweight yet… only 15 pounds of that 35 is actual fat. When I went to the clinic they said all they could help me lose was the 15 pounds of fat.

    I walked into a weight loss clinic, a money-hungry machine fed by the weight anxiety demon of American women, told them I wanted to lose 40 pounds to be the right BMI for my height and they told me, to my face, that all they could assist me with losing the 15 pounds of fat. Then they tried to sell me a personal trainer for “toning” but that’s another story.

    So yes, BMI is wrong. It’s horribly wrong. I’ve always been told that I look like I’m in the 130′s or 140′s for weight but I didn’t believe it until that experience.