Q&A Series: Should We Care About BMI?

worthnotanumber

In our Q&A series we’ve unpacked the paleo diet, the gluten-free dietcleanses, and yoga therapy. This week, Kayla Walker, MFT Intern, spoke with Megan Holt, MPH, RD, Potentia’s Coordinator of Nutrition and Wellness to learn about using BMI as an indicator of health.

Note from Rebecca: The following post may be triggering for some who are early in their recovery or struggling with their recovery, so please pause here if this information will not be helpful for you right now. There is some frank talk about numbers in this post because we want to offer some accurate information about the BMI, what it is, why it is not an accurate or helpful indicator of health and how its use is fueling the disordered eating spectrum.

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Kayla: What is BMI?

Megan: BMI stands for body mass index. It’s an equation commonly used in healthcare venues to estimate risk of developing chronic diseases that often accompany increases in body fat, such as diabetes, heart disease, and many forms of cancer.

Kayla: How do you calculate BMI? How do you know whether your BMI is in a healthy range?

Megan: The formula for BMI is:

BMI = weight in pounds/(height in inches x height in inches) x 703
or
BMI = weight in kilograms/height in meters squared

CDC recommendations categorize BMI in ranges of underweight, ideal weight, overweight, and obese, as follows:

Below 18.5 = Underweight
18.5 to 24.9 = Ideal
25.0 to 29.9 = Overweight
30.0 and above = Obese

Note from Rebecca: In 1998, the FDA changed the ranges for the BMI and overnight millions of people became “overweight” and “obese.” In his movie America the Beautiful, Darryl Roberts noted this changed was approved by a board that was directly connected to the dieting industry. Given the annual 50+ billion dollars which are spent on diets and diet related products, the BMI is regularly used as a marketing tool to support the use of various products in this industry. And since diets do not work – and in fact set you up to regain the weight and often more within 1-2 years – it seems the BMI is more of a marketing tool than a predictor of true health.

Kayla: Where did the idea of using BMI as a marker of health originate?

Megan: A mathematician (not a clinician) from Belgium by the name of Lambert Adolphe Jacques Quetelet came up with the BMI in the early 1800’s. His aim was to come up with an inexpensive proxy for measuring degree of obesity. Named the Quetelet index (and later BMI), it was used as a means of assessing “appropriateness” of weight for height.

Kayla: Why is BMI used?

Megan: After WWII it was noted that obese and overweight life insurance policy holders were at higher risk for morbidity and mortality were getting increasingly fatter.

It’s easy to understand and compute, it’s inexpensive, and gives us some helpful feedback in terms of anthropometric assessment, though this holds true mainly in the extremes (very underweight and very overweight/obese).

Note from Rebecca: Recent studies are showing a lower death risk for those who are considered “overweight” according to the BMI  furthering doubt the BMI ranges are not helpful in indicating true health.

Kayla: What are the limitations of using BMI as a marker of health?

Megan: BMI does not account for differences in bone mass/structure, fat mass and lean body (muscle) mass, nor where fat is stored (visceral vs. subcutaneous).

Visceral fat (fat around the abdomen/vital organs) is much more inflammatory and problematic in terms of health risks than subcutaneous fat (under the skin).

It implies that thin or normal weight individuals are healthy and have lower risk of developing preventable disease relative to their overweight (according to BMI) counterparts, and this just isn’t the case.

Athletes are an excellent example of persons who tend to have higher BMI’s but carry lower disease risk. Similarly, body fat is underestimated in the elderly, as they typically carry very little lean body (muscle) mass. Remember, one can be thin and simultaneously unfit and/or unhealthy.

Kayla: What should we be using instead, or at least in conjunction with BMI, to predict health risks? What are other markers of health?

Megan: Waist to hip ratio, for one, needs only a measuring tape, and has more predictive power than BMI. Women should have a waist-to-hip ratio of 0.8 or less, and men 0.95 or less. Women are advantageously pear shaped, and thus carry lower risk for preventable diseases. Think of this next time you’re cursing your curves, and please STOP hating on your body!

Other methods exist that are quite costly and/or intrusive, but may be more accurate, such as requesting a lipid panel (which requires blood work) from your physician, or assessing body fat through use of skin fold calipers, underwater weighing, or bioelectrical impedance. However, assessment of percent body fat alone still does not account for ‘location’ of fat-visceral versus subcutaneous.

Kayla: How do you assess your clients? Do you use BMI as a health indicator?

Megan: I rarely, if ever, calculate BMI when working with clients, whether they are athletes or people struggling with disordered eating.

Rather, I use an assessment of their current diet and lifestyle behaviors and blood work results from their physician to measure risk.

When working with individuals who do fall in the extremely obese category, I find that they are well aware of where they fall in terms of BMI categories, and that calling attention to this is not helpful.In fact, it often deters these individuals from wanting to make changes to lifestyle, as they likely will remain in the ‘obese’ category even with a fairly significant weight loss.

We know that even mild weight loss, 5-10%, for example, is enough to significantly decrease risk of “Western” diseases, such as diabetes, heart disease, and numerous cancers.

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Thanks for reading our Q&A on BMI!

What are your thoughts about using BMI as an indicator of health? Has it been helpful or harmful in your journey to health? What additional questions do you have about health, weight, or body image?

We would love to hear from you and address your questions on health and wellness in a future Q&A blog post.

In good health –

Kayla & Megan

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Holding the Numbers Lightly

lifetooshort

 

Numbers.

I have a lot of conversations about numbers in my line of work. And not the numbers that my accountant or financial planner talk with me about (ugh) but the numbers that are used to help us measure our physical health.

My clients over the last decade have taught me that these numbers can be destructive, shaming, and spike their inner drill sergeant to start screaming awful things about their worth + value.

Working with those who struggle with eating disorders, negative body image, and disordered eating has taught me a lot about some numbers and how they can be draining and all-consuming.

I am referring to the number:

on your scale
of the size of your pants
of calories or points of a food item
on your labs (I like these numbers but they can often be used incorrectly)
of calories burned

While I believe our emotional, relational, and spiritual health are deeply enmeshed with our physical health, I want to address these numbers — particularly the number on your scale — and how you use them as you seek to make changes in your physical well-being.

When it becomes clear to me that these numbers are toxic to my clients and are preventing any real change from happening, I often ask them to take a big risk and leap of faith.

I ask them to get rid of their scale.

Sometimes they are not ready to get rid of it, so I hold it at my office (you should see the space under my couch) or they put it in the trunk of their car or have a trusted friend hold it or hide it.

Afraid of losing control without their scale, my clients ask:

What if I gain a ton of weight?
How will I know if I am making progress?
What will motivate me for change without the scale?

I always respect this resistance. I get it.

It’s a frightening idea to let go of this measure that helps them manage their anxiety + fear and has been serving as an emotional container for some time. But if they are in my office, I suspect this means of containing has reached capacity.

The scale simply does not serve as an effective means of control and in fact spikes obsessive thoughts about weight, food, numbers, and what other people think.

Stepping on the scale fuels the “never enough” crazy-making because:

  • If it is higher than you would like, you feel anxious, depressed, ashamed.
  • If it is right where you want it to be, you are excited but also paralyzed by fear of doing anything that will change that number in the wrong direction.
  • Even If you have achieved a weight in the range that is best for your body, sometimes the desire to go even lower gives a rush that is hard to resist.

Contrary to the many messages we are inundated with in our culture, weight is not a direct correlation to our health.  Last week, the results of a meta-analysis study of weight and mortality revealed those deemed overweight were associated with significantly lower all-cause mortality.

This study is more indication of the need to rethink how we define overweight and obese. I want to be clear, the results of this study are not a pass for those who need to make changes in how they care for their body. But shaming people to make changes to better their well-being is not effective and is destructive.

Determining our well-being is way more complex than a number on a scale or an antiquated formula or chart. These faulty formulas are pervasive in our culture and prey on those who are feeling pretty crappy about themselves, who are desperate for change and relief.

When the number on the scale is the primary measure of your success in achieving your goals, you are vulnerable to a shame spiral.

When this number has power over your worth and value, it is time to get off the scale until you can recalibrate that way of thinking and learn how to bench negative emotion so you respond to your pain in ways that are not harmful to yourself and others.

Many clients report a positive emotional benefit after taking a break from the scale. They report less anxiety and that their inner drill sergeant has dialed back the volume.

Let me be clear: I think it is important to own all of these numbers…

…at the right time in your healing journey.

At the wrong time, shame, perfectionism, impatience, and fear can take these numbers and wreak havoc on your sense of worth, your mood, your focus.

Megan Holt, Potentia’s Coordinator of Nutrition + Wellness, often monitors the numbers on the scale for our clients while working with them on strategies towards true health that are customized for each individual. (Note: We all need a Megan in this culture!)

When our worth gets tied up in numbers, we make changes — often needed changes — for reasons that do not support sustaining change.

Our goal is to help people really discover where their bodies have the most energy and function the best. We support people discovering their food preferences and moving away from calling food good or bad. It is so amazing to see people find a way to enjoy food while still nourishing well.

When we use eating, restricting, or eliminating food in unsafe ways to take away the pain or to numb, dull, and repel, we do not allow ourselves to develop the emotional muscle to bench the hard stuff in life.

Food — eating it or restricting it — is powerful. It can be fun + enjoyable, too.

But for many, tolerating joy is very triggering and even less tolerable than shame and fear. Going back to the dark space, albeit uncomfortable, is known. And our brains like known.

So, if you are starting off this new year and food + body issues are one of your primary goals to tackle this year, awesome.

But please hold the numbers lightly.

And if you notice the numbers on your scale or on food items you are eating or the size of clothes giving fuel to your inner drill sergeant, then take a pause.

Ask your dietician, your nurse, or doctor to do blind weigh-ins for a while and not to talk about numbers for a bit as you seek to recalibrate your thinking.

These numbers are one of many factors that measure your progress on the journey towards true health, but they are not the sole indicator of progress as they may fluctuate for a variety of reasons.

Hold the numbers lightly as you seek true health in your life, and fiercely guard your heart from believing your worth is tied into a number.

Cheering you on —

Rebecca

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