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WillBrink
06-02-14, 07:34
A fairly balanced article on the strengths and weakness of the BMI:


Obesity rates: Is the Body Mass Index a good measurement?
(http://www.cbc.ca/news/canada/obesity-rates-is-the-body-mass-index-a-good-measurement-1.2658426)
The Body Mass Index, a scale scientists use to determine whether someone is overweight, is not the most accurate tool to determine whether one needs to lose some pounds, but it's a useful measurement when studying global populations, experts say.

"The problem with BMI is if you’re using it for yourself, on an individual basis to guide yourself as to whether you’re obese, it’s not particularly useful," said Dr. John Millar, vice-president of the Public Health Association of B.C.

"But as a population measure, it’s very good for measuring obesity. So yes, it’s perfectly valid."

Two recent studies have revealed some startling figures about the problems of obesity. Researchers at the Institute for Health Metrics and Evaluation at the University of Washington found that more than two billion people, or one third of the world's population, is either overweight or obese.
Britain Fat World

Recent studies revealed some startling figures about obesity. Researchers at the University of Washington found that one-third of the world's population is either overweight or obese. Meanwhile, an OECD report found the majority of adults in OECD countries are overweight. (Kirsty Wigglesworth/Associated Press)

That story comes on the heels of a report by the Organization for Economic Co-operation and Development, which found the majority of adults in OECD countries are overweight, and that in Canada, one in four Canadians is obese.

Both studies relied on the use of the Body Mass Index scale, which is simply a ratio of one's weight in kilograms divided by their height in metres squared. Health Canada uses four categories of BMI ranges in the Canadian weight classification system:

Underweight (BMI less than 18.5)
Normal weight (BMIs 18.5 to 24.9)
Overweight (BMIs 25 to 29.9)
Obese (BMI 30 and over)

To translate that into feet and pounds, an individual who is 5-8" and 170 pounds would have a BMI of 25.8, meaning that according to the BMI, they would be overweight.

Controversial index

But some argue the index too often classifies those who are healthy as being overweight or obese. For example, muscular athletes with little fat may have a high BMI because muscle weighs more than fat.

"There is no question that it is a less than ideal way to look at an individual," said Dr. Yoni Freedhoff, founder of the Ottawa-based Bariatric Medical Institute. "It’s a measure of how big a person is, not whether that person has health concerns. And it is a very simple number, which doesn't take into account things like race, age, sex, body frame, or muscle mass. And so for those reasons it is not an ideal measure for an individual.

"But looking for global trends, in looking at health-care resource utility, and costs and those sorts of things, it is useful for governments and it is useful for statisticians because it’s an easy calculable number."

In part, the scale is used as a global indicator of obesity because it's much easier to gather mass data on height and weight than other factors.

Freedhoff said when he wants to determine whether one of his patients is medically well or not, he considers the individual as a whole and not just the number that comes out of the scale.

"Scales don’t measure the presence or absence of health in individuals, but they are useful in population based studies," he said.

Millar agreed that body fat, rather than weight, is a much better measure of someone's overall health, and that electronic devices and not the BMI are better suited to examine that.
Fat accumulates

"It’s particularly the fat that accumulates inside your body and ends up around the kidney and around your liver and around your heart," he said. "That’s the really worrisome stuff."

Jennifer Kuk, associate professor at Toronto's York University School of Kinesiology and Health Science, said that people may not be aware that society is becoming more overweight, because as some studies have shown, people's goal weight has shifted upward over time.

"So that means what you think is normal and what you want to weigh has actually also drifted up," she said.

"That means people don't notice that they're overweight until much later. People don't notice that they're obese until much later and they don't consider it overweight because overweight implies you're not normal."

But Freedhoff suggested the debate about BMI distracts from what should be taken from these studies.

“I think the most important thing to take from this piece is that weights are rising whether or not you want to nitpick around what level we should call the cutoff for medical obesity. You can, but the bottom line is we are as a globe gaining weight and not slowly."

Hmac
06-02-14, 08:09
BMI is a pretty crude tool for judging one's health, but as a screening tool that is a component of a set of screening tools, in an appropriate population, it's valid and useful, quick and cheap.

Yes, Mr. Universe has a Body Mass Index of 44. I can assure that when someone with a body mass index of 44 is sitting in my office, I can tell the difference between a body builder and a morbidly obese 35 year old mother of 4. And when we look at populations and the increasing BMI over time, it's not because we have become a nation of body builders. Correlating T2DM rates clearly defines the severity of the problem. As long as T2DM rates parallel BMI, I'd say that validates BMI as a general screening tool pretty well.

Yes, there are "fit-but-fat" individuals...people who are obese but haven't manifested any co-morbidities yet. Key word in that statement is "yet".

WillBrink
06-02-14, 09:01
BMI is a pretty crude tool for judging one's health, but as a screening tool that is a component of a set of screening tools, in an appropriate population, it's valid and useful, quick and cheap.

Yes, Mr. Universe has a Body Mass Index of 44. I can assure that when someone with a body mass index of 44 is sitting in my office, I can tell the difference between a body builder and a morbidly obese 35 year old mother of 4. And when we look at populations and the increasing BMI over time, it's not because we have become a nation of body builders. Correlating T2DM rates clearly defines the severity of the problem. As long as T2DM rates parallel BMI, I'd say that validates BMI as a general screening tool pretty well.

Yes, there are "fit-but-fat" individuals...people who are obese but haven't manifested any co-morbidities yet. Key word in that statement is "yet".

The article coincides well with your view to be sure and I agree as well. It's a tool like all tools, used correctly, has it's utility. It is however astounding the number of medical professionals who should know better that Mr Universe and Mr not Mr Universe with the identical BMI are at very different populations. I have had a number of "discussions" with them over that. I'm glad to see an article discussing those +/- of the BMI as a tool.

As you say, we are a nation (and growing world) of obese, with a fraction of people who are overly muscular, but BMI penalizes those with high LBM and that's where the clinician needs to actually assess the difference, and perhaps look at BF% and other metrics.

Hmac
06-02-14, 10:25
The article coincides well with your view to be sure and I agree as well. It's a tool like all tools, used correctly, has it's utility. It is however astounding the number of medical professionals who should know better that Mr Universe and Mr not Mr Universe with the identical BMI are at very different populations. I have had a number of "discussions" with them over that. I'm glad to see an article discussing those +/- of the BMI as a tool.

As you say, we are a nation (and growing world) of obese, with a fraction of people who are overly muscular, but BMI penalizes those with high LBM and that's where the clinician needs to actually assess the difference, and perhaps look at BF% and other metrics.

I was amused to note that the recent health screening that my son went through for insurance at work found his BMI to be 26 and they labeled him as "overweight". Not based on anything other than just that number. No actual physical exam by anyone. Otherwise healthy, no meds, normal lipid profile. He is 6' 5", and while not an all-out body builder, he does hit the gym twice a week and is a muscular guy. That is indeed misuse of BMI as a screening tool.

9mm_shooter
06-02-14, 11:33
I agree with you all. The BMI measurements should be correlated with an estimate body fat % as well - particularly centripetal body fat. All of the techniques available now are fraught with problems for general applicability in a primary care setting (and for health statistics). Of all of these, the USMC measurement of circumferences does a pretty good job, so whenever there is a concern with an elevated BMI, this technique could help clarify things FOR SOME (on paper at least).

WillBrink
06-02-14, 11:59
I was amused to note that the recent health screening that my son went through for insurance at work found his BMI to be 26 and they labeled him as "overweight". Not based on anything other than just that number. No actual physical exam by anyone. Otherwise healthy, no meds, normal lipid profile. He is 6' 5", and while not an all-out body builder, he does hit the gym twice a week and is a muscular guy. That is indeed misuse of BMI as a screening tool.

In my experience, that's the norm.

skywalkrNCSU
06-02-14, 21:03
I think it's fine for a blind indicator that doesn't cause any decisions to be made. For the average couch potato it is fine but if you lift weights it is beyond worthless. If my insurance made adjustments to my premiums based on my bmi I would be pretty upset since I have a fair amount of muscle mass, not anything special but enough to throw off that figure.

Hmac
06-03-14, 08:53
Yeah, I get that a lot. "I'm not fat, I'm just big-boned" :)

Decisions, and valid ones, are made based on BMI every day, but by people who are experienced and who are actually there examining the patient. In larger people, there's a much greater margin for error...much easier to over or under-estimate their fat percentage just by looking at them. Skin fold thickness, body circumference (wrist, forearm, waist, thigh), are the simplest methods at estimating body fat and might push you one way or the other if you have someone where you have to determine if their BMI is relevant or not. DEXA scanning is also pretty helpful, although usually not worth the expense since the decision is rarely that critical. Plethysmography is interesting, but inconvenient and rarely worth it.

My decision-making is usually whether or not someone who has a BMI of 40 and over and no co-morbidities needs bariatric surgery. From a practical standpoint, that's not a hard decision to make and comes up only very rarely, although I will occasionally have them measure for the Navy method, or even (rarely) get a DEXA scan.

J-Dub
06-03-14, 12:52
For the avg fat American that thinks one flight of stairs is a "workout", sure.

For those of us that take our workouts seriously, its bullshit.

Heavy Metal
06-03-14, 13:03
I climbed two mountains this weekend. I am doing leg night at the Gym tonight. I'm not Superman but I do 6-12 hours a week of physical activity in the Summer, 4-8 in the Winter. (2.5 Weightwork, the rest Hiking ant Trail Running.)

I guarantee you I would fail BMI.