The BMI is Bullshit - Here's What to Use Instead!

Episode Summary:
In this episode of Blasphemous Nutrition, Aimee delves into the limitations and shortcomings of the Body Mass Index (BMI) as a tool for assessing health risks. She highlights the historical context of the BMI, its drawbacks when applied to individuals, and offers alternative methods for evaluating health, emphasizing the need for more precise and individualized approaches to health assessments and advocating for a shift away from reliance on the BMI.

 By shedding light on the limitations of the BMI and presenting practical alternatives, Aimee equips listeners with valuable knowledge to make informed decisions about their health and well-being.

Key Takeaways:

• The BMI was originally intended as a population-level tool and lacks precision when applied to individuals.
• Alternative methods like waist-hip ratio measurements and DEXA scans may provide more accurate assessments of health risks.
• Ethnicity and genetic factors can impact health risks and may not be adequately accounted for by the BMI.
• Understanding the limitations of the BMI can help individuals advocate for appropriate healthcare access and services.
• Precise health assessments require a more personalized approach that considers individual factors beyond overall mass.

Resources:

Work with Aimee
Blasphemous Nutrition on Substack
Photography by: Dai Ross Photography
Podcast Cover Art: Lilly Kate Creative

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Transcript

0:00

Hey Rebels, welcome to Blasphemous Nutrition. Consider this podcast your pantry full of clarity, perspective, and the nuance needed to counter the superficial health advice so freely given on the internet. I'm Aimee, the unapologetically candid host of Blasphemous Nutrition and a double degreed nutritionist with 20 years experience. I'm here to share a more nuanced take. On living and eating well to sustain and recover your health. If you've found most health advice to be so generic as to be meaningless, We're so extreme that it's unrealistic, and you don't mind the occasional F bomb. You've come to the right place. From dissecting the latest nutrition trends to breaking down published research and sharing my own clinical experiences, I'm on a mission to foster clarity amidst all the confusion and empower you to have the health you need to live a life you love. Now let's get started. Welcome back to blasphemous nutrition. I'm your host, Aimee and I like mixing a little chili with my chocolate. Today. I want to talk about the BMI. I made him reference to the BMI back in my episode on slow weight loss talking about how it was utter bullshit. And I want to come back and revisit this topic to explain myself and also to give you some higher quality tools to work with when assessing your own health risks. Now the BMI has been the population standard that we have used to assess heightened weight proportionality since the late nineties. I have been in the field long enough that I remember when this switch was made and how, aghast so many people were to suddenly discover that they went from being within normal weight, per insurance data, which was previously used to being overweight. All of a sudden overnight, the government decided that these people. Who were normal weight yesterday are now fat There was a little bit of a shit show and a lot of tears. Let me tell you. Now we legitimately abandoned using insurance data to assess weight problems and disease risk in part, because that data did not take into account the significant confounding variable of smoking. Which was clearly an issue as smokers tend to be leaner, but are certainly not without risk. So in this transition to BMI, not only did we all suddenly become fatter over night, according to our health officials, but we also made what was ultimately a lateral move, which is again, relying on the simplicity of overall mass to project health outcomes. Now the results of this have been lackluster and disappointing. Because taking data that tends to be helpful in assessing health risk at a population level does not quite translate well to the individuals sitting in front of you. I know it's astonishing. Isn't it? The BMI was developed in the late 18 hundreds as a way of assessing current weight versus ideal weight at a population level. It was never intended to be used to assess individual ideal weight. In fact, the Belgian mathematician and sociologist who created it. And I'm totally gonna butcher his name. Cause I am not Belgian Lambert. Adolf jock, quit. Let. Even stated this as such. But humans, crave simplicity, and these important details got lost in the game of telephone, so here we are 150 years later and we have this nonsense that's governing our insurance premiums, our access to surgical procedures and probably a lot more. So, yeah, we see this association of a high BMI at a population level being indicative of increased risk of cardiovascular disease, diabetes, and other chronic disease. However it should not be used to assess an individual's personal health risk. The BMI does not take into account other stronger individual factors that increases disease risks such as ethnicity. Individuals of Asian or Southeast Asian descent often develop type two diabetes at a lower BMI than those of Western European descent from whom this original data was taken. Right. The BMI is based mostly on Western European. Individuals. There have been some adjustments made over time due to these discrepancies. But that doesn't negate the overall like foolishness of using this to assess individual health risk. There are also individuals who are of a heartier stock, Northern European Germanic folks who my grandmother would have referred to as big boned. These individuals have a genetic tendency to have more bone mass, more muscle mass than the generic average person whom the BMI is based off of. And so they will not ever fall within a normal BMI unless they are very ill or on starvation rations. The BMI is just too generic to be used how it is being used in healthcare. There are actually no really precise ways to quickly. Efficiently assess an individual's health risk. However, a waist hip circumference measurement can be used to ascertain risk of any extra visceral fat around the abdomen. Which does put us at increased risk of chronic disease. Another potentially promising measurement is the visceral fat calculator from the Luxembourg Institute of health. It also relies upon circumference measurements to estimate visceral fat. Now the challenge with measuring tape is of course, high risk of user error. I think if one is well under or well over that marker of 0.85 or less for women and 0.9 or less for men with regards to the waist, hip circumference, or significantly under or significantly over 130 centimeter squared for the visceral fat calculator it may be less of an issue, but even variances such as whether or not you're slouching, whether or not you're bloated can put you in a category that you don't actually belong in. Much like the stress of sitting in traffic before seeing a doctor can in and of itself cause your blood pressure to increase to the point that that doctor might encourage you to go on a beta blocker. Now I put my own health data into the visceral fat calculator and did the calculation, and then compared it to my DEXA scan results, which I'll talk about in a moment. but the two results are not transferable. Because the DEXA estimates, visceral fat and pounds. And the visceral fat calculator estimates in centimeter squared. So I can't compare one against the other for accuracy, but again, we have that limitation of user error. When it comes to taking circumference measurements to consider as well. Now the DEXA scan is a more costly and less accessible option, but it is now considered the gold standard by many. The DEXA scan has historically been used primarily to assess bone mineral density and as a diagnostic tool for osteoporosis, but it has the advantage of also giving a precise and less invasive way of measuring body fat than the dunk tanks of old. For those of you who are unfamiliar with dunk tanks, this former gold standard that we could use in the public domain. It involved getting into a swimsuit. And exhaling all of the air out of your lungs before submerging yourself underwater in this, you know, tank of water for as long as possible. In the research and in clinical settings, it is called hydrostatic weighing. So imagine this. You have the self-consciousness of being in a swimsuit. The discomfort and hassle of getting totally soaked. And then whatever emotions emerge to entertain you while you are wholly submerged with no air in your lungs, sitting and waiting patiently. Now once the reading was taken, the presiding professional who is conducting the test would knock on the tank to let you know that you could come up for air. This dunk would typically be repeated three times for the sake of accuracy. Now I'm certain, you can think of a whole host of reasons why this gold standard would be a hard sell for many. The three readings of water displacement that occurred while you were submerged would be then put into a formula to ascertain lean mass and fat mass. And I mean, this was the gold standard for generations. But everybody was happy to let that technology fall to the wayside in favor of the DEXA. Now the DEXA scan is an equally precise, but far less troublesome way to assess body fat with the added bonus of measuring muscle mass and bone density as well. The DEXA scan uses two very low dose x-ray beams at different energy levels. And these different energy levels pass through the body and are absorbed by different tissues. Our bone, our muscle, our fat at different rates. It takes about 10 minutes overall to do a scan. But the results are very precise measures of muscle, bone, and fat mass within your body. So while you can still access DEXA from within the medical community, more and more, I have been seeing direct to consumer DEXA services available to the public. And this is what I will often recommend to my clients in order to get their baseline, to assess bone, muscle, and fat mass. They can usually reassess as desired if utilizing a direct to consumer company. Although I don't recommend more than once a quarter, unless there has been significantly rapid weight loss. And that's mainly to make sure that there hasn't also been significant muscle loss along with that total weight loss. Now a bioelectrical impedance scale is much more accessible, but less precise. If your scale at home tells you your body fat percentage, it is using BIA or bioelectrical impedance analysis technology. BIA measures the resistance or the impedance of body tissues to a small electrical current. Now this current travels more easily through muscle and other lean tissue, which contains more water and more electrolytes than it does through fat, which is less conductive overall, but a major limitation of home BIA measuring devices is that they only measure half the body. A scale is only going to measure your lower half, which is why it overestimates a woman's body fat percentage and can underestimate a male's body fat percentage. Or you can get a handheld device, but that will only measure the upper part of the body. The most precise. scales will include hand levers as well as a scale that you step on. However, other factors such as under hydration or over hydration, having exercise within a couple hours of measuring or even having a meal beforehand can skew the readings. So if this is the method to be used, it is really important to be mindful of these limitations. And to use it as a means to track change over time, rather than relying on it as a precise measurement of where you are currently. So each of these means have limitations, but the height, waist ratio and the visceral fat calculator and the full body. B I, a scale is a more precise way to measure then a BMI. And it's fairly low cost and low invasive enough to be used in the medical system by trained professionals. Now, none of these measurements are best utilized alone as an obesity diagnostic tool but rather to support certain treatments and additional testing to ascertain or rule out diagnoses associated with obesity and excess to visceral fat, such as fatty liver disease, cardiovascular disease, and diabetes. I do suspect within the next generation, we will see the BMI fall out of favor and should something more precise, but just as simple to access come to the forefront before then maybe the transition would occur even sooner. Few knowledgeable and skilled professionals actually hold much credence to the BMI as it pertains to the person in front of them. But with. Insurance companies in north America utilizing the BMI. And the NHS in the UK utilizing the BMI as well as many other government health institutions across the world. Relying on this it's not likely to be replaced anytime soon. But we can do is use the BMI to our advantage. If you have insurance coverage and a BMI that is above 30, you may have certain preventative health services covered. If your BMI is being used medically to withhold access to services, such as joint replacement surgery, using other stronger indicators of health, such as your overall inflammation levels of lipid panel, blood sugar, and CBC panels can strengthen your case to fight for access to care. It is worth inquiring. And knowing if this metric is being used as a check mark against you, or if you can utilize it to get access to services. And if your BMI lowers from obese to overweight or from overweight into the normal ranges, Americans may be able to lower health insurance premiums as well with just that piece of data. These are nuanced details worth knowing and asking your insurance brokers and your primary care physicians about. I hope you have found today's episode of Blasphemous nutrition, informative and helpful. If so, please write a review in iTunes to help spread the word and let others who would benefit from this information be able to find me. This 32nd effort on your part really makes a significant difference in the success of this show. And unless you have a podcast of your own. You probably do not realize how much of a difference it makes, but it really does. We don't just say that. Most of us, don't have huge production teams and mega marketing budgets to get found. And it really is your written reviews and your ratings that allow us to be seen in this space. Now in the show notes, you're going to find a link to my sub stack, where you can find references and citations for what I've talked about today. And you'll also find instructions for leaving a written review in iTunes. Now until next week, my friends stay sharp and question all that is accepted as normal. Any and all information shared here is for educational and entertainment purposes only and is not to be misconstrued as offering medical advice. Listening to this podcast does not constitute a provider client relationship. Note, I'm not a doctor nor a nurse, and it is imperative that you utilize your brain and your medical team to make the best decisions for your own health. The use of information on this podcast or materials linked to this podcast are at the user's own risk. No information nor resources provided are intended to be a substitute for professional medical advice, diagnosis, or treatment. Be a smart human and do not disregard or postpone obtaining medical advice for any medical condition you may have. Seek the assistance of your healthcare team for any such conditions and always do so before making any changes to your medical, nutrition, or health plan. If you have found some Nuggets of Wisdom, make sure to subscribe, rate, and share Blasphemous Nutrition with those you care about. As you navigate the labyrinth of health advice out there, remember, health is a journey, not a dietary dictatorship. Stay skeptical, stay daring, and challenge the norms that no longer serve you. If you've got burning questions or want to share your own flavor of rebellion, slide into my DMs. Your stories fuel me, and I love hearing them. Thanks again for tuning in to Blasphemous Nutrition. Until next time, this is Aimee signing off, reminding you that truth is nuanced, and any dish can be made better with a little bit of sass.