Once upon a time, people acknowledged the fact that there were actually different, innate body types. I call them the "morphs": ectomorphs, mesomorphs and endomorphs.
Ectomorphs are fine-boned, lean individuals who have trouble gaining weight (see this post). Mesomorphs are athletic, have well-defined muscle mass, the typical male (upside-down triangle) or female (hourglass) body shape, gain muscle easily but also gain weight somewhat more easily than ectomorphs. Endomorphs have "soft" bodies, gain weight easily and their muscle mass is less well-defined. Of course, most people are a combination of either ecto/mesomorphs or meso/endomorphs. An ecto/endomorph would be a contradiction in terms.
Once upon a time, there were also body charts that presented a range of healthy weights for an individual. I found one that calculated that a large-boned woman measuring 4'10" could weigh anywhere from 118 to 131 pounds. That's quite a range. (The large-boned determination for this calculation was based on wrist circumference). Let's contrast this with what the sacred BMI tells us: this same woman--no matter whether she is large, medium, or small-boned--should weigh no more than 119 pounds. Past 119 pounds, she is overweight. At 131 pounds, she is squarely in the middle range of the BMI classification for overweight.
Now, some may say that we should follow the BMI's ruling. After all, the lower the weight the better. Right? [sarcasm alert]. Many may say that pleading the "large bones" defence is simply a cop-out. But how can one number encompass the endless variety of bodies we see in this world of ours? How can we make abstraction of the differences that exist in body morphology between a "typical" Northern European and a "typical" Asian? How can we make abstraction of the fact that--even when we factor out weight--some women have larger breasts or wider hips than others?
We have forgotten the morphs and with it, we have instilled in people (including, sadly, too many medical professionals) the insane notion that salvation and success lie in one number and one number only: one's BMI.
In my travels around the weight-o-sphere, I have frequently come across people who measure their success--but usually their failure--by their ability or inability to grab the brass ring of the below 25 BMI. Tragically, many people who have made great strides in improving their health through reasonable physical activity and healthy eating (not dieting) feel an all-encompassing sense of failure because the "correct" BMI number remains outside of their grasp. Often, in despair, they give up totally on their healthier habits when they realize that the "right" BMI is just not in the cards for them, despite the fact that they have actually succeeded in making a healthier life for themselves.
I say "bring back the morphs" and with them the recognition that people don't all have to look the same or share the same sacred number to be healthy!
The BMI allows a large range for normal. Data supports the accuracy of the BMI for health at at least 99.9% Almost all the people who do not like the BMI usually have a high BMI. Back in the day there was not much health data, now there is. The incidence of morbidity and mortality goes up with a rising BMI. Those facts do not care what we may think, they just are.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteDr. J.: Science is constantly evolving. Facts are often not just facts. They are the sum total of our current and highly imperfect knowledge of the world, frequently dressed up with a side order of bias and blame.
ReplyDeleteBTW, I would also really appreciate some citations for your statement regarding the 99.9% accuracy rate of the BMI.
July 20, 2011 9:15 AM
I love the morphs! I think that would be a much healthier way for professionals and lay people to enter into conversations, especially if the Endos were not the object of disdain, but simply descriptors.
ReplyDeleteDr. J is too content with simple, inaccurate "answers." To wit: "The incidence of morbidity and mortality goes up with a rising BMI." Uhm, no.
With regard to mortality (at ten years from measurement of BMI), I understand the graph to be a J shape, with a BMI of roughly 27 at the bottom of the J. Extremely thin and extremely fat people are, on average, more likely to die ten years from measurement than people who are in the "overweight" category (JAMA, April, 2005, Flegal et. al.), and this makes sense. Very large people do suffer from some associated co-morbidities. (Often the direction of the "cause" arrow is unclear -- does obesity cause diabetes, or is it the other way around? PCOS? You get the idea.) But, moreover, very large people engage in risky behaviors (such as weight-loss surgery, taking unregulated diet supplements, yo-yo weight cycling, etc.) in order to lose weight and this compromises their health and increases their mortality. They also suffer more stress from weight bias and discrimination, which is also life shortening. On the other end of the curve, very small people suffer increased mortality because they have no reserves to help them fight if they experience a catastrophic illness.
That's mortality as related to BMI. With regard to co-morbidities, it's not so clear. Each disease -- diabetes, osteoporosis, etc. -- has its own most advantageous BMI. There is no simple graph that shows that an increasing BMI will also increase all morbidities, as well as mortality.
Those facts do not care what we may think, or that we would want weight to be so simple as a BMI chart, they just are.
In any event, since we cannot choose our BMIs, it is a silly argument. We should simply do our best to live healthfully regardless of our BMI category. That's where conversations should begin, and where the morphs might be helpful.
Dr. J: Perhaps you should calculate the BMIs of the top, most fit, male US athletes. Or I'll save you the time. I randomly solicited names from those in the know of top athletes in various sports. 5 of the 6 met criteria for obesity based on BMI; one came in as overweight. These are fit, healthy athletes. The more we misrepresent this issue--pathologizing genetically larger, yet healthy individuals--the more we will create a range of secondary problems in this population, while failing to address those truly in need.
ReplyDeleteCheck out this BMI post for more:http://dropitandeat.blogspot.com/2011/02/where-bmi-goes-wrong-lessons-from-cupid.html
Thanks for a great post!
Lori Lieberman, RD, CDE, MPH, LDN
www.dropitandeat.blogpot.com
signing in this way as it won't let my google acct show!
Many thanks to Debra and Lori for excellent responses that really put "meat on the bones" of this issue. Blind obedience to the BMI--even by medical professionals--does little or nothing in helping people to improve their health. The implication that an individual cannot be healthy if his or her BMI exceeds even by a few fractions of a point the sacrosanct 24.9 makes me seriously wonder about the validity of one's definition of health.
ReplyDeleteWow, Dr. J. I'm 5 foot 4 1/2 inches, weighing in at 170 -- BMI of 28.7, just about 7 pounds shy of "obese." I'm not a top athlete or body builder. A couple of weeks ago I did a 43-mile bicycle ride, and about 90 miles for the week. My cholesterol is so low I get error messages when I try to use the American Heart Association's risk calculator. Never had an out of range fasting blood glucose in my life. You're telling me I'm unhealthy?
ReplyDeleteDr. J,
ReplyDeleteAre you even a real doctor? You don't have your credentials listed on Calorie Lab, so I'm assuming by your simplistic understanding of weight regulation and health.
But let's get right down to it, shall we? Any study that accounts for the fitness levels of the study participants shows without a shadow of a doubt that being fat and fit is better than being thin and sedentary. Studies also show that increasing your fitness will have a profound impact on your metabolic health, REGARDLESS OF WEIGHT LOST.
But you know what is a metabolic nightmare? Weight cycling. This is something that any physician worth the paper his degree is printed on knows. And on your blog, you acknowledge the fact that weight cycling is wide spread when you say: "A recent survey by Wakefield Research states that most women (and likely many men) have unsuccessfully tried several different diets in a failed attempt to lose weight in their lifetime. The time spent doing this dieting for the individual averages 31 years!"
Yet, Dr. J has the solution! Dr. J has the weight loss answers that will provide PERMANENT weight loss. Except you don't because your "eat less/move more" philosophy has been covered by the LEARN program created by Kelly Brownell, which has equally appalling failure rates.
Weight loss leads to weight cycling leads to metabolic disaster. You are nothing more than another diet shill, so take your denial elsewhere.
Peace,
Shannon
I'm curious. What is the difference between blind obedience to a BMI number (ex. 5'4", weight range between 110-145 pounds)and a height/weight chart which allows for frame size (5'4", weight range between 108-132 pounds)? If a person is distressed that they have a BMI of 25, or 145 pounds, for example, wouldn't that same person, who exceeds 132 pounds on the height/weight chart, be equally distressed that they have not achieved the golden number of 132?
ReplyDeleteThe only difference I really see between the two is that the BMI figures attach labels (underweight, overweight, obese, super obese, etc.) to the weights that lie on either side of the "healthy" weight range.
The height/weight charts, including those allowing for different frame sizes, simply do not address the issues of underweight, overweight or obesity.
I believe that the height/weight charts and the BMI are just two different ways of providing the same--or very similar--information. I also see that the weight range within the "healthy" weight category for a 5'4" leaves ample room for variations in frame size. Both mechanisms are meant to be simply guidelines--something to strive for, in addition to feeling better and engaging in healthy activities.
The person who throws in the towel completely because they have not attained a certain BMI OR a certain range on a height/weight chart possibly has unaddressed psychological issues.
I have also noticed that some folks enjoy tracking their dropping BMI, as they move from number to number or category to category.
There is something more here, something unwritten, in both the post, itself, and the very defensive comments.
By the way, Dr. J, did you miss the whole NHANES report that shows mortality dip throughout the "overweight" BMI range? Or is that just selective reasoning?
ReplyDeletePeace,
Shannon
I also meant to say, New Me, that your blog is very thought-provoking and that you raise some very interesting topics in your posts.
ReplyDeleteSo, thank you for taking the time to write!
gotta pause at the idea of someone maybe having "unaddressed psychological issues" as evidence of refusing to...? what is the inference contained in "throwing in the towel?"
ReplyDeletei'm curious. what would "throwing in the towel" mean in terms of weight?
this could be an interesting direction to explore but unfortunately the argument (assuming there is one) is not stated in a way that we can respond, as participants in a dialog, in a way that would advance the conversation beyond the remark. pity. we have to guess at what might be included in "throwing in the towel" and "unaddressed psychological issues"--and guessing might lead to additional distortion.
i'm wondering what it would mean to "address psychological issues" such that there would be a different outcome for a person; it seems implied, too, that the "address" would need to be "effective" in some way, which means that a particular result happens (other than throwing in the towel) if "efficacy" is successfully achieved...would that outcome be: a lower weight? (for how long?) different eating patterns? different thinking? different what? what variable(s) re: "throwing in the towel" (whatever that means) should be controlled? and how would a person go about controlling those?
critical thinking and reasoned discourse is complex. it would be nice to pursue the "something unwritten" by "anne". anne?
sorry. should have addressed my comment, above, @Anne. there's a lot left unexamined in her comment that might be worthy of examining.
ReplyDeleteHi Hopeful and Free--
ReplyDeleteIn my comment about throwing in the towel (meaning giving up) and unaddressed psychological issues, I was referring back to New Me's post, second to the last paragraph, in which she mentions the people who give up completely in their endeavors to gain a healthier lifestyle because they have not been able to reach the magic BMI number. To give up all that has been gained (or lost!) because one has missed the number, even by a 10th of a percentage, seems, well, disturbing. If I knew such a person, I would probably think that, perhaps, they had become a little obsessive about it.
I think my original comments were addressed to New Me's post only--asking about the difference between the BMI figures and the height/weight charts of the "morphs," in terms of reaching/not reaching the desired number in either set of guidelines. It's just that New Me seemed to be saying that the "morph" height/weight charts were somehow different . . . better. But, in reality, both of them offer a range of weights for a person's height. A range which might take into account the size of an individual's frame. I am looking for clarification from New Me, and, I guess, everyone else here, about why/how one set of guidelines is superior to the others.
The BMI set of guidelines clearly engenders a lot of defensive, even angry, posting. I'm curious about why it stirs up such emotion. This is the "something unwritten" about which I wrote. Why does a simple set of guidelines bring about such a reaction?
Hi Anne,
ReplyDeleteI appreciated your clarifications and would like to respond:
As far as "throwing in the towel" goes, it is heartbreaking to see how many bloggers feel defeated by their inability to lose those last 5-10-20 pounds to reach BMI nirvana and how they actually spin out of control in their despair over failure. I once wrote a post where I described certain bloggers and their self-perceived victories and failures. The post was not meant to point fingers, but several people were very hurt by my description of their trials and tribulations. I therefore no longer talk about other bloggers' situations, as I really don't want to hurt anyone. You'll just have to take my word on the self-hatred and self-blame that I've seen in the weight-loss blogosphere--much of it because of those last few pounds on the way to reaching the ideal BMI number.
I do think that there is a lot of emotional pain in the weight-o-sphere. Not amongst everyone trying to lose weight, but certainly many. From what I've read and seen, there is a tragically high number of people whose weight issues coincide with some kind of emotional and/or sexual abuse.
LET ME MAKE THIS CLEAR: I do not believe that overweight is simply a symptom of abuse and that all overweight people have been the victims of abuse. I'm just saying that it can be a factor and it can play a part in "throwing in the towel".
As to what I see as the difference between the BMI and a range of weights based on one's body type, I think it's pretty clear in my example of the 4'10" woman. The BMI tells her that beyond 119 pounds, she is fat, whereas as an endomorph she has some valid leeway. Let's say that she takes up weight lifting. She may very well gain muscle weight and lose some fat but still end up at the higher end. Does that make her unhealthy? On the contrary. She is probably better off weighing 125-130 and carrying more muscle than being less muscular at 119. I prefer shades of gray to black and white. I don't think the truth lies in one single number beyond which you are doomed (i.e. fat). The BMI does not in any way take into account one's frame. It just sets a rather low cut-off (it was calculated downwards in 1998, BTW) beyond which no argument allowed.
In one of your comments, you also bring up what I would call the "sour grapes" argument. Dr. J. does the same when he states: "Almost all the people who do not like the BMI usually have a high BMI." You put it somewhat more delicately, referring to "defensive comments". I think this is an important subject and I don't have time right now to deal with it. You've inspired me to write a whole post about it. Please stay tuned.
Thanks for commenting and clarifying, New Me.
ReplyDeleteYour point to Dr. J about constantly-evolving science is a good one. In many ways, I think the jury is still out about the BMI recommendations because the rates of overweight and obese have been climbing so significantly and quickly. I've read that the elderly do better carrying a bit of extra weight, but is that true for younger people? Is there a cummulative effect in carrying extra pounds? Because someone enjoys good health while being nearly-obese in their twenties, will that translate to equally good health in their sixties, after carrying that extra weight for 40 years?
My mother's generation (b. 1923) were, for the most part, very lean as young people. That generation also enjoys rates of increasing longevity. Those of us in our 40's, 50's and 60's, who have been increasingly heavy for an entire generation or more, may or may not be so lucky. And younger people will have been heavier for even longer than my generation. I think we are not yet at a point where solid conclusions can be reached--by anyone.
I stand by my assertion that any of these charts and graphs are simply recommendations. Your thoughts about people who are utterly sidetracked when not able to reach "BMI nirvana" are a completely different matter. I get that. The important thing is to feel comfortable in one's own skin. Sometimes that takes addressing issues differently than just dropping some pounds.
I think Dr. J's comment about people complaining about the BMI recommendations having higher BMIs was not necessary. But maybe that's truly been his experience. We don't know if he's referring to people who carry an extra 5, 10 or 20 pounds due to increased muscle mass, or to people who are carrying 50 or more extra pounds.
Frankly, some of the responses to his relatively straightforward comment were somewhat vicious. Of course, people can respond to his comment, but I see no reason to call him "simplistic" and a "shill." Good grief! This does seem defensive to me, but doesn't mean what's been said is related to anyone's BMI. There is no "sour grapes" argument here--just a desire to see people dial it down a little bit and remain calm and unemotional.
Looking forward to your next post!
The concept that weight predicts longevity or health, or the idea that this generation won't live as long as previous because of greater girth, well, it upsets people when stuff like that gets cited as if it is TRUTH, proven, or demonstrated by solid research because it basically is saying, gee, being too fat is gonna make you die sooner. Generalities and correlation do not equal causation. And, because some people believe their statements about fatness are TRUE, they also tend to believe that people who are fat should change (reduce). Somehow. For instance, it has been implied by some believers that getting psychologically "healthier" will lead to reductions in weight. No research to indicate the validity there. I weighed over 300 lbs and am now "normal weight" and I don't believe the common cultural assumptions about weight carry much credibility, and to go around repeating those assumptions as if they are truths is HARMFUL for individuals and for our social organization as human beings. Those kinds of cultural assumptions turn us against each other, further divide us, and alienate us from each other as human beings. They perpetuate bias and discrimination. Maybe that's why people feel emotional and seem defensive. They have been hurt, deeply, by such bias. They want the harming of human beings, which is perpetuated by bias, to stop.
ReplyDeleteHopeful and Free: bravo!
ReplyDelete@Dr. J again:
ReplyDeleteFor the record, my BMI falls both in the normal range (20.52) and outside your generalization about those who dislike the measure. I fault it not for personal reasons obviously, but because it is a senseless measure. btw, over my 48 yrs as I've lost a bit of stature (physically, not professionally, I'll add), my BMI, by definition increased, yet I am stronger and more fit than ever before.d