More BMI Bashing (A Good Thing)

Yes, recently I've been bashing away at the BMI. Who knows how many times I will be accused, openly or more subtly of simply suffering from sour grapes. Only time will tell.

But if you think what I have to say is a load of uninformed bull, maybe...just maybe...you might take more kindly to the opinion of Dr. Arya Sharma, a world-renowned obesity specialist.

As my regular readers know, I have had my ups and downs with Dr. Sharma. Sometimes we just don't see eye to eye, not that I'm in personal contact with him, aside from a wonderful chat we had a few months ago when he was in town. However, the following article is, I believe, a must-read for those whose mental well-being seems to hinge on their current BMI number ("Yeah, hooray, today my BMI is 24.9. I'm therefore "normal". Or: "I've got to lose 22.3 pounds, otherwise I'm clinically overweight/obese and I am DOOMED.").

Here it is: Why I Don't Like BMI.

Sour Grapes?

The Free Dictionary defines the expression "sour grapes" as:

• denial of the desirability of something after one has found out that it cannot be reached or acquired
• the attitude of affecting to despise something because one cannot or does not have it oneself
  [from a fable by Aesop]

I'm sure that at least one of my readers is convinced that this is my "real" problem with the BMI. It's not that it's a blunt or inaccurate measure of health or that it can potentially backfire on those who look to it as the bottom-line arbiter of good health nor that it can actually encourage individuals to give up healthy habits since their BMI still doesn't register at or below the correct number. No. It's that since clearly my own BMI is too high, I am just reacting with a petulant expression of sour grapes.

Well, sorry, but the lady is going to protest.

The sour grapes argument, in my opinion, actually hides some very serious and dangerous underlying messages.

I believe the most damaging underlying message is that an overweight person who criticizes the BMI does so only because she is too lazy, slovenly, weak-willed and greedy to suck it up and do the work required to lose weight. If she just put her nose to the grindstone, success would be hers. If she just stopped wallowing self-pity and shut her fat gob, she too would become svelte and healthy. The implication is that everyone under similar conditions will gain or lose weight in exactly the same way or at exactly the same rate (three British documentaries certainly beg to differ: Why Thin People Don't Get Fat, Super Slim Me and Super Skinny Me). It therefore follows that slim people are that way simply because they are more virtuous than fat people. If fat people only behaved like slim people, they would be slim too.

But let's go even further. Something perhaps even more insidious lies behind the above attitude: the overwhelming belief that achieving a "normal" BMI (or let's just say losing weight or looking good in a bikini or wearing a size 0) is purely a question of individual will and the choices one makes as an individual every day. It's the belief that we are ultimately the masters of our own fate.

Sadly, this manichean view of life--the black or white view that hard-working people succeed and slackers don't--permeates our society and enables those who "succeed" to lay the blame for failure squarely at the feet of the vast majority who, for reasons both within but more importantly outside their control do not become society's winners.

Let's be clear: I do not believe that we are merely puppets in the hands of some otherworldly being, or that our fate is written in stone the minute we burst into the world.

I consider myself someone who has worked and continues to work hard to achieve certain goals in life, be they financial, personal or health-related. In many ways, I consider myself a person who has succeeded in life by making and implementing decisions that have enabled her to overcome certain obstacles in life.

Yes, I admit it: I make choices. And choices seem to be at the heart of the belief that "you can do it if you only try", which underlies the whole weight loss movement.

But there's a problem when it comes to weight loss: despite what many medical professionals, laypeople, and reality TV show creators alike believe, not every person who is overweight eats like a pig and lies around watching TV all day. Not every person who exercises regularly and eats a balanced diet full of reasonable quantities of fresh, unprocessed foods is slim or at least no larger than 24.9 on the BMI. Like my 98-pound weakling friend, doing all the right things does not necessarily get you to goal.

Many people--particularly in North America--could no doubt benefit from making some better personal choices in what they eat. Do I worry about people who chug-a-lug large bottles of sugar-laden pop every day? Am I concerned about the current spate of commercials suggesting parents serve their children a product for breakfast whose total calories are composed of 50% fat and 40% sugar (the other 10% does have some food value)? Of course I am.

Do I make what I consider thoughtful, healthy food choices in my own life? Yes, again.

And would I be thrilled to see better phys ed programs in the schools; more walkable cities; better public transit; a tax on junk food and subsidies for locally grown, pesticide and hormone-free foods; the elimination of food deserts.

I firmly believe that there are many societal measures and personal choices we can make that do contribute to making us healthier individuals and creating a healthier society. They just won't make us slim.

On a population level, we know that 95% of people who diet fail (and fail repeatedly) and we strongly suspect that many of these people end up even heavier than before they dieted. Evidence is also growing that what the body perceives as on-going starvation (aka dieting) acts as a damper on one's metabolism, making it increasingly hard to lose weight and much easier and quicker to gain it back. While choice can make the difference on a personal level, society-wide the only thing we can be sure of is that people spend upwards of $60 billion yearly trying to lose weight and failing to do so in both the short but especially the long-run.

It seems that our obsession with the BMI has led us further away from striving for good health, as opposed to a "good" number. We don't actually know what the effects on population health would be if, as a society, we implemented campaigns to improve our health through eating healthier, less processed foods rather than simply concentrating on limiting portions or eating lo-cal Frankenfoods. Nor do we know what would happen if ALL kids in school were encouraged to be active, rather than shaming the fat kids into withdrawing from sports while pouring lots of money, time and effort into building elite athletic teams that build the school's reputation.

If as both individuals and a society, we focused on positive attitudes and activities rather than on striving for a magical number, we would end up in a world filled with healthy people of many different sizes. That's not sour grapes. That's striving for health for myself, as an individual, and for a healthier world. Rejecting the tyranny of the BMI is not sour grapes, it means taking the focus off aiming for a number and putting it where it belongs: aiming for a healthy life.

Politics is Getting in the Way

I've got a couple of blog posts under construction but have been involved in municipal politics recently. Sadly, the Tea Party has arrived in Canada and its name is the Ford Brothers.

I was at City Hall making a deputation at 1 a.m. on Friday morning. I had my 20 tweets of fame on Twitter, but now the world has moved on.

I leave you with my favourite quote of all times:

"Taxes are the price we pay for a civilized society."
Oliver Wendell Holmes, Associate Justice of the Supreme Court of the United States, 1902-1932

I'll get back to my usual blogging sooner than later.

Recently at the Grocery Store

The other day, I was standing in line at the grocery store to pay for my food order. At a certain point, I heard some serious wailing coming from another register nearby.

Right away, the mother in me kicked in. "How old is the baby?" I wondered. The screaming continued.

My order bagged and ready to go, I proceeded to push my cart down the aisle and looked over surreptitiously to get a good luck at the little screamer. Just as I thought, the child was about 18 months to 2 years old. She was twisting around in great distress in her stroller, clearly dying to get the heck out of that horrible contraption. Maybe she was hot (yes, the weather here is just broiling), despite the air conditioning. Maybe she was hungry. Maybe she was tired. That wraps up most of the reasons a child that age would be screaming in her stroller.

Just as I walked by, I heard her mother say something like "there, that better?" in a very matter-of-fact way. The kid continued to scream. Curious, I again shot a quick glance over at the child. She was now holding a chocolate bar, which was still wrapped up tight.

"Horrors!" thought I. And then I immediately looked at the mother, my subconscious expecting to see the quintessential fat, slovenly mother who is pushing her little girl into morbid obesity. Come on, didn't you think the same thing?

Well, of course, the truth was quite different. The little girl's mom was a slender woman, probably in her early thirties, wearing a lovely summer dress. She looked fairly well off.

Oh, the assumptions we make...

Whatever Happened to the Morphs?

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 More I Read...

The more I read about weight, be it the writings of bariatric experts, the fat acceptance blogosphere, weight loss "champions", weight loss maintainers, weight loss/gain strugglers, nutritionists, doctors, low carbers, intuitive eaters...the more I realize that there is absolutely no single answer to the conundrum of weight.

Personally, I have not found the holy grail of weight loss. I have, on the other hand, stabilized my weight at a level which is higher than 20 years ago and somewhat lower than five years ago. My weight varies within a five-pound range. Through trial and error (tempered by the inability to try out certain approaches due to physical limitations), I think that I have a fairly good idea of how my body functions and what I can and cannot ask of myself on both a physical and a psychological level.

The most important word in the above paragraph is "my", as in: my body. I no longer presume to tell anyone what's good or bad for them or what really works as opposed to what doesn't. I know only one thing: there are no cut and dry answers.

It is within this spirit that I recommend you read the following article: Don't Blame Obesity on Carbohydrates, by nutritionist Andy Bellatti on his blog, Small Bites. If you have the time and energy, read the comments too. Not everyone agrees with what he says.

The title of the blog post puts Bellatti squarely at odds with the low carb camp of Gary Taubes and company. Personally, I found the article interesting and I admit that it fits with my particular philosophy, namely that we cannot blame someone's weight on one single reason. As an intuitive eater, I also appreciate that Bellatti stresses healthy foods from all categories rather than demonizing a whole slew of foods including oatmeal, potatoes and strawberries (but NOT including mass-produced sweets made with refined flour or sugar-laden soft drinks, for instance).

I am not presenting this article as a "told ya so". Rather, I think it is an interesting starting point for discussion. I know of successful low carbers as well as people who have found this approach totally untenable in the long term. Once again, the bottom line is that there is no single right answer for everyone.

Why Are Thin People Not Fat

A few months ago, I ran across a BBC documentary on Youtube called "Why Are Thin People Not Fat?". You can watch Part One here. Just follow the links on the right-hand side of the page to watch the other episodes (total of 7).

This self-described "controversial" program documents an experiment done with ten young, decidedly slim people who went on a 5,000 calorie a day diet with no exercise allowed for four weeks. The seven episodes intersperse the regular "fat epidemic!!!!!!! we've got to do something or we're all damned!!!" fear mongering with discussion by medical professionals and, of course, interviews with the subjects themselves.

The goal of the experiment, as the Swedish scientist who led it states, is to "learn from those who can't get obese". Most studies are done on those who are already overweight and the prevailing attitude in society is that people are fat because the eat too much and exercise too little. Generally (and certainly in the weight loss universe), overweight is seen as a personal failing and "normal" or slim people are seen to be morally superior. This program turns that premise on its head and looks at the people who frustrate us beyond belief: the naturally slim.

Do different bodies cope differently with an excess of food? According to this experiment, the answer is a resounding "yes!"

This is a fascinating program and the results are, for the most part, not surprising. While the subjects all gained some weight during the experiment, they also lost it effortlessly once the experiment had ended. I was particularly struck by the young Asian man whose body at a certain point went into metabolic "overdrive" and literally prevented him from continuing to gain weight, despite the large quantity of food he ate every day and his total lack of exercise.

I highly recommend you watch this documentary. Despite the film maker's need to repeat all the old saws about the dangers of overweight (because, as we all know [eye rolling allowed], you can only be healthy if your BMI is under 25), the documentary still makes an important point about how different people's weights vary due to factors far beyond how much they may eat or exercise.