Do You Believe Everything Your Doctor Says?

Between 1830 and 1850, a concept was developed by the Belgian polymath Adolphe Quetelet. Within a short amount of time, this concept would become well known and widespread. It is the Body Mass Index, or BMI, and finally, doctors had a blanket criterion to determine whose body weight was healthy, and whose was not.

Therein lies the problem, however. The Body Mass Index, the measurement that has become a doctor’s first go-to when advising his or her patients about their weight, cannot be applied to everyone, and it is flawed.

BMI is determined with (what else?) a mathematical formula:

BMI   bmi

BMI     bmi2

It’s really very simple. Basically, if you are short, you should be thin. If you are tall, you should be…Heaven forbid, not fat. But bigger.

The problem with this “tool” is that it does not take into consideration the distribution of your muscle or bone mass. If you are an athlete, you will have more muscle, and therefore, you will have a higher BMI number. But, with a higher BMI number, you will be literally “lumped” into the category of clinically obese – or even morbidly obese.  According to his BMI, basketball star Kobe Bryant is “overweight.” But if you look at the man, he is nowhere near:

 kobe-bryant-14098-1920x1200

It also doesn’t take into consideration things like heart or lung function. Of course, it is only meant to evaluate your weight according to your height, but these are not the only things to look at when looking at healthy or unhealthy weight. I have extra fat and I have curves. But my heart functions just fine (and yes, it has been tested). My lungs are a different story because I have asthma and have had it since I was a child, but one puff on my inhaler and that problem is solved.

Apparently, according to this article on Slate.com,  the development of the BMI had nothing to do with obesity itself, and Quetelet was apparently only trying to describe the standard proportions of the human build (the ratio of weight to height in the average adult). But it has led to a whole society using this concept as a way to single out those who are not deemed attractive because of their body types. What’s more is the insurance companies began large-scale studies of obesity in the early 20th century, comparing height and weight among their policyholders to show that “overweight” people died earlier than those of “ideal” weight. It led to subsequent studies finding that obese people were also more likely to get diabetes, hypertension, and heart disease. And suddenly, the insurance companies had a reason to deny coverage to people with high BMIs because they were too at risk not for their own health, but for the insurance companies’ pocketbooks.

In addition, the BMI is seen as cheap and easy. The formula can be plugged into a calculator – and there are now BMI calculators as well – and within nanoseconds, you have someone’s BMI. This means less work for doctors, meaning (in theory) fewer healthcare costs overall because of the minutes it saves from doing calculations or doing more in-depth examinations of someone’s personal situation. Therefore, everyone gets lumped into a category, and no other factors are taken into consideration. I don’t know about you, but knowing my doctor just cares about dealing with my health in a cheap and easy way doesn’t allow me to put much confidence in his or her abilities.

The aforementioned slate.com article has some other very good points. For example, if one goes online and plugs in his or her information into a BMI calculator and finds his or her BMI to be higher than “normal,” that person could start having a negative self-image. He or she could be drawn to fad diets or unhealthy attempts to lose weight, such as by starving oneself. I would rather we not use the BMI at all, but if someone is going to calculate it, I would rather they do so in the supervision of a doctor, rather than online with no input from a professional. Because no matter how strongly a doctor believes in the BMI, most doctors would never suggest a patient stop eating or turn to fad diets.

The slate.com article goes on to suggest that there is a better way to determine an unhealthy amount of fat, simply by taking a measurement of the circumference of your waist. There is some evidence to show that the more fat around your middle, the higher the risk of diabetes and other diseases. I feel especially sensitive to this information because Type I diabetes runs in my family, and I am therefore also more susceptible to developing Type II diabetes if I don’t pay attention to these things. Unfortunately, there is a direct correlation between the amount of fat in your body and Type II diabetes. I would like to be able to say that all people who have a lot of body fat shouldn’t worry about their health at all. But it’s not realistic. In my previous post, I said that it shouldn’t matter what you look like, it should matter how healthy you are. But if you are at risk for a disease like Type II diabetes like I am, it’s dangerous to just “let yourself go.”

The American Diabetes Association posted a study that is laden with medical jargon that even I don’t understand, but it confirms the suggestion of the article on slate.com. You can try to read it here.

There are many reasons why BMI should be phased out and another sort of evaluation should replace it. It may have worked in the 1800s when the medical community did not have as many thorough studies, but that is just not the case anymore. There is already talk about ceasing to use it as a standard of measurement, something mathematician Keith Devlin has undertaken. If you Google “against body mass index,” you will find many articles about this very thing.

I also had a “fitness assessment” at my gym, where they took my blood pressure and plugged in some numbers (my height and weight). I was pleased that the trainer who did the assessment never once mentioned BMI, while he did look at how much fat is in my body (according to the calculations by the machine). He also looked at things like how I eat, how much exercise I do, and any risk of certain diseases I might have in my family history. This is how these things should be done, especially by medical professionals, and it’s something we  all should start pushing to change.

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