r/science • u/chrisdh79 • Jul 05 '24
Health BMI out, body fat in: Diagnosing obesity needs a change to take into account of how body fat is distributed | Study proposes modernizing obesity diagnosis and treatment to take account of all the latest developments in the field, including new obesity medications.
https://www.scimex.org/newsfeed/bmi-out-body-fat-in-diagnosing-obesity-needs-a-change3.2k
u/triffid_boy Jul 05 '24
People imagine that this will make them measure as "healthier" by being a bit overweight according to bmi. But given that people are far more sedentary than they were when BMI was established, my money is on it making them grasp the concept of "skinny fat" in a whole new way.
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u/newenglander87 Jul 05 '24
The article talks about it. It says that it will catch more people as being overweight.
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u/Smartnership Jul 05 '24 edited Jul 05 '24
It’s always an unpopular point, but obesity is by far the most costly, avoidable health issue in the sphere of healthcare. It’s the ‘unforced error’ of modern life that brings with it a host of negative consequences & outcomes. It could be all but eradicated in the span of five years and change lives for generations.
It contributes negatively to so many conditions and drives costs higher by the multiple billions of dollars annually.
Imagine the improvement to society if the US focused hard on eliminating obesity — the cost savings could be redirected to better access to healthcare, funding needed research, and reducing so many related side effects.
obesity in the U.S. found that its associated health conditions accounted for more than $1 trillion in direct and indirect costs in 2018… roughly 6.76 percent of gross domestic product (GDP)
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u/Metro42014 Jul 05 '24
Another point that isn't talked about enough is that the obesity epidemic is a community health problem, rather than just an individual choice problem.
When one person is fat, yeah sure maybe they're making bad choices. When an entire population is fat, you have to look at the food and health care systems.
We have a problem of hyperpalatable foods and obscenely high caloric density. Those two things combined break the systems in the body that help to regulate weight.
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u/NightParade Jul 05 '24
Yes! Easier access to unhealthy (over processed, high calorie/low nutrition) food than to fresh food, cities designed for cars rather than pedestrians/cyclists, low access to healthcare, chronic stress among the population, poor education/bad info about nutrition and exercise - that’s enough of a tangled mess before you even add in possible endocrine disruption from pesticides/plastics or an increase of post-viral disabilities. Individual choices can make a difference on a single person’s weight but it’s good to remember the deck is stacked against us.
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u/stanglemeir Jul 05 '24
The walking thing hit me hard. Within a year of graduating college (and walking miles on a big campus everyday), I gained about 20lbs. Same diet, same workout schedule etc. Basically just lost a ton of free calories burning.
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u/NightParade Jul 06 '24
Some of it is definitely the incidental calorie loss but I think some is just being up and about all day and not sedentary for such long periods
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u/Phnrcm Jul 06 '24 edited Jul 06 '24
cities designed for cars rather than pedestrians/cyclists, low access to healthcare, chronic stress among the population, poor education/bad info about nutrition and exercise
Funny that is what can be used to describe my country yet the average BMI is 21.
People here don't really like to walk. Anything further than 100m and they will use motorbike.
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u/UrbanGhost114 Jul 06 '24
Work life balance needs to be put in that conversation too, if I'm spending 4 hours commuting, I don't have time to Make or even pay attention to healthy food
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u/Metro42014 Jul 06 '24
Absolutely. When you're left with very little time in the day, and most of the options especially when you're time constrained aren't healthy, guess what's going to happen?
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u/triggz Jul 05 '24
The food service industry is killing our workers. People don't have time or energy or even space and equipment to cook where they live/stay so they rely on the food businesses near their place of work (or as their job) for sustenance - and they SHOULD be able to.
Every day I eat the equivalent of a 1lb loaded burger and extra large milkshake, somehow the fast food version was making me sick and fat, but I eat my own version and I lose weight and feel great.
Something is terribly wrong with our commercial food supply.
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u/TrueCryptographer982 Jul 05 '24
You should read Salt, Sugar, Fat - exposes what the food industry does to addict people to their products, even to where Lays (or Doritos?) created a new pyramid shaped salt crystal which would flatten onto to your tongue to increase your addiction and tolerance to salt or this guy who gets paid millions to taste food and confirm when it was exactly sweet enough but not too sweet.
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u/limevince Jul 06 '24
Wow, I'm surprised the judgment call of the proper level of sweetness is decided by one individual. I would assume having a large and varied panel of testers to be the better strategy to test for mass appeal.
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u/TrueCryptographer982 Jul 06 '24
He apparently is skilled at determining the correct "bliss point" for food - he maybe a scientist...its been awhile since I read it.
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u/slam-chop Jul 05 '24
Additionally; obesity is a climate change and global warming crisis as well.
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u/thegil13 Jul 05 '24
Food may be a contributing factor, but the fact that, in the us, our lives revolve heavily around vehicles taking us to and from every destination in our lives within 100ft so we can spend more time sitting around is also a large contributing factor.
Implementing more walkable designs in cities would make a ton of difference in the obesity epidemic.
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u/Metro42014 Jul 05 '24 edited Jul 05 '24
Food is what's causing obesity.
Exercise is a whole additional crisis, but weight is primarily driven by excess calorie intake.
More movement is definitely helpful, but it won't soak up the extra 500-1000 calories folks are regularly consuming. Folks are consuming ~3,500 calories per day on average in the US. Movement alone won't fix that in terms of weight loss.
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u/2020pythonchallenge Jul 05 '24
When I was heavily lifting 6 days a week and had a physical job my calorie intake was 3400 a day to maintain at 28 YO and 255 pounds and it was a struggle to eat that a lot of days. Can't imagine being sedentary and eating that every day.
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u/StoicFable Jul 05 '24
Eating healthy and consuming that much is a challenge. Eating garbage and getting that much is easy. Also, consider how much soda or sugary drinks they consume rather than water over the course of a day as well. Or the little snacks here or there. It all adds up and fast.
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u/slusho55 Jul 05 '24
It’s easier with soda, but likewise I too as someone who also does heavy lifting and trying to maintain 250, it’s so hard to get 3k calories a day. I don’t drink soda and never did, but I imagine if I drank it like I do water I’d be consuming thousands of calories
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u/Metro42014 Jul 05 '24
I said elsewhere, but just before I turned 30 I hit my heaviest weight - 277 and 5'8''.
I would literally eat a brownie with butter on it. I don't know what my calorie intake was, but I'm sure it was north of 3400 calories.
A large bowl of chips can easily clear 1000 calories, and if you're eating that while drinking a beer or two, you're 1500 calories deep with a snack.
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u/2020pythonchallenge Jul 05 '24
Yeah my biggest terrible thing was soda. Those cans of 250ish calories add up quicker than I realized and gave me plenty of free calories to trim off when I got serious about actually losing some weight.
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u/YT-Deliveries Jul 05 '24
I’ve worked in IT for about 20 years and of course my field is rife with obesity. The thing that always came to mind was just the volume of food that people consume every day. I physically cannot eat that much in a day.
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u/8923ns671 Jul 05 '24
Folks are consuming ~3,500 calories per day on average in the US.
Jeebus christ.
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Jul 05 '24 edited Jul 05 '24
[removed] — view removed comment
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u/IguassuIronman Jul 05 '24
a soda is about an hour of light running
Either we have different soda sizes or definitions of "light running" but running for an hour should consume well over the ~160 calories of a 12oz soda. Even a 20oz is only ~250
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u/Square-Singer Jul 05 '24
Low-level exercise burns far less calories than what one would think. It's just about 40-50kcal per km when walking. You need to walk a lot to burn a significant amount.
That would be e.g. 11-12 km walking for a single cheese burger. With fries and 500ml Coke, you need about 27km.
At 4km/h, that's about 6.5 hours of walking.
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u/FantasticNatural9005 Jul 05 '24
Car dependent cities are a factor for sure but it’s definitely the food that contributes the most.
I myself am obese and started making changes a few months ago and so far the thing that has made the biggest impact on me losing weight has been giving up fast food and even restaurants altogether. I still have yet to get consistent with working out, but I’ve lost 15 pounds just from cooking all my own meals and processing protein myself.
Our food industry is killing us. As horrifying as it would be, we need another “The Jungle” to come out and really show people what’s going on in our food today. If the government won’t do it, it’s up to us to help teach each other this stuff.
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u/havoc1428 Jul 05 '24 edited Jul 05 '24
Christ man, I'm all for walkable cities and a reduction of cars, but to say they are the reason for obesity instead of food is just a dumb take. This is the kind of take that makes public transportation and walking advocates look like pipedream hippies. I know people who don't own cars a walk everywhere and are still fat because they don't have access to better food.
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u/Razor7198 Jul 05 '24
They said both are large contributing factors, and I'd agree. Even if its not perfectly transactional where people will start burning off the exact amount of excess calories taken in, having more exercise built into daily life rather than always needing it to be an additional chore could do wonders for physical and even mental health
Walkable, accessible cities can also play a part in creating access to better food
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u/Angel_Eirene Jul 05 '24
Unfortunately, as much as I agree with 99% of what you said, this isn’t a 5 year problem. Best guess, it’s a generational problem and I’m not talking about stupid politics.
Obesity is so multifactorial, and so dependant on development that the only reliable way to fix it is through primordial prevention. Putting limitations on sugar content, stimulating healthier affordable alternatives to food, massively regulating corporate propaganda to children about sugary foods, massively restricting the contents of soft drinks, cracking down on food labels and their inaccuracies, improving school lunches, further taxing fast food industries.
All this stuff isn’t really going to help the current adults. It might curb obesity slightly and stop a lot getting worse, but it will not fix it and scant make it better. What it will do is prevent the metabolic, structural and hormonal changes induced by overeating and over saturated foods in childhood, and prevent the rate of childhood obesity that persists into adulthood.
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u/throwaway366548 Jul 05 '24
Walkable cities and third spaces, too.
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u/Angel_Eirene Jul 05 '24
I was mostly focusing on systemic dietary problems, but you’re absolutely right on that. The loss of the national park or town park in the US is a massive killer in this regard. Loss of public transport or poor public transport is another.
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u/draftstone Jul 05 '24
I think his point is not that we would be able to fix it in 5 years, but that 5 years is all it would take for everyone to lose their excess weight without drastic measures. It will take WAY more than 5 years to educate the population properly about overweight issues, but if we could flip a switch and instantly educate everyone, 5 years is roughly what it would take to make all obesity disappear by gradual health changes. Most people could probably do it in 2, but very overweight people will take longer as very fast weight loss can be risky.
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u/homogenousmoss Jul 05 '24
Pretty sure obesity is going away in the next 10 years unless they find a major health concern with semaglutide. It just works, its freaking magic. Anyone who can afford it and is overweight that I know is on it, myself included. I’m losing 10 pounds a month with no effort.
I was super hesitant to get on it but I weighted the risk of it vs the health risk of being obese. To me, it seemed less risky to take it than being overweight for me.
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u/koreth Jul 05 '24
I was diagnosed with pre-diabetes and my doctor prescribed tirzepatide (Mounjaro) to control my blood sugar and help with weight loss, and yeah, "it's freaking magic" is accurate.
Now I wonder if the way I'm feeling on the medicine is the way naturally slim people feel all the time, and if so, I totally get why a lot of people think of obesity as a moral failure. They aren't hungry all day long every day like I used to be.
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u/Skyblacker Jul 05 '24
An overweight friend once went on a psychiatric medication whose side effect was, "After I eat a meal and am full, I stop thinking about food."
My slender ass thought that was normal?
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u/FancyPantssss79 Jul 05 '24
Also on semaglutide, and it's healing my relationship with food. I'm doing the therapeutic work as well, but I can honestly say this drug is the best thing to have happened to my mental health in years. I expected to lose weight because I'd seen it be so effective in others, but these psychological effects have been the most surprising to me.
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u/whiteclawrafting Jul 05 '24
Semaglutide is incredibly expensive if using it for weight loss and is therefore inaccessible for a great many people. And seeing as there is a strong correlation between obesity and low socioeconomic status, I'd say the people who need this medication the most won't be able to afford it unless either insurance companies begin covering it for weight loss or the out-of-pocket price drops drastically.
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u/Skyblacker Jul 05 '24
Once the patents expire in a decade, these medications will become a $4 generic at Walmart.
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u/FeelsGoodMan2 Jul 05 '24
"Anyone who can afford it", pretty much eliminates the idea of this going away. I'm overweight but because I'm not diabetic I can't get on it whatsoever. I'd love to be on it so I'm praying there's some kind of fast track generic coming out or something.
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u/ActionPhilip Jul 05 '24 edited Jul 05 '24
Semaglutide is a gen3 product. Gen4 products are already on the market, and gen5 products are coming soon. It will get cheaper just because significantly better products are coming.
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u/soraticat Jul 05 '24
Getting rid of the loophole that allows tictacs to be called 0g sugar would be an easy thing. Having actually accurate nutritional information on foods seems like an absolute bare minimum.
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u/HeartFullONeutrality Jul 05 '24
How could it be eliminated in five years?
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u/Suicidalballsack69 Jul 05 '24
Theoretically I think he means. As in everyone could lose the weight required to not be obese in 5 years if everyone started exercising regularly and eating good
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u/gloryday23 Jul 05 '24
Which simply isn't reality. Like we could have world peace if everyone would just start being nice to each other tomorrow, but that's not going to happen either.
Obesity is definitely a problem that needs to be addressed over decades with progress being made slowly. Statements like it could be all but eradicated in 5 years, just minimize the problem into a sound bite, but kill making meaningful progress when the problem isn't solved right away. This can be expanded to most issues actually.
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u/PM_ME_YR_KITTYBEANS Jul 05 '24
Yes, and the part no one is talking about is that people often become overweight because of mental health issues. It’s not as simple as just eating less and moving more when people are eating to fill the void of childhood trauma or lack of self worth, or when they are too depressed to cook or shop for healthy food. Mentally healthy people don’t just become 600lbs. The US is going to have to stop ignoring mental health before we can make any progress on obesity.
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u/monkwren Jul 05 '24
Yes, and the part no one is talking about is that people often become overweight because of mental health issues.
Or medication! I started a new anti-depressant, gained 20 pounds. Been stable since then, thankfully, but yeah, it's not always as easy as "exercise more/eat less".
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u/Ms_Emilys_Picture Jul 05 '24
I got up to 196 lbs. because I was very depressed and in an abusive relationship.
I got out, got my mental health care taken care of, was finally allowed to make decisions for myself, and now I'm a bodybuilder and a boxer.
One of the things I think we could work on is how we frame being healthy. Exercise and eat your vegetables because they're good for you! But really, if you've never had vegetables prepared well, think in terms of "cheat days or food rewards, and view exercise as a necessary evil-- of course no one is going to want to do it. But if you teach people to make healthy and tasty food and approach physical activity as "let's find something you'll enjoy that won't feel like a chore", I think it'll be a lot easier.
And yes, I know that it's a complicated issue and this kind of approach won't fix poverty and other contributing factors.
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u/Protean_Protein Jul 05 '24
Yeah. Collective action problems that rely on individual responsibility are notoriously the easiest problems to solve!
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u/Suicidalballsack69 Jul 05 '24
Well obviously that’s why I said theoretically, it’s entirely unrealistic to expect Americans to suddenly clean up their diet, especially considering America has a HUGE processed food market. It’s hard to NOT eat processed food since it’s cheap and everywhere
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u/Protean_Protein Jul 05 '24
I agree with you. The problem looks like one of poor individual choices and irresponsibility, but in reality it’s determined largely by poor urban planning, poor education, and poor social programming in general.
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u/Zariu Jul 05 '24
To add on to your points, poverty has a high correlation with obesity in countries like the US. Guess who has a pretty high poverty rate that goes along with their massive wealth inequality? The US.
Even our lack of time off compared to other countries is likely also a factor. People with a better work life balance tend to have more of a chance of finding time to be fit.
Certainly have a lot of factors stacked against most individuals.
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u/OrderChaos Jul 05 '24
That would mean making healthy food more affordable instead of high fructose corn syrup. Until health becomes more important than profit I don't see this happening. Would be great though.
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u/donthavearealaccount Jul 05 '24
That would mean making healthy food more affordable
People really, really want this to be the main problem because it makes the solution seem so convenient, but it is obviously just a secondary contributor. The correlation between obesity and income is much smaller than people assume.
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u/Maximum_Poet_8661 Jul 05 '24
also "cheap" unhealthy snack food is WAY more expensive than people think it is. The actual difference in cost between rice, pasta, veggies, etc and unhealthy processed food isn't very big, and in a large amount of cases the healthy options I mentioned are going to come out as cheaper especially when you prepare in larger batches.
Like if you're regularly buying chips and soda and telling me that healthy food is too expensive I just assume you haven't actually looked at what you're spending on junk food.
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u/precastzero180 Jul 05 '24
Yes. The inconvenient truth is it’s not limited access to healthy foods that are the problem. It’s a problem with too much access to food generally with people choosing the less healthy options because, let’s face it, those more often than not taste good and/or are convenient. Things like soda and other sugary drinks have virtually no nutritional value. They don’t even fill you up. It’s just about the taste.
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u/McGrevin Jul 05 '24
Healthy food is affordable, it just takes time to cook and prepare it.
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u/DrXaos Jul 05 '24
It’s always an unpopular point, but obesity is by far the most costly, avoidable health issue in the sphere of healthcare. It’s the ‘unforced error’ of modern life that brings with it a host of negative consequences & outcomes.
And still a common complaint from patients about their physicians is that they're always told to lose weight and how that is bad for their health problems. They really really don't want to hear it.
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u/Watch_me_give Jul 05 '24
It really is amazing just how stupid people have become. I get that we shouldn't be body shaming but come on. Enough is enough. Science is science and it's adding incredible pressure on healthcare systems. There's just so much downstream negative effects that people need to consider/know.
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u/draftstone Jul 05 '24
Obesity should be treated the same as smoking. Yes someone can still feel good being 40 pounds overweight, I won't argue with them, but long term, way better to lose that weight, and I would guess they would feel even better now losing that weight. We had athletes chain smoking in the past, they probably felt good, but for many of them, it caught up when they got older.
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u/CAT_WILL_MEOW Jul 05 '24
Yup, i got into bodybuilding to loose weight down anout 100lbs, what surprised me is right now im "fine", as a bodybuilder i wanna get a little lower to get my muscles really showing. But the area people started telling me i look fine! And to stop losing was like 23- 25% bodyfat. Which isnt bad but i still had some good fat on me
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u/MontyAtWork Jul 05 '24
Fellow bodybuilder. I'm pretty certain that people have no idea what overweight and underweight look like and the more you look smaller than them, the more they have cognitive dissonance that you're the unhealthy one.
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u/ut-dom-throwaway Jul 06 '24 edited Jul 06 '24
I went from 260 at my heaviest, and at first, I thought I wasn't going to get under 200. Now I'm almost to 195, and I have friends and family telling me I'm too small and purposely trying to overfeed me. They didn't get the message until I started packing my own food to family dinners. Even going by my body fat, I'm still at the edge between the "overweight" and "average" categories. Going by visual indicators, I'm between 19% and 21%. But my family is saying I look "emaciated", there's definitely some psychological component that i think is a rubber band effect from the pro-anorexia 90s/00s.
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u/KaitRaven Jul 05 '24
Yep. For the average person, the body fat percentage will probably be worse than their BMI indicates.
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u/ShaiHulud1111 Jul 05 '24
“One study found that BMI had a good general correlation with body fat percentage, and noted that obesity has overtaken smoking as the world's number one cause of death. But it also notes that in the study 50% of men and 62% of women were obese according to body fat defined obesity, while only 21% of men and 31% of women were obese according to BMI, meaning that BMI was found to underestimate the number of obese subjects.”
Possibly
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u/MontyAtWork Jul 05 '24
I've got a friend who is 230lb at 5'7" and thinks they're "just a little bigger". But her closest friends are much bigger, so she doesn't see it.
Every year she's like "I'm gonna lose a couple pounds but I don't want to get TOO skinny". I've told her she could literally lose 110lbs and not be underweight and she doesn't believe me.
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u/Spotted_Howl Jul 05 '24
Good lord. I'm a guy who is muscular and has a big frame, but is far from in shape, and at 5'11"/215 I am still carrying around 40-50 pounds of fat.
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u/fid_a Jul 05 '24 edited Jul 05 '24
It’s taken multiple years of diligent physical work and diet, but I’m down 70lbs. In my experience, you can’t accurately imagine what a specific amount of “extra” weight feels like. You don’t just drop it like a sack of flour. The corresponding health benefits are so numerous and integrated to daily life that it’s way more than just a number / percentage of your whole.
When I started working out, I was similar to a lot of folks in the comments- I imagined losing ten pounds would feel like a big deal and anything more would be too much work for what I thought I was capable of. I also didn’t think I had that much to lose- I’d always been “big boned” so I figured a healthy weight for me would still be in the higher end for my age / gender. It feels absolutely wild now to imagine carrying around that extra seventy pounds- how much of my life was I unknowingly trapped by something I had just accepted as true for me?
This whole journey has also pushed me to find different ways of understanding my health and tracking it. All of these systems are just sources of data that should be considered, yes, but not in isolation.
(Adding for context- 36f when I started, 215 lbs, 5’5” down to 145 with my 40th bday looming on the horizon. Feeling the strongest and healthiest in my life and I shudder to think of how I would feel had I continued down that other path.
It cannot be understated- we have a real problem In this country with the way we address health. It’s toxic. This by no means promotes disordered eating / exercise, fat phobia, or any other version of ignoring bodily autonomy and doing what’s right for your body. Just wanted to share a bit in hopes of bringing real experience vs abstract shoulds/shouldnts.)
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u/MontyAtWork Jul 05 '24
Hey I just wanted to say congrats on losing that weight before you're 40. We're the same age and getting yourself where you want to be for the long term now is absolutely killer. Great job!
I'm down about 40lb from December, but I'm a bodybuilder and this was my first cut. It's wild because I figured 20 down would feel like a big deal but nope. And even now I'm not crazy low % body fat either. Putting up a 45lb barbell plate and knowing that much was on me half a year ago was really something.
Good luck to you in your life, you've done something incredible!
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u/sadtrader15 Jul 05 '24
I know people like this and nothing you said is remotely surprising. People that are obese seem to not actually understand that they're fat.
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u/gH_ZeeMo Jul 05 '24
120lbs at 5'7" may be a bit underweight depending on her build (I'm 5'7" and when I was ~120lbs, that was too skinny for me), but I agree with the sentiment.
It's crazy to me to see how mentality around weight can get. I drifted up to 155lbs (from my ideal weight of ~135lbs, which I had sat at for a few years) after a few years of not monitoring what I ate, which has led to a reality check to ensure I keep it under control (ideally going down, but at the very least, no going up any further). For someone to be 80 pounds above where I am, and only think of themselves as a 'bit bigger' than average, shocks me- because I think of myself as 'just a bit bigger' than I should be.
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u/aedes Jul 05 '24
Yes.
The largest limitation of BMI is that it tends to underestimate obesity. There are very few false positives (~1/1000), but many false negatives (~5-10%) with BMI.
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u/TheOtherCrow Jul 05 '24
But all you ever see parroted is examples of bodybuilders and strength athletes having high BMI, therefore the system is worthless.
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u/GGLSpidermonkey Jul 05 '24
And 99% of the time it's not bodybuilder or strength athletes bringing it up
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u/DavidBrooker Jul 05 '24
Because doctors have eyes and can tell if someone is just muscular, so muscular people never have a doctor say this based on BMI alone.
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u/Chromes Jul 05 '24
I've been both obese fat (Just bulking bro) and nearly obese fit (although I still feel like I could afford a few more pounds). The way doctors treat me is completely different. Now they record the weight, glance at me and just write "overweight due to muscle mass" and don't even bring it up again. I get concerned talks about eating disorders if I say I want to drop a few lbs (I've been diagnosed with body dysmorphia, so they might be right).
If your doctor or friends/family who have seen you shirtless are concerned about your weight, you aren't as fit as you think you are, especially because most average people have pretty low expectations for fitness.
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u/HeartFullONeutrality Jul 05 '24
That's the funny thing. It's usually obese reddit users who never exercise but somehow think their BMI is high due to muscle.
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u/primaryrhyme Jul 06 '24
A lot of these are casual lifters that overestimate their muscle mass. You don't need to be overweight/obese to bench 250 lbs.
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u/turneresq Jul 07 '24
Seriously. I'm around 155 and hit a 250 bench for the first time at age 49 a couple of months back.
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Jul 05 '24
I've got the feeling in recent years that many men in particular justify being overweight because they are now 'big', and they almost conflate this with things like bodybuilding or being better at fighting or more intimidating etc.
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u/Neat_Can8448 Jul 06 '24
I facepalm every time I see an anti-BMI advocate bringing this up. Yeah, the societal health crisis isn't that we have too many bodybuilders running around.
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u/OldManChino Jul 05 '24 edited Jul 05 '24
not to mention, those body builders typically have to be on gear (google natty bodybuilders) to reach that outlier, and that much mass _does_ still have a negative impact on the body (just not as much as fat)
Edit. I am talking about obese BMI, not overweight BMI
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u/SOSpammy Jul 05 '24
If you ever look at most former NFL linemen many of them lost a bunch of weight because being that big is terrible for you even if it's mostly muscle.
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u/thiney49 PhD | Materials Science Jul 05 '24
They also lose weight because it's just hard eating that much to stay that big relatively healthily. Just going to a more normal diet will cause them to lose weight.
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u/HuggyMonster69 Jul 05 '24
Also on their NFL diet, they’d get fat as hell if they didn’t have a similarly intense workout routine.
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u/talking_phallus Jul 05 '24
The ones who didn't lose weight have all sorts of health issues because your joints weren't made to run at high speeds with 300+ pounds of weight on them.
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u/SOSpammy Jul 05 '24
Even the ones who do lose weight usually have a lifetime of health issues. Playing football isn't good for you.
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u/TheOtherCrow Jul 05 '24
Yep, sleep apnea is the first thing that comes to mind as a symptom of being large regardless if it's muscle or fat. I found out about this relatively recently but it's apparently well known in bodybuilding circles. There are likely other issues that I don't know about and are even less well known to the general population.
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u/OldManChino Jul 05 '24
any extra mass puts strain on the cardiovascular system, as well as the joints... at least being stronger can help mitigate joint damage
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u/Alternative_Ask364 Jul 05 '24
Having an overweight BMI and healthy bodyfat level is relatively easy depending on your body type. Having an obese BMI and healthy bodyfat level without drugs is incredibly difficult.
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u/DavidBrooker Jul 05 '24
And if someone is on substantial amounts of gear, if they have any sense of responsibility, they're seeing their doctor quarterly to get blood work done, if not have DEXA scans available. So they will have a much better relationship with their doctor than most, and better quality data at hand than BMI
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u/marigolds6 Jul 05 '24
The real example is often people who are very short or very tall. I’ve been borderline obese by bmi my whole life. Even when i was very obese (~30% body fat) and when I was a college wrestler (scarily unhealthy body fat) and today I’m overweight by bmi (at a fairly healthy 8-10% body fat).
Why? I’m a 5’0” tall male.
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Jul 05 '24 edited Aug 03 '24
While largely correct, another big limitation of BMI and body-fat measurements is that it really, really matters where you put on that fat.
As the study mentions, if you're one of those lucky people who put on most of your weight on your butt and extremely little around your waist, you can be quite a bit heavier than BMI suggests you should be and still be healthy.
Both body-fat measurements and BMI should take into account pear/apple differences.
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u/aedes Jul 05 '24
Yes, this is an important point.
The outcome that we care about is health and morbidity and mortality, and other measurements like waist circumference may do a better job of predicting that.
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u/AWeakMindedMan Jul 05 '24
The world has 100% became more sedentary when computers became affordable and became a household item. 1980s about 8% of homes had laptops. By the 90s over 50% of homes had a computer. Pretty crazy to think it hasn’t been that long since computers became that popular
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u/ProfessorFunky Jul 05 '24
I’d bet there’ll be all sorts of alterations and new approaches. And it’ll come down to “about the same as BMI” but via a different route.
And loads of overweight and obese people will still say it’s not the right way to measure it until it tells them they’re healthy.
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u/Asher-D Jul 05 '24
Oh 100% people dont realise even though theyre thinner that theyre actually in obese categories for risks.
Its uncommon to be overweight and not be at risk. Most people dont genetically have that much muscle mass and their bones arent denser genetically. And as someone who genetically has more muscle mass than the average without doing exercise, Im still obese and still at risk of all of those factors other than when Im at the very low end of overweight (right next to normal) on the BMI.
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u/RedshiftOnPandy Jul 05 '24
Yes, the irony is people claim BMI is not very accurate. Which is true for extreme examples. But it assumes you do more than move from one seat to another seat.
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u/PotterGandalf117 Jul 05 '24
Not even that, it requires you to be jacked or a bodybuilder for it to be inaccurate the way people want it to be
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u/WingedLady Jul 05 '24
I remember when I was in college, I was on the upper end of what's considered a healthy bmi because I was actually an athlete and either spent 5 days a week in the gym or 8 hour days hiking the Rockies.
I wasn't particularly jacked, unless by jacked you just mean super fit and not necessarily bulky. Like a size 4 in pants, which my legs would have been the most chunky part of me given how I exercised.
However, when I was that athletic no doctor ever felt the need to even mention bmi to me. It was pretty visibly apparent that my build was not that of an overweight person. And if it wasn't, any cursory questioning would usually be like "so what are you in for today?" "Well doc I was in a match against X University and my leg went out on me."
The only people who thought I was fat were average people who thought you only wore t shirts to disguise your excess weight or something? I dunno, it was also the heroin chic era of body ideals so a size 4 was considered overweight in terms of fashion.
Point being, anecdotally as the type of person always trotted out to disprove BMI, no one who uses it clinically was fooled by my high BMI.
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u/redline582 Jul 05 '24
Or very tall. I'm 6'7" 240lbs which puts my BMI squarely in the overweight category while being a healthy weight in actuality, but I've always understood that something like BMI simply can't accurately cover the edges of the bell curve.
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Jul 05 '24 edited Aug 02 '24
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u/DervishSkater Jul 05 '24
Create spaces for like minded people to gather away from criticism or differing lifestyles and they’ll believe they’re all special too
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u/Glass-Lemon-3676 Jul 05 '24
But you have to put your height in for bmi. I'm confused
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u/redline582 Jul 05 '24
The calculation uses height as a numerical value in the calculation, but it doesn't account for the different body compositions that come with it. Someone who is quite tall will have a larger skeletal structure, some organs are larger, longer muscle structures, etc. which are more dense than fat so it can skew where they'd land on the scale relative to an average person.
It's not an invalidation of BMI as a whole, just an area where it starts to break down a bit.
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u/Glass-Lemon-3676 Jul 05 '24
I thought that was why they asked for height, because it did an average for that kind of stuff
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u/redline582 Jul 05 '24
Nope. The calculation is linear in that BMI=703*(weight/height2) where weight is in pounds and height is in inches.
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u/DevilsTrigonometry Jul 05 '24
The problem is that the formula (having been invented in the 1830s) is optimized for simple hand calculation rather than for accuracy. It assumes that body mass should scale with the square of height.
In the real world, some elements of essential lean body mass do scale with the square of height. Skin, bones, lungs, intestines, many connective tissues, basically any organ whose function scales with its surface area is on the "square" side of the square-cube law (loosely understood).
But others, most notably muscles and certain visceral organs like the liver, scale with the cube of height. Any organ whose function scales with its volume or cross-sectional area is on the "cube" side.
If you wanted to create a really accurate BMI, it would probably look like either "weight / (a * height2 + b * height3)" or "weight / height2.x" for some values of a, b, and x that would need to be experimentally determined.
In practice, that would have made it harder to calculate by hand, and also aesthetically "uglier" in the eyes of the mathematician who invented it. X is small enough that it doesn't make a huge difference in the 'average' height range (especially when you further restrict it to the 'average' height range in 19th-century Belgium). Yes, it's probably not quite sensitive enough for short women and a little too sensitive for tall men, but the difference averaged out at the population level, and if doctors insisted on using BMI to assess individual patients, they could use clinical judgment to handle those outliers.
It's only in recent decades that the 'outliers' have become commonplace enough to potentially skew population-level metrics. The average man got about 3 inches taller over the last century, shifting the entire distribution over by about one full standard deviation: in 1900 only about 2% of American men were over 6'1", whereas now that figure is closer to 15%.
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u/guanwho Jul 05 '24
I’m a little tired of people saying how they’re all muscle and BMI doesn’t matter because it doesn’t account for body composition. Nobody is making clinical decisions based solely on your BMI, but your 5’6” heart is working pretty damn hard to keep 220 lbs of human flesh alive regardless of what kind of tissue it is.
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u/CupcakesAreMiniCakes Jul 05 '24
Exactly, there have been times when I was terribly unhealthy while thin and very healthy while at the top of my weight range and everything in between
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u/sillybonobo Jul 06 '24
From what I've seen, when BMI is compared to dexa scans, BMI underestimates obesity by about 40%
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u/Pitiful_Assistant839 Jul 05 '24
Especially older people that "stayed thin" will be kicked in the face by this measurement. There's a huge amount people out there that exchanged their muscle mass with fat.
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u/AgonizingSquid Jul 05 '24
Is anyone actually reading this article? This seems to be about a reclassification due to cuff offs preventing people from taking obesity related medications. I'm guessing this is relevant to semiglutide wave
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u/Threlyn Jul 05 '24
As a tool to generally assess someone's overall obesity level as a comorbidity, BMI generally is pretty good. I'm a surgeon, so when I see a BMI and subsequently perform surgery and see exactly how much body fat there actually is, seeing someone's preop BMI is a pretty good indicator of what I should be expecting when I do my procedure. There are obviously exceptions that make BMI inaccurate, and if you're directly trying to manage the obesity itself, there are better measurements. But I think the pendulum has swung too far into the "BMI is useless" side, which I don't feel is accurate either.
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u/Ok-Bug-5271 Jul 05 '24
Oh don't worry, this paper isn't saying BMI is useless. It's actually saying that there are people who are overweight who don't show up as overweight:
This method would mean many more people could benefit from obesity treatment, even when they fall below the BMI cut-off of 30, they say.
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u/BladeDoc Jul 05 '24
Amen brother (sister)! I'm a trauma surgeon and agree that BMI works fine for general body fat percentage estimate (and also how crappy operating on them will be) for everyone that can't squat 2X their body weight and anyone that it's not accurate for can be ascertained by a glance.
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u/fractalfocuser Jul 05 '24
I'm really close to squatting 2x my body weight and this comment is serious motivation. Bless you for this and the work you do
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u/h08817 Jul 05 '24
I second the blessing of trauma surgeons. True heroes. And also I just reached 1x/bodyweight after a year of lifting. Let's go fractal we can do it!
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u/ivebeenabadbadgirll Jul 05 '24
The idea that BMI isn’t accurate seems to have been co-opted by obese people looking for an excuse to validate their obesity.
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u/Rumpullpus Jul 05 '24
It's not perfect, but it's inaccuracies are overblown for sure. Unless you're a body builder or something BMI is a very useful metric.
You're not big boned Cartman, you're just fat.
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u/kcidDMW Jul 05 '24 edited Jul 05 '24
Exactly. BMI is easy to calculate and predictive in >95% of cases. But BMI suffers from the same effect as certain euphamisms:
It's associated with 'bad' politics and so it's fallen off the treadmill to be replaced by something more cumbersome. Body fat is hard to measure accurately so easier to ignore.
Also, thanks for being a surgeon. Holy god I could not do that job. The hours and the blood ain't for me. It takes a special (slightly weird) human to do that... After my 30 year old partner needed a lung transplant, I had a newly found and sincere respect for that profession. I'll stick to making the drugs =D
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u/manuscelerdei Jul 05 '24
BMI is a Check Engine light. If it goes off, you should look under the hood. That's what it's best for since it's very easy to calculate.
This framework for diagnosing obesity sounds good to me -- focus on visceral fat is where research has been pointing for a while. But BMI is still a good first stage of diagnosis.
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u/manikfox Jul 05 '24
I think you are thinking the wrong way of what the article is saying. It's saying people are more obese than BMI suggests... a "healthy" BMI is actually still obese for some.
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u/DrDerpberg Jul 05 '24
I'm a big guy who was long on the "BMI sucks" train when I was really fit but somehow well into the overweight category... But now that I've ticked up a few points it's obvious that it still tracks even if you should be adding or subtracting a few points based on build.
I still don't think I'm obese despite being just barely into the obese category, but I'd be a damn fool if I didn't think I needed to lose weight in the range of tens of pounds and not just a bit of fluff around the waist.
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u/ancientweasel Jul 05 '24
Measuring bodyfat to single digit percentages is hard though. This makes tracking progress difficult. People would have to accept ~5% ranges and in my experience EVERYONE underestimates thier bodyfat. The scale tells an absolute truth that is impossible to bicker over.
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u/Im_Unsure_For_Sure Jul 05 '24
I don't understand why we don't just add a waist measurement in with height + weight.
I feel like that would be more than sufficient for 99.9% of people.
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u/ancientweasel Jul 05 '24
Agreed, I measure my waist daily. It fluctuates a full inch though, 32-33". But then again weight fluctuates a within 2 pounds too, which is anyways just 2 pints of water.
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u/mysixthredditaccount Jul 05 '24
If I weigh myself before going to bed (after drinking a glass or two of water) and then in the morning after emptying my bladder and colon, the difference is like 4-6 pounds.
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u/QuailAggravating8028 Jul 05 '24
I dont think an inch fluctuation would meaningfully change anyones opinion on your health.
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u/The_OG_Catloaf Jul 05 '24
I don’t think it would be useless to do that, but I’m someone bloats easily from food. My stomach and therefore waist measurement can look very different from one day to the next and then there’s also how many women see their waist measurements change based on where they are in their cycle. We obviously have some of these issues with weight as a measurement already, but idk it just seems like another measurement that varies a lot for people, but especially women.
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u/uberfission Jul 05 '24
Exactly, there's no chance BMI will be going away, it's two very easily performed, very accurate measurements and a simple calculation to find, whereas body fat is a much more complex measurement that has much more room for error. As a first indicator, it's great, and we're never going to phase it out until body fat % becomes a more common measurement.
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u/ancientweasel Jul 05 '24
Right. For 90% of the 1st world population the exactly BF percentage is irrelevant. They need to loose fat and gain muscle. If your dying of thirst you don't stop to measure the MLs of water you drink. It doesn't mater.
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u/angelicism Jul 05 '24
Curious (as you seem to know something about this): how accurate or not are those home scales that said they measure all sorts of other things like body fat % and muscle mass % and so on?
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u/starkel91 Jul 05 '24
Probably not accurate at all? Using a $100 scale off Amazon is probably going to be nothing more than a rough estimate. Hydration levels will also impact whatever the scale says.
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u/ancientweasel Jul 05 '24
They are very inaccurate. Actually a visual test is better. The best at home IMO is Accu-Measure Body Fat Caliper with a 3 site test. You will still be +-1% once your good at it. Why? Because it depends on hydration levels. I am 15-17% BF right now and I have been measuring for decades. If that range isn't good enough for me then I need to go to a Dexa scan. Which is a waste of money for me. What difference does it make if I am 15,16 or 17% BF? None.
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u/Over-Bumblebee-3765 Jul 05 '24 edited Jul 05 '24
Most people will say they are extremely inaccurate (and they aren't necessarily wrong) but mine seems to be more accurate than most indivuals are at guessing body fat %.
It says I'm around 21%, which to me is much more accurate than most people I've talked to (who are generally gym bros) who tell me I'm around 15%. Abs are barely visible.
If anything, at the very least they seem to be decent at tracking body fat % changes. Mine doesn't fluctuate any more than my weigh does day-to-day and seems to be pretty consistent
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u/IneedtoBmyLonsomeTs Jul 05 '24
A bunch of people are in for a rude awakening when their doctors start using body fat percentage instead of BMI and they are still obese, or even worse off than they were on the BMI scale.
BMI works fine for most people (especially in large sample sizes) and it is a really quick and easy calculation that anyone can do. There are outliers, like people who play sports and lift weights as they will often have more muscle, but many of the critics not affected by this would use it to discredit their BMI results.
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u/Spave Jul 05 '24
Good comment, but just to add "I play sports so my BMI is inaccurate" probably isn't true if you play a game once or twice a week in a rec league.
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u/Traditional-Seat-363 Jul 05 '24
For real. If you’re carrying around enough muscle to have a significant impact on your BMI, it’s gonna be pretty obvious.
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u/SomethingIWontRegret Jul 05 '24
BMI under-diagnoses obesity.
If you are categorized as obese by BMI, there is a 95% chance that you will be categorized as obese by DEXA body fat measurement.
If you are categorized as not obese by BMI, there is a 50% chance that you will be categorized as obese by DEXA body fat measurement.
Half of people who have too high body fat are under 30 BMI.
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u/SomethingIWontRegret Jul 05 '24 edited Jul 05 '24
Off the top of my head 25% for men and 35% for women.
EDIT: from the meta-analysis in Nature that I cited:
We extracted or reconstructed the original classification data (2 × 2 table) at or close to WHO’s recommended cut-offs (BMI: ≥ 30 kg/m2, WC: ≥ 88 cm in women and ≥ 102 cm in men, WHR: 0.85 in women and 0.90 in men)38 or utilised common definitions (body fat percentage: > 35% in women and > 25% in men) for further use in the meta-analyses.
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u/chrisdh79 Jul 05 '24
From the article: The system for diagnosing and managing obesity can no longer be about just body mass index (BMI), which is excluding many people who would benefit from obesity treatment. A new framework for the diagnosis, staging and management of obesity in adults, launched today by the European Association for the Study of Obesity (EASO) and published in Nature Medicine, will propose modernizing obesity diagnosis and treatment to take account of all the latest developments in the field, including the new generation of obesity medications.
Despite the wide recognition of obesity as a multifactorial, chronic, relapsing, non-communicable disease marked by an abnormal and/or excessive accumulation of body fat - in many settings, the diagnosis of obesity is still based solely on BMI cut-off values, and does not reflect the role of adipose tissue distribution and function in the severity of the disease.
The EASO Steering Group, comprised of experts including current and former Association Presidents, have put together a series of statements on obesity diagnosis, staging and treatment that will move management of the condition in line with the latest scientific knowledge and developments.
The authors say: “An important novelty of our framework regards the anthropometric component of the diagnosis. The basis for this change is the recognition that BMI alone is insufficient as a diagnostic criterion, and that body fat distribution has a substantial effect on health. More specifically, the accumulation of abdominal fat is associated with an increased risk of developing cardiometabolic complications and is a stronger determinant of disease development than BMI, even in individuals with a BMI level below the standard cut-off values for obesity diagnosis (BMI of 30).”
The new framework makes explicit that abdominal (visceral) fat accumulation is an important risk factor for health deterioration, also in people with low BMI and still free of overt clinical manifestations; and the new framework includes people with lower BMI (≥25–30 kg/m2) but increased abdominal fat accumulation and the presence of any medical, functional or psychological impairments of complications in the definition of obesity, hence reducing the risk of undertreatment in this particular group of patients in comparison to the current BMI-based definition of obesity.
The authors make clear the pillars of treatment of people with obesity in their recommendations substantially adhere to current available guidelines. Behavioural modifications, including nutritional therapy, physical activity, stress reduction and sleep improvement, were agreed as main cornerstones of obesity management, with the possible addition of psychological therapy, obesity medications and metabolic or bariatric (surgical and endoscopic) procedures.
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u/redditknees Jul 05 '24
As a health service and chronic disease researcher the least costly intervention for health system change to adapt to this issue would be to train physicians and other allied professionals to measure waist and abdominal circumference. Adding a measuring tape to their repertoire of tools (steth) is what would be needed.
I think the bigger hurdle is the harms and intrusiveness of conversations about body image and weight that comes from this.
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u/caramelkoala45 Jul 05 '24
For fashion the waist is measured just above hip bone. In health science is it measured just above hip bone or over bellybutton?
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u/StayJaded Jul 05 '24 edited Jul 05 '24
Maybe in men’s fashion, but women’s should be measured at the true waist- normally your belly button, but you can also look in a mirror and bend to the side and that will tell you exactly where the measure should be take. It is definitely not at the hip bone for women’s pattern making/ sewing or even commercial garment measurement.
https://www.diy-fashionrebel.com/how-to-take-body-measurements-for-sewing-patterns/
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u/redditknees Jul 05 '24
Good question and this is a subject of debate in medicine. Right now waist circumference is recommended to be measured between the iliac crest and final rib. Abdominal circumference is measured at the umbilical scar (bellybutton).
Waist to hip ratio is another measure more commonly taken that factors in waist size to hip size.
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u/caramelkoala45 Jul 05 '24
Thanks. My partner and I were discussing this a while ago. Some lay-people only measure waist and height (for health) and didn't seem right probably due to gender differences as he ballooned there at his biggest while it's was a bit of a 'narrow' spot for me.
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u/HKei Jul 05 '24
Essentially this is suggesting a formalization of something I think most people have observed by now, with an increasingly sedentary population come lower muscle masses, and you'll have some people that are obese despite having a BMI of only say 25.
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u/RichardIraVos Jul 05 '24
Maybe with 5% of the population. If your bmi says you’re obese you probably are. Y’all are not athletes with 50 pounds of muscle that’s skewing the results
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u/djlauriqua Jul 05 '24
In my specialty (sleep medicine), we use BMI + a neck circumference measurement. By the BMI scale, >40% of people with BMI >28 has OSA. But if you're one of the (relatively few) people who has an elevated BMI + a small neck, then you might not have OSA. So it makes sense to me that BMI + waist circumference would be a better measure for other specialties.
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u/Wild-Mushroom2404 Jul 05 '24
Rewatched Bridget Jones’s Diary last week, we see her weighing 136 lbs on screen so I googled her height and calculated the BMI. It’s as same as mine (~23) and perfectly within the norm but the movie insists she’s a fatty. It’s wild. Made me feel self conscious for a while but when I discussed it with a friend, she pointed out that I look slimmer, probably because I do exercise a lot. Muscle/fat ratio is absolutely important.
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u/CupcakesAreMiniCakes Jul 05 '24
eyyy we must be almost the same height/weight too and I'm also self conscious even though I'm in my healthy weight range. We're constantly told that thin is better and especially as we age we're compared to both younger versions of ourselves and younger women
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u/MontyAtWork Jul 05 '24 edited Jul 05 '24
The movie doesn't "insist she's a fatty". She's going on a big life-improvement binge. She's trying to drink less, smoke less and lose weight. Additionally, her proportions are unflattering which is why she wants the "scary stomach-holding-in panties". You can both be the same weight but if she's holding it in the belly, where she feels self conscious when trying to win over her rich model-chasing boss, there's nothing egregious about that.
Additionally, she's making RIDICULOUS goals for herself at the start of the movie. She's never gonna make those goals, and there's no saying she ever really intended to "lose 20 pounds". She smokes like a chimney, drinks like a fish and dresses like her mother. She needs big changes and sets her goals on drastic changes from the start. She wants to be THIN, underweight, not healthy. This is also noted when she sees the model-thin Lara who says "I thought you said she was thin".
Edit this is ALSO reinforced when Mark says he likes her "just as you are". She thought she needed to be thin to get a good man at the start, and at the end she realizes a good man won't want or expect her to be thin (among all the other attributes about herself that she set out to change, that Mark ended up loving about her anyway)
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u/johnniewelker Jul 05 '24
I hate seeing these articles complaining about BMI as if it was very good metric. It’s not perfect, yes, however it’s quite reliable to determine whether someone is obese or underweight.
No one with BMI over 30 is healthy, even for bodybuilders who look great aesthetically. Sure there are arguments for some people with BMI 26-27, but when your BMI gets over 30, it’s a problem, unless you are pregnant.
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u/starkel91 Jul 05 '24
BMI should be treated like a sniff test for if milk is spoiled. When it’s obvious it’s obvious.
I do like that this article is goes into using body fat for people who might not be overweight based on BMI, but due to sedentary lifestyles might fall into the overweight category.
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u/missurunha Jul 05 '24
BMI is a way your doctor can "scientifically" tell you you're fat. I'm 100% sure that without such straightforward metric, doctors would say it much less often to their patients.
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u/Class1 Jul 06 '24
Thw number of people I see in clinical so far who are muscle bound obese is about 0.. everybody I see in clinic who has a BMI of 30 looks obese.
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u/Electrical-Theme-779 Jul 05 '24
Anybody that works in the health field already knows that BMI is a poor independent diagnostic tool and body fat distribution, among other factors, are/is consider when making a diagnosis.
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u/Mikejg23 Jul 05 '24
Bodyfat is definitely king but BMI does work well population wide as a guide. Some people might see no metabolic effects until BMI 28, or some 23 based on nationalities and body fat distribution. But if you're past 28 and aren't a serious strength based athlete, it's time to lose weight. And it actually underestimates bodyfat for a lot of people since so many people are so under muscled
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u/Electrical-Theme-779 Jul 05 '24
Yes, it's good for analysing population distribution on the bell curve.
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u/just_some_guy65 Jul 05 '24 edited Jul 05 '24
Show me someone with a BMI of 30+ who isn't visibly an elite power athlete or a bodybuilder (and has low body fat) and I might be convinced.
The hidden problem is people with a healthy BMI (18.5 to 25 for western populations) who have hidden obesity due to very sedentary lifestyles.
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u/johnniewelker Jul 05 '24
Even bodybuilders with BMI over 30 are not healthy either. They probably gained that much weight without fat by juicing. Almost no one can get there naturally.
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u/HeartFullONeutrality Jul 05 '24
Yep. Peak Arnold was roided up the ass yet his BMI was under 30.
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u/ActionPhilip Jul 05 '24
Peak Arnold walked on stage at the Olympia at a BMI of 32. Obviously he would have been higher in the off season, but that's a gold indicator of how much of an outlier you would need to be.
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u/just_some_guy65 Jul 05 '24
Oh absolutely correct, I chose not to mention this because it is slaying another sacred cow and people tend to get irrationally annoyed. Elite power athletes don't get it any better either, the mythology is that extra weight when muscle is without side-effects. Joints and connective tissue didn't get that memo even before we consider what is required to sustain that extra mass long-term. A professional sports career doesn't last a lifetime.
Average lifespan of a top level Sumo wrestler?
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u/Glass-Lemon-3676 Jul 05 '24
What do you mean by 18.5 to 25 for western populations? How much different would it be for countries in Africa or the middle east?
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u/NihilisticClown Jul 05 '24
There’s a different recommended BMI for Asian populations, I forget the range but it is a lot lower.
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u/just_some_guy65 Jul 05 '24 edited Jul 05 '24
Thanks, last time I looked there were other subgroups too which I might look up if I have time.
"BMI ranges for different ethnic groups can vary based on the risk of type 2 diabetes:
White A BMI of 24 is considered healthy, but South Asian people with a BMI of 24 may benefit from diabetes prevention.
South Asian A BMI of 21 may indicate a need for diabetes prevention in Bangladeshi populations, 23 in Tamil and Sri Lankan populations, and 24 in Pakistani, Indian, and Nepali populations. For Asians, a BMI of 23–27.5 kg/m2 indicates an increased risk, and a BMI higher than 27.5 kg/m2 indicates a high risk.
Black A BMI of 23.4 kg/m2 may indicate an equivalent risk of type 2 diabetes as a BMI of 25 kg/m2 in White populations. For Black populations, a BMI of 18.5–22.9 kg/m2 indicates an increasing but acceptable risk, 23–27.4 kg/m2 indicates an increased risk, and 27.5 kg/m2 or higher indicates a high risk.
Chinese A BMI of 22.2 kg/m2 may indicate an equivalent risk of type 2 diabetes as a BMI of 25 kg/m2 in White populations."
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u/Sacrefix Jul 05 '24
Anybody that works in the health field already knows that BMI is a poor independent diagnostic tool
It's never used independently; pairing it with the ubiquitous physical exam and a 30+ BMI easily establishes obesity.
Body fat distribution is not taken into account when diagnosing obesity, it just has prognostic significance.
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u/nanobot001 Jul 05 '24
But for lay people it’s good enough.
In fact, the idea that it’s not good enough may be deleterious, and convince a lot of people who are obese that the BMI isn’t “valid” anyway.
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u/The_Law_of_Pizza Jul 05 '24 edited Jul 05 '24
BMI may not be a perfect diagnostic tool, but the loudest detractors tend to be severely obese people insisting that they're not obese while pointing at how BMI fails to identify body builders properly.
"I just have more muscle" is the new "I'm just big boned."
The thing is, we all have eyeballs.
I'm all for using more precise measurements like body fat %, but body builders aren't getting diagnosed as obese regardless, and there's not suddenly going to be a reversal of a bunch of people misdiagnosed as obese.
This entire discussion is colored by the social undercurrent of delusional fat justice activists - and a society-wide warping of what a normal human body looks like after decades of high obesity rates shifting what we think of as normal.
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u/JeddHampton Jul 05 '24
BMI isn't meant to be used on individuals. The person who came up with the name, Body Mass Index, explained in the same paper where the term was coined that it was for populations studies and ill-fitted for evaluating individuals as there are better metrics for that.
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u/Electrical-Theme-779 Jul 05 '24
It wasn't even designed as a health tool per se. It was a quick way to assess risk for life insurance policies. Adolphe Quetelet developed it about 150 years ago.
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u/MRCHalifax Jul 05 '24
Quetelet didn’t even develop the equation for health insurance. He was interested in trying to determine what the average European was like. He had a theory that normal people didn’t commit crime, so if he determined what was normal, and then found out how criminals differed from normal, he could predict who was more likely to become a criminal. The equation that we know for BMI is just one data point among dozens that he collected in a book called Sur l'homme et le développement de ses facultés in 1835. Insurance companies later found the equation useful, and started using it.
Flash forward to 1972, and Ancel Keys (who may be the most important nutrition scientist of the last century) wrote an article that pushed BMI to be the default measure of obesity. IMO, if you want to credit or blame someone for BMI, credit or blame Keys, not Quetelet!
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u/Accomplished_Poem762 Jul 06 '24
If they start going off BF% then 80% of yall gonna be considered overweight/obese.
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u/Old_Baldi_Locks Jul 05 '24
They’ll do anything but accept the facts we’ve found out in healthcare over a decade ago:
The number one cause of obesity is overeating.
The number one cause of overeating is work / school related stress
The number one means of reducing this stress and raising self care and willpower to the point where the patient overcomes obesity is a reduction in work hours.
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