Body Mass Index Under Scrutiny

In yesterday’s post "The Obesity-Disease Connection" The New York Times explained how obesity can make ovarian cancer even more dangerous and harder to survive. Nicholas Bakalar reported:
But among patients with Stage III or Stage IV disease, the most advanced stages, those with B.M.I.’s greater than 25 survived disease free for an average of 17 months, compared with 25 months for people with indexes lower than 25.
For each increase of one unit in the index, the researchers found a 4 percent increase in the risk of recurrence and a 5 percent increase in the risk of death.
In Eat to Live you’ll see Dr. Fuhrman agrees; obesity increases a person’s risk of a whole host of medical conditions:
  • Increased overall premature mortality
  • Adult onset diabetes
  • Hypertension
  • Degenerative arthritis
  • Coronary artery disease
  • Cancer
  • Lipid disorders
  • Obstructive sleep apnea
  • Gallstones
  • Fatty infiltration of the liver
  • Restrictive lung disease
  • Gastrointestinal disease
Alright, so we know being obese doesn’t help your chances of living a long healthy life, but what about this whole BMI thing? As reported by The New York Times the whole ovarian cancer study was based on these measurements. But is it really the be-all-end-all for determining if someone is obese, or even if they’re just overweight?

Linda Carroll of MSNBC reports some health experts definitely concerns about the Body Mass Index:
The real question, says Dr. Donald Cutlip, an associate professor of medicine at the Harvard Medical School, is whether body mass index is a good measure to determine whether someone is overweight.

The conflicting studies, each based on BMI scores, point out flaws with the common measure, basically a comparison of height to weight.

New research shows that there’s a better, more informative way to figure out if you are overweight—the waist-to-hip ratio—and all it requires is a measuring tape.
A lot of the worry stems from the BMI’s inability to give an accurate measurement for elderly people or individuals with a lot of muscle:
Cutlip agrees that BMI can be way off, especially when it comes to assessing a particular individual. The commonly used measure can give a skewed result not only for fit body builders who come out with a high number because of the extra weight associated with muscle, but also for the elderly, who tend to have scores that underestimate obesity because they have so much less muscle.
A more favorable way of determining if someone has dangerous levels of body fat might be the Waist-To-Hip Ratio. Carroll explains:
The best way to predict heart attack risk and other obesity-related diseases is a measurement that divides the circumference of your waist by your hips.

If you’re a woman, the waist-to-hip ratio should come out as no more than 0.8. Men have a little more wiggle room: a healthy waist-to-hip ratio for them is 0.95.

This means, if your belly has bulged out enough to catch up to the size of your hips, you should start worrying about your heart, experts say.
(Be sure to try out the calculator accompanying the article.)

Now considering all this, how does Dr. Fuhrman determine if a person has an unhealthy bodyweight? The answer is right between his fingers:
I just take a pinch near the umbilicus and squeeze it lightly between two fingers and measure the distance between the fingers.
In a previous post he talks about his method: A Life Plan for The New Year
Most people lose weight and then stop losing when they have reached their ideal weight. You are not the judge of your ideal weight; your body is. As almost everyone is overweight, many people think they are too thin when they have reached their best weight. I have many patients who, after following my plan to reverse diabetes or heart disease, report, “Everyone tells me I look too thin now.” I then measure their periumbilical fat and check their percentage of body fat, and usually show them they are still not thin enough.
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