Thursday, January 3, 2013

Massive Bodyness

Through the years of medical check-ups, I was always told I was "basically healthy" but could stand to lose weight. I had a high BMI (in the obese range), but overall my vitals were good. That changed as I got older. My "slightly elevated" blood pressure was considered full-blown hypertension by the time I hit 40, and I was put on medication. My cholesterol, which was always a worry, was now considered dangerously high. (An attempt at meds came with too many side effects, so I just pretended to monitor it). I lost a lot of my stamina and got sick often. And I suffered from IBS, which I blamed on my misspent youth and surreptitious intake of various substances, not on anything I might actually be eating at that moment.

With weight loss and exercise came better results: My cholesterol dropped 90(!) points, my BP is almost perfect, my digestive issues have all but vanished and I rarely ever get sick. The fact the rest of my life has been pretty stressful the past few years and I still am healthier than before makes me believe that this is due to my current weight, food intake and exercise regimen. Basically, I just FEEL better, even when the day is crappy.

But interestingly enough, my BMI still puts me in the "Overweight" category. 75 lbs. lost and I'm still overweight. Granted, it's by one measly point, but there it is. Even if I no longer have to go to the "Special" sections to find pants or shirts or belts, I am overweight in some sense. I'm certainly not chiseled (I still have what I refer to as "the donut" around my middle), but I am certainly healthy. In fact, I've even gained a pound or two as my fat to muscle ratio has changed dramatically in the past 3 months. It can't just be height and weight as the basis for health.

All this comes to mind because of the buzz surrounding a recent article in JAMA, in which the authors aggregated various studies and found that people in the "overweight" BMI category tended to have a lower mortality rate than those in the "normal" category. The diet industry and health professionals are screaming bloody murder. The "anti-diet" folks are beaming with smirky pride.

Now, as someone who has made their living mulling through research, I can honestly say that results are where you find them.Yes, in many of these studies, this difference in mortality rate was recorded, but there's often no data presented as to what else was going on with these test subjects. As the accompanying editorial to the article states: "Body mass index is known to be an imperfect predictor of metabolic risk." And then cites another article which studied "metabolically obese normal weight subjects."

And yet we still look to BMI as the indicator. The posters about your BMI are in every gym and doctors office. There's thousands of BMI widgets all over different websites. 

An editorial by Paul Campos in the NY Times responds to this whole study. Campos has railed against the diet industry in this country before and I do agree with him on many levels. We are obsessed with an unhealthy view of ourselves. 

But we're also very unhealthy folks.Do you need a BMI number to tell you that not being able to walk up stairs unwinded or having to be on medications is not a good thing?

I think instead of crying "bad science" about the article or the claiming new found freedom that a lot bloggers seem to be chanting over this study, we should all just agree that basing one's health solely on height and weight is not the best thing. Yes, you can be too fat or too thin, but that can never be the sole reason for a unhealthy diagnosis. But being healthy at a higher BMI is a lot different than just having a higher BMI.

One day I may get into the "normal" BMI range, but I doubt that one point will be the stake that adds or drops years from my life. However, the 13 points I dropped in BMI numbers from when I was at my heaviest? Yeah, that does count. A lot.


Flegal KM, Kit BK, Orpana H, Graubard BI. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA. 2013;309(1):71-82. doi:10.1001/jama.2012.113905. 

Heymsfield SB, Cefalu WT. Does Body Mass Index Adequately Convey a Patient's Mortality Risk?. JAMA. 2013;309(1):87-88. doi:10.1001/jama.2012.185445.  

Florence Conus, Rémi Rabasa-Lhoret, François Péronnet.Characteristics of metabolically obese normal-weight (MONW) subjects. Applied Physiology, Nutrition, and Metabolism, 2007, 32:4-12, 10.1139/h06-092.

Campos, Paul. “Our Imaginary Weight Problem.” The New York Times, January 2, 2013, sec. Opinion.

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