Beautiful post that I’d love to see trending online but it made me feel good rather than outraged so I expect it to just kick ass on substack and not pop up in recommended reads online.
I think one reason why there’s so much push-back on BMI is that “overweight” and “obese” are socially loaded words. Especially for the health conscious, these terms denote failure. So, this is where nuance from potentially confounding factors like exercise become important.
I agree 100%. I'd have to do some research, but I'd guess the words were rather non-controversial when first used by doctors and scientists. But they've developed a stigma over time.
Do the higher risks of medical issues still apply to athletic people? For example I've always been a big athletic guy and have always been categorized as overweight/obese according to BMI. However my Resting HR sits around 42 and I would have to lose nearly 35lbs before I would be considered a "Normal Weight" even though I am already pretty trim at my higher weight. Do athletic people scew the "higher risk" data or are they such an anomaly that on a global scale its negligible?
I've noticed that the people who are the loudest about "BMI doesn't measure muscle mass!" are usually people who do not appear to have much muscle mass at all.
I see a lot of ladies my age group claim that they are obese by BMI because they have "a lot of muscle mass", and thus BMI is complete garbage. However, a rather cursory investigation into the off-season weights of professional female bodybuilders shows that while it is *possible* to be overweight or even verging on obese by BMI due to excessive muscle, we really only see that in elite professional bodybuilders, most of whom are chemically enhanced. It is very, very obvious when you look at those ladies, even at their off-season weights, that they have more muscle mass than a lot of *men* do; and that they are clearly a different situation altogether than your typical woman with the same BMI.
In my own case, at one point I dieted down to a very low bodyfat (around 16%) just to see what it would be like - and I was absolutely shocked to discover how much muscle I did not have. I mountain bike, lift weights, and have been working out for many years - but I would not have even had enough muscle mass to compete in a novice-level bikini competition.
So it's always amusing when I hear women who don't even lift weights (or only lift the teensiest of dumbbells) claim that they are BMI 30 or higher but it's OK because they are "so muscular."
Great post! I really appreciate hearing the science behind the metric.
I was confused by one point, though. You talk about a "hip-to-waist ratio" and explain how to measure it (reposted below), but it seems like that's just a measurement of the waist, not a ratio. Is it the waist measurement that is important or is there an additional ratio metric that's (also) important?
"To measure hip-to-waist ratio:
Wrap a tape around your middle, halfway between the bottom of your ribs and the top of your hips.
Breathe out, relax and pull so it’s taut but comfortable.
A measurement over 40 inches is a sign to speak to your doc and get a full assessment."
BMI as a measure for an individual’s health is pretty crude and this has limited utility.
But at the population level, BMI is incredibly useful to track the outcomes associated with increased rates of obesity. There are no controversies with BMI if you use the metric the way it was developed to be used.
Maybe change the title to “Anti-Anti-BMI: Using Common Sense and Rational Research to Make Use of Established Tools” and see how the exact same article does in search engines. Common sense and research are pretty anti-click bait though
Just like other indicators, BMI is simply a tool based on person-years of research. Couple BMI with resting HR, blood pressure, VO2max, etc. to get some idea of where you are on the spectrum of health. Even if you are the perfect specimen of health, you could still get hit by a bus, have a major health event, or be abducted by aliens (as noted above). So BS aside, “ass out the door” is the best way to improve your health!
Just looked at the BMI chart and it is really stupid. 120 is the minimum weight?? a 5'0" woman shoudl weight 100 pounds based on the HAMWI. At 5'6" I was underweight a few months ago at 117 pounds while I was in Chemo. I wasn't underweight-- i just looked too good for the fatsos at the CDC. BTW, their website before the new director -- big turnover there-- had photos of employees and all were obese. The current one has removed all those photos but their 55,000 employees in Atlanta are 65% FAT. Do you know that since 2008 JAPAN has had annual waistline measurement and men can't be over 33.5 inches; for the women it is 35 inches because they get pregnant-- except here where men get pregnant too!!. This country is in decline and all of the gluttony in food and exercise will enable China to be #1.
The BMI is a fraud. We used to measure with HAMWI where a 5'6" female at 160 pounds is OBESE. Since 1985 and the grading on the curve BMI thanks to the CDC, that woman at 5'6" is NOT OBESE at 185 pounds!! That is all anyone has to know. The CDC and NIH changed the formula in 1985 so Americnaas could continue to SHOP all the time; BUY more than they could afford; EAT EAT and EAT; they didn't anticpiate Covid which is really bad news if you are FAT. So we had to close down since our obesity is actually 60% not 41% which was stated by the flawed BMI. NOW the CDC gets a free paas since only waistline matters. Guess What? Everyone agrees on 35 inches as obese and the average Americna woman is 38.7 inches. Thank you Ozempic and Mounjaro. One of these drugs needs to be in the water supply. Then we can begin to figure out how a particular body should exercise which is good for health IF it is correct for the body doing it. Phony "nutrition" is something we need to drop unless the person is very sick.
The issue I have with BMI is that it doesn’t take your frame/skeletal size into account. My BMI is “normal” and I have also been “obese.” I have wide hips and shoulders and therefore a larger skeleton than someone who is my same height but has a smaller frame. I don’t think BMI is completely useless, but I do think this is an important consideration.
DEXA can give you a better sense of how much of your weight is muscle versus fat.
Downsides: DEXA is an expensive (in time and money) test and usually looking in the mirror or doing a caliper test can give you basically the same info at less cost.
One trouble with BMI is it is only one of many measures but I find doctors will size you up and decide he's just fine because I'm going to be one of the thinner men they see all day, 23 BMI.
There is a bias either way over concerned for people with high BMI's and lack of concern for people people with lower BMI's.
This is such a pleasant read. Thank you for calling out the invitation as well to ask for other tests from your doctor if your BMI concerns you—personalize it and take action.
Beautiful post that I’d love to see trending online but it made me feel good rather than outraged so I expect it to just kick ass on substack and not pop up in recommended reads online.
I think one reason why there’s so much push-back on BMI is that “overweight” and “obese” are socially loaded words. Especially for the health conscious, these terms denote failure. So, this is where nuance from potentially confounding factors like exercise become important.
I agree 100%. I'd have to do some research, but I'd guess the words were rather non-controversial when first used by doctors and scientists. But they've developed a stigma over time.
Do the higher risks of medical issues still apply to athletic people? For example I've always been a big athletic guy and have always been categorized as overweight/obese according to BMI. However my Resting HR sits around 42 and I would have to lose nearly 35lbs before I would be considered a "Normal Weight" even though I am already pretty trim at my higher weight. Do athletic people scew the "higher risk" data or are they such an anomaly that on a global scale its negligible?
Great question. I'm addressing this question on Wednesday! Thanks for weighing in.
I've noticed that the people who are the loudest about "BMI doesn't measure muscle mass!" are usually people who do not appear to have much muscle mass at all.
I see a lot of ladies my age group claim that they are obese by BMI because they have "a lot of muscle mass", and thus BMI is complete garbage. However, a rather cursory investigation into the off-season weights of professional female bodybuilders shows that while it is *possible* to be overweight or even verging on obese by BMI due to excessive muscle, we really only see that in elite professional bodybuilders, most of whom are chemically enhanced. It is very, very obvious when you look at those ladies, even at their off-season weights, that they have more muscle mass than a lot of *men* do; and that they are clearly a different situation altogether than your typical woman with the same BMI.
In my own case, at one point I dieted down to a very low bodyfat (around 16%) just to see what it would be like - and I was absolutely shocked to discover how much muscle I did not have. I mountain bike, lift weights, and have been working out for many years - but I would not have even had enough muscle mass to compete in a novice-level bikini competition.
So it's always amusing when I hear women who don't even lift weights (or only lift the teensiest of dumbbells) claim that they are BMI 30 or higher but it's OK because they are "so muscular."
Great post! I really appreciate hearing the science behind the metric.
I was confused by one point, though. You talk about a "hip-to-waist ratio" and explain how to measure it (reposted below), but it seems like that's just a measurement of the waist, not a ratio. Is it the waist measurement that is important or is there an additional ratio metric that's (also) important?
"To measure hip-to-waist ratio:
Wrap a tape around your middle, halfway between the bottom of your ribs and the top of your hips.
Breathe out, relax and pull so it’s taut but comfortable.
A measurement over 40 inches is a sign to speak to your doc and get a full assessment."
BMI as a measure for an individual’s health is pretty crude and this has limited utility.
But at the population level, BMI is incredibly useful to track the outcomes associated with increased rates of obesity. There are no controversies with BMI if you use the metric the way it was developed to be used.
Maybe change the title to “Anti-Anti-BMI: Using Common Sense and Rational Research to Make Use of Established Tools” and see how the exact same article does in search engines. Common sense and research are pretty anti-click bait though
Just like other indicators, BMI is simply a tool based on person-years of research. Couple BMI with resting HR, blood pressure, VO2max, etc. to get some idea of where you are on the spectrum of health. Even if you are the perfect specimen of health, you could still get hit by a bus, have a major health event, or be abducted by aliens (as noted above). So BS aside, “ass out the door” is the best way to improve your health!
Just looked at the BMI chart and it is really stupid. 120 is the minimum weight?? a 5'0" woman shoudl weight 100 pounds based on the HAMWI. At 5'6" I was underweight a few months ago at 117 pounds while I was in Chemo. I wasn't underweight-- i just looked too good for the fatsos at the CDC. BTW, their website before the new director -- big turnover there-- had photos of employees and all were obese. The current one has removed all those photos but their 55,000 employees in Atlanta are 65% FAT. Do you know that since 2008 JAPAN has had annual waistline measurement and men can't be over 33.5 inches; for the women it is 35 inches because they get pregnant-- except here where men get pregnant too!!. This country is in decline and all of the gluttony in food and exercise will enable China to be #1.
The BMI is a fraud. We used to measure with HAMWI where a 5'6" female at 160 pounds is OBESE. Since 1985 and the grading on the curve BMI thanks to the CDC, that woman at 5'6" is NOT OBESE at 185 pounds!! That is all anyone has to know. The CDC and NIH changed the formula in 1985 so Americnaas could continue to SHOP all the time; BUY more than they could afford; EAT EAT and EAT; they didn't anticpiate Covid which is really bad news if you are FAT. So we had to close down since our obesity is actually 60% not 41% which was stated by the flawed BMI. NOW the CDC gets a free paas since only waistline matters. Guess What? Everyone agrees on 35 inches as obese and the average Americna woman is 38.7 inches. Thank you Ozempic and Mounjaro. One of these drugs needs to be in the water supply. Then we can begin to figure out how a particular body should exercise which is good for health IF it is correct for the body doing it. Phony "nutrition" is something we need to drop unless the person is very sick.
The issue I have with BMI is that it doesn’t take your frame/skeletal size into account. My BMI is “normal” and I have also been “obese.” I have wide hips and shoulders and therefore a larger skeleton than someone who is my same height but has a smaller frame. I don’t think BMI is completely useless, but I do think this is an important consideration.
One test that can quantify body composition is the DEXA scan. Can this provide better risk assessments than BMI? Worth a dive.
DEXA can give you a better sense of how much of your weight is muscle versus fat.
Downsides: DEXA is an expensive (in time and money) test and usually looking in the mirror or doing a caliper test can give you basically the same info at less cost.
One trouble with BMI is it is only one of many measures but I find doctors will size you up and decide he's just fine because I'm going to be one of the thinner men they see all day, 23 BMI.
There is a bias either way over concerned for people with high BMI's and lack of concern for people people with lower BMI's.
I really appreciated this deep dive into BMI. It was very well presented and thought provoking.
I had a really long response in my head, took a deep breath and instead will just say thanks for a great read. Looking forward to Wednesday’s article!
This is such a pleasant read. Thank you for calling out the invitation as well to ask for other tests from your doctor if your BMI concerns you—personalize it and take action.