Tag Archives: body mass index

Honesty is the best policy when it comes to your health

Have you ever justified your weight by saying you are “big-boned”? What about your eating and exercise habits? How often do you really eat out? How many days did you actually get to the gym last month? Are you being honest with yourself when it comes to your health? And are you asking others to be honest with you?

Being honest about your health is the topic of my Health & Fitness column in the Aiken Standard this week.


Being honest with yourself is essential for initiating health behavior changes and setting good goals. For example, someone who tells themselves they need to lose “a few pounds” may really need to lose much more and may not take their weight loss as seriously as they should. Convincing yourself that you are doing more exercise than you really are may mean that you won’t see the fitness or weight loss results you were expecting.

This type of self-deception is easy to do. Take body weight for example. The current standard for determining if you are at a healthy weight is body mass index (BMI), calculated from your weight and height (kg/m2). It requires a bit of math, so using a mobile app or online calculator is a good idea.

A BMI between 18.5 and 24.9 is considered normal, 25-29.9 is overweight, and if your BMI is 30 or higher, you are classified as obese. To put this in perspective, a BMI of 30 is equivalent to about 25–30 pounds of excess fat.

Let’s say your BMI puts you in the obese category, suggesting you should lose weight. But then you think about an article you read about how BMI isn’t accurate because you can be considered obese if you have excess muscle, not fat. And then there was the story on the news suggesting that it is okay to be obese as long as you are physically fit. So, maybe you don’t need to worry about your weight!

See how easy it is to tell yourself that you don’t really need to lose weight? In reality, BMI is an accurate method of assessing your body fatness; the inaccuracies reported in the news almost always involve athletes or people with lots of muscle mass developed through physical labor. Be honest…is that really you? It’s also true that people who are fit and fat can be healthier than people who are thin and sedentary, but it requires a lot of exercise to reach that level of fitness. Again, are you really that fit?

Probably the best test is to take a good look in the mirror and be honest about what you see. Try to “pinch an inch” of fat around your belly. One inch isn’t necessarily a problem, but take notice if you can pinch a handful of fat. Measuring your waist circumference (or looking at your pants size) can give you the same information. People who have a high BMI because of extra muscle, like athletes, have thin waists. If your waist circumference is greater than 35 inches ( women) or 40 inches (men), you have excess fat.

This honesty also applies to others, including your doctor. Many physicians are reluctant to discuss weight and weight loss with their patients, and many patients don’t want to hear what they interpret as a personal attack. Don’t be one of those patients! Ask your doctor for an honest assessment about your weight and the impact it might have on your health.

This is a real problem. According to one report, only 39 percent of obese people surveyed had ever been told by a health care provider that they were obese.     To help combat this problem, the American Medical Association has developed resources to help physicians better communicate with patients about their weight.

Making changes to diet and activity habits is a difficult process, to be sure. Telling yourself that you don’t need to make them only delays getting started and can lead to poor health in the meantime. When it comes to your health, honesty is the best policy!


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Honesty is the best policy

Being honest about your health is the topic of my Health & Fitness column in the Aiken Standard this week.

Have you ever justified your weight by saying you are “big-boned?” What about your eating and exercise habits? How often do you really eat out? How many days did you actually get to the gym last month? Are you being honest with yourself when it comes to your health? And are you asking others to be honest with you?

Being honest with yourself is essential for initiating health behavior changes and setting good goals. For example, someone who tells themselves they need to lose “a few pounds” may really need to lose much more and may not take their weight loss as seriously as they should. Convincing yourself that you are doing more exercise than you really are may mean that you won’t see the fitness or weight loss results you were expecting.

This type of self-deception is easy to do. Take body weight for example. The current standard for determining if you are at a healthy weight is body mass index (BMI), calculated from your weight and height (kg/m2). It requires a bit of math, so using a mobile app or online calculator is a good idea. A BMI between 18.5 and 24.9 is considered normal, 25-29.9 is overweight, and if your BMI is 30 and higher you are classified as obese. To put this in perspective, a BMI of 30 is equivalent to about 25–30 pounds of excess fat.

Let’s say your BMI puts you in the obese category, suggesting you should lose weight. But then you think about an article you read about how BMI isn’t accurate because you can be considered obese if you have excess muscle, not fat. And then there was the story on the news suggesting that it is okay to be obese as long as you are physically fit. So, maybe you don’t need to worry about your weight!

See how easy it is to tell yourself that you don’t really need to lose weight. In reality, BMI is an accurate method of assessing your body fatness; the inaccuracies reported in the news almost always involve athletes or people with lots of muscle mass developed through physical labor. Be honest…is that really you? It’s also true that people who are fit and fat can be healthier than people who are thin and sedentary, but it requires a lot of exercise to reach that level of fitness. Again, are you really that fit?

Probably the best test is to take a good look in the mirror and be honest about what you see. Try to “pinch an inch” of fat around your belly. One inch isn’t necessarily a problem, but take notice if you can pinch a handful of fat. Measuring your waist circumference (or looking at your pants size) can give you the same information. People who have a high BMI because of extra muscle, like athletes, have thin waists. If your waist circumference is greater than 35 inches (for women) or 40 inches (men), you have excess fat.

This honesty also applies to others, including your doctor. Many physicians are reluctant to discuss weight and weight loss with their patients, and many patients don’t want to hear what they interpret as a personal attack. Don’t be one of those patients! Ask your doctor for an honest assessment about your weight and the impact it might have on your health.

This is a real problem. According to one report, only 39 percent of obese people surveyed had ever been told by a health care provider that they were obese.     To help combat this problem, the American Medical Association has developed resources to help physicians better communicate with patients about their weight.

Making changes to diet and activity habits is a difficult process, to be sure. Telling yourself that you don’t need to make them only delays getting started and can lead to poor health in the meantime. When it comes to your health, honesty is the best policy!

Why BMI matters–Commentary from my soapbox.

My Health & Fitness column in the Aiken Standard this week is about body mass index (BMI), the most commonly used measure of body fatness and health. It was prompted by a recent article in the journal Science that raised familiar questions about whether or not BMI is a valid indicator of obesity and health.

This lead to reports in the popular media about BMI, like this one in Time magazine, the tone of which suggests that doctors and researchers who use BMI don’t know what they are doing. Since I use BMI in research and in practice, I  felt I should address both the article and share some other important points and additional thoughts about BMI.

1. BMI is so widely used because it is simple to measure – it only requires knowing height and weight – and because it is a good indicator of body weight and health risks. That said, it’s not perfect (see below). You can calculate your BMI here.

2. One of the biggest criticisms of BMI is that it can’t distinguish between fat and non-fat tissue, meaning that a person could have a high BMI but not be overly fat. The elevated BMI could be due to excess muscle, as is common in athletes. This is true: BMI doesn’t differentiate between muscle and fat. In fact, it isn’t even a measure of body fat. But in most cases, people who have a high BMI do have a high percent fat.

Don’t believe me? Then try what I call he Wal-Mart test. Go to Wal-Mart someday and measure the BMI and percent fat of everyone who comes through the door. What you will no doubt find is that the majority of the people who have a high BMI are overfat and relatively few have a high BMI due to excess muscle. This is why BMI works so well on a population level.

3. Even though BMI may misclassify some people as overfat when they aren’t, there is a simple way to avoid this: measure their waist circumference. People who have a high BMI due to excess muscle will have a narrow waist (think body builders) and those who are overfat will have a high waist circumference (think Homer Simpson). The point is that it is easy not to misclassify someone if they are in front of you.

4. Another criticism is that it is possible to have a normal BMI but have a high percent fat. This is something that we have seen in our lab and it almost always occurs in people who are thin but unfit–they don’t exercise.  The problem is that a normal BMI indicates good health, but if a person has a lot of fat they really aren’t very healthy.

This is also a valid criticism. And it is especially true if the excess fat is visceral fat, which is stored deep in the abdomen and is associated with higher risks of diabetes, hypertension, and heart disease. But there are other indicators of health risk beyond body fatness, including blood pressure, blood glucose, and blood cholesterol. BMI should be used in conjunction with these other factors to assess overall health.

5. Research also suggests that being overweight or obese according to BMI isn’t necessarily unhealthy and that having a normal BMI isn’t always better. But that is only part of the story. The part that gets left out is physical fitness. It’s true…research shows that the risk of death is lower among people who are overweight or obese but have a high level of physical fitness compared to normal weight individuals who are unfit.

This suggests that regular exercise (to become and stay fit) is at least as important as body weight in determining the risk of death. No question this is true!

However, this doesn’t mean that people who are “fit and fat” are necessarily healthier. The research shows a lower risk of death during a specific follow-up period, but doesn’t make claims about the health during that time. It is possible, even likely, that obesity is associated with some impairment of health—back pain, for example—that normal weight subjects might not experience. Exercise can reduce those problems, but there are likely still some reasons why losing some weight might benefit even those obese individuals who are fit.

Furthermore, I wonder how many obese people are fit enough to have a lower risk of death. I suspect that number is low. Maybe we should add a fitness test to the Wal-Mart test to find out.

6. These problems aren’t a failing of BMI itself, it is the fact that BMI isn’t meant to be used alone. BMI is just one measure of health. When used in combination with others, like waist circumference and physical fitness, BMI is a much better predictor of current and future health problems.

Using BMI alone and complaining that it doesn’t accurately assess health is inappropriate.  Your doctor wouldn’t measure just your blood pressure, find hat it is normal, and proclaim you healthy, right? The same is true for BMI.

With that said, I will step off my soapbox. At least for now.