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“BMI” and “snake oil” in the same article: I like it!

Posted by on Mar 20, 2011 in Blog Posts | 9 comments

7. It suggests there are distinct categories of underweight, ideal, overweight and obese, with sharp boundaries that hinge on a decimal place.

That’s total nonsense.

That was # 7 of 10. Here’s the link to the article on NPR in the Top Ten Reasons BMI is bogus… Parents beware! Here’s a post I did a little while back about pooping or not and how it could tip your child from one category to the next… One mom I talked to today shared that she was appalled that her two year old was being labeled. What are your BMI horror stories?

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  1. MrsSlats

    Hm.. docs have never used BMI on my kids, but they’re underweight “Your son is below the 7th percentile in weight”
    Didn’t pester me much about it either, just suggestions on content rich foods, and he wound up evening out (smack in the middle of average now). They didn’t say a word about my daughter being underweight, since my son was and turned out fine- even though she has a heart condition. She’s also smack in the middle of average now.

    I just hope they don’t have to have the same issues as me when they grow though, since now that I’ve had two kids, and happen to take after everyone in my family I’m now “obese.” But hey, at least this “obese” chick eats right (or perhaps too /little/) and exercises :)

    • katja

      That’s lucky you haven’t been pestered, and you point out a statistical fact, most kids at the “extremes” will tend towards the mean if they are supported well with feeding. The fact that you are not worried about their size, and not pushing them to eat more to make them bigger makes it more likely they are eating based on hunger and fullness cues and will make them more able to self-regulate as they get older. I don’t think it’s a coincidence that we see 85-90% of parents push kids to eat more (one more bite…) and that we have seen rising rates of fatness. Oh, and I love the Health at Every Size model. “obese” can be healthy, and sounds like you are living well and raising happy and healthy kids.

  2. ila

    The widespread use of the BMI, and the parallel equations where fat=unhealthy and thin=healthy, can be extremely harmful, even for thin people. An elderly person in my family has terrible osteoporosis, and her doctor is always telling her that she needs to do some exercise, even if it’s just a 30-minute walk every day, to strengthen her bones and muscles. She worked a sedentary job for fifty years and, now that she’s retired, she has a very sedentary lifestyle. She refuses to exercise because “Why should I? I’m not fat, I’ve been wearing the same size clothes since I got married, my BMI is perfect, I’m healty. If I was fat, like some of my friends who have started doing aquagym or pilates to lose weight, I would think about it, but I clearly don’t need it!”

    • katja

      yes, this is the flip-side. If we only use BMI as a measure, we ignore and miss the opportunity to help all the lean kids who are not healthy (no fitness level, poor nutrition etc…) As in your mother’s case, it is a false sense of security, and who can blame her? We don’t hear stories about the epidemic of sedentary un-fit folks, we hear about the fat folks, some of who are in excellent health.

  3. RachelB

    My parents are in the process of packing up to move, so during my last few visits, I’ve been sorting through the old scrapbooks they saved from my elementary school days. Among it all, I found some records from the Presidential Physical Fitness campaign (Reagan era, I think), which measured how we did as individuals on a number of fitness tests– arm strength (flexed arm hang), leg flexibility, cardiovascular fitness (running a mile), the number of sit-ups we could do in a minute. And, capping off the test, they measured our individual BMIs.

    In retrospect, even the fitness tests that were skill-based seem a little silly: Why should the flexibility or strength of one muscle be presumed to tell anything about the flexibility or strength of all your muscles? What about kids whose cardiovascular systems are in great shape, but who don’t have use of their legs?

    But what I want especially to point out here: The paperwork we got telling us how we did on all of these items compared us to our peers nationwide in percentile terms– the same terms that standardized tests use (e.g., “You were more flexible than 80% of the people who took this flexibility test”). Our teachers encouraged us to try to “improve” our numbers every year. It strikes me as downright dangerous to treat include BMI in such a fitness assessment, to treat a low BMI as if it’s an achievement, something to strive for.

    I don’t believe that BMI is a marker of health. And I really don’t believe that any good can come out of treating a lower BMI as something to compete with one’s peers for. (I do remember seeing a disclaimer about “If you’re in the whateverth percentile for BMI, we do not recommend that you try to lose more weight.” But I was already into the range of parent-concerningly thin, yet did not fall into the presidential fitness BMI “we don’t mean you!” disclaimer range, for what that’s worth.)

  4. AmandaL

    My husband went to his doc for the first time, and was weighed (fully clothed, by the way) and told he needed to lose some weight, since he was BMI 29. He got his initial visit completed and went home. All was fine until we got the bill, which had the entire claim rejected by insurance because there was an “obesity clause”, where anything that had an obesity diagnosis was rejected, and the doc had put on the code for “obese”, even though he had only talked to my fella about it for 1 minute out of a 25 minute exam. We had to pay nearly $400 out of pocket for what was supposed to just have been a routine physical. When we called the office to try to explain that a) he had not gone to be seen for his weight and b) that the code was what was causing the problem and could they resubmit with a different code? the office manager accused us of asking them to lie about what the visit was for, even though they didn’t have the code on for the initial physical in the first place! It was totally ridiculous.

    A good friend of ours, who was using the Navy SEAL training regimine to work out just because he wanted to see if he could do it, was also told that he was “technically obese” by his doc because his BMI was 29, even though he had 4% body fat and was simply solid muscle.

    • katja

      that is totally outrageous, and I would fight that one… Even DCD and WHO say BMI is not a diagnostic test. You could probably challenge that one… I bet the doctor didn’t document adequately what he did to justify such a high charge. They are going to rake in money if they code “obesity” and do “counseling” (eat less, exercise more, that’ll be $400…) Also, the measure wasn’t accurate, and if the BMI was 29, it was not technically obese. I would fight this to get that code off your chart… You can email me privately if you want more ideas. Even that code on the record might mean higher premiums, denial of coverage for a “pre-existing condition” etc…

  5. Anna

    Oh God. The BMI! -shakes fist-

    I’ve always been a really heavy kid, but when I was younger I was not particularly fat. However, I still remember being ten years old, and we all had to work out our BMIs and have it put on a chart. My BMI was much higher than everyone else’s, but it didn’t bother me until I brought it to the teacher. The teacher then insisted to weigh myself with him watching because he couldn’t believe what I told him.

    It was the first of many times because have been stunned because their idea of “obese” people didn’t match what the BMI actually said. So many times I’ve heard people go on and on about obesity, and how BMI should be used in schools, only to not believe me when I tell them that I’m obese too. I remember going to a doctor who lectured me about my high bmi, even though I was in the midst of an eating disorder where I ate nothing for days and exercised for seven to eight hours a day. He never asked me what I ate or how much I exercised, just imemdiately started in on how I should lay off the chocolate. BECAUSE THE BMI TOLD HIM SO.

    • katja

      A) that’s insane that they had you do that in school B) those numbers are meaningless for many, just as you say, when I show people pictures of “obese” kids in conference, there are audible gasps C) BMI is ridiculous, not a diagnostic test. I urge everyone to challenge any diagnosis code based on BMI alone…