10 reasons why BMI is bogus

I love, love, love this piece from NPR on the top 10 (suggesting there are more than 10) reasons why BMI is a bogus measurement. My favorite:

The person who dreamed up the BMI said explicitly that it could not and should not be used to indicate the level of fatness in an individual.

Go read the rest for yourself.

Argh!

This is exactly the kind of story that makes me wish the New York Times really would close the Boston Globe, as they've been threatening. Not to blame the messenger or anything.

But come on--has it really come to this? This fall, Massachusetts schools will send home "weight reports" with students in first, fourth, seventh, and tenth grades, which will, according to this story, alert parents "if their child weighs to much or too little."

Multiple levels of Argh! apply here. Too much or too little according to whom? Will this be another episode in the Annals of Administrators Acting as Doctors? Who, exactly, will become the Weight Police?

Authorities in Mass. promise that the new reports will "provide suggestions on where to turn for help." I'd love to see them. No, wait, I've already seen them! Because there's nothing concrete or new here. We can predict that the state's suggestions on how to "help" kids who weigh "too much" will not be helpful at all, because, um, read the news, people--we don't know how to make people thinner. Even if we all agreed that everyone should weigh a certain weight, we haven't the faintest idea on how to get them to weigh that for more than a month or two.

Have these folks not seen the research on how dieting makes you fatter? Do they think they know something the rest of us don't know?

The geniuses behind this legislation dismiss worries that the new mandate will trigger eating disorders. That's pretty ignorant. I'm guessing they have no idea how toxic the dialogue gets around food and weight, especially in middle school. My 8th grader tells me that body bashing is "a bonding experience" among the girls in her class; if you don't join in, you're not one of the group. Swell. I think a mandate like this will really help, don't you?

Please go to the article and leave a comment. Please, if you live in Massachusetts, write to your legislators. (Here's a list with links.) Let your voice be heard on this one.

Suffer the little children

The latest "SmartSummary" from our much-hated health insurer arrived in the mail yesterday. I'm sure one reason our premiums are so high is that they periodically generate an 8-page booklet for each member of the family, replete with all sorts of useless information.

The piece that really burned my boat was this page, which arrived only with my 8th-grader's package. Let's take a minute to deconstruct this noxious document, shall we?

First, take note of the underlying threatening tone of the introduction. In case you can't read the scan, here it is:

Before you go back to school, take a minute to think about how sitting in class means you'll need more time for physical activity outside of school to stay healthy. Use this Body Mass Index (BMI) to figure out if you're in a healthy weight range, then you can see how to burn more calories and eat healthier in a way that fits your lifestyle.

Ths little gem offends on a variety of criteria, starting with the grammatical and syntactical errors (comma splice, word repetition, and excess verbiage). It then moves on to emotinal blackmail. Sitting in class leads to not staying healthy, unless you add more physical activity. There's a not-so-implicit threat here: You've got to burn off every minute you spend sitting on your tush and studying, kids.

For a kid like my older daughter, who likes to play by the rules and do everything "right," this notion could be enough to trigger a lifelong eating disorder, not to mention a fear of school and studying. And who's to say that each kid isn't already plenty physically active? The summary assumes that kids aren't getting enough exercise. Maybe they are, maybe they aren't. But this piece of paper sure as hell doesn't know.

Moving down the page, notice the list titled "Burn the Calories." One of the most egregious ideas behind the whole "wellness" movement is the idea that you can quantify and generalize in this way. Whereas anyone with a whiff of education on the subject knows that this depends not only on the size and age of the person in question but on his/her particular metabolism. Yet this paper confidently announces that a half hour of soccer burns 238 calories. Bullshit.

The eating disorder triggers continue on the bottom left of the page, where my daughter is told that 1 small cheeseburger would take 29 minutes of jogging to "burn off." There's a lot wrong here, starting with the idea that every bite you take must be "burned off." That's like saying every gallon gas you put into your car must be used immediately. Then there's the implicit idea that the foods listed here--plain "donut" (sic), cheeseburger, piece of pie, fried chicken sandwich--are bad for you and must be routed from your system asap.

Finally there's the ubiquitous BMI calculator and BMI chart. Once more with feeling: The idea of "ranges" is beside the point, especially for growing children. What's healthy for one child at one point in her life will not be the same as what's healthy for another child, or for the same child six months later.

I call this Bullshit 101. And I'm ever so glad my hard-earned money will no longer be going toward creating such appalling crap.

If I had a (smaller) hammer . . .

To a hammer, everything looks like a nail. And the proverbial hammer we often talk about is the BMI, a simple height/weight ratio that's more and more being used to identify and punish everyone from schoolchildren to the lederly for being fat.

Of course, BMI is a crude tool, a hammer, if you will, because it doesn't take into account muscle mass, or percentage of body fat, or anything beyond height and weight. So most athletes fall into the overweight if not obese category, according to BMI charts. Tom Cruise's BMI makes him obese, because he's short and densely muscled.

Now, finally, someone somewhere is paying attention. In a study published in Nutrition Journal, researchers at the University of Pavia in Italy did a small study looking at how weight loss recommendations would change for a group of people when they applied different measures of overweight:

The researchers obtained each person's BMI as well as body-fat measurements including waist circumference and total percent body fat. The also calculated a measurement similar to BMI that identifies fat mass called body fat mass index. The investigators then compared the percentage of the study group that would be told to lose weight according to each calculation.

BMI calculations, they found, identified 11 percent of the group as needing strong recommendations to lose weight and 41 percent as needing basic recommendations to lose weight. By contrast, waist circumference measurements indicated about 25 percent would need strong recommendations to shed pounds and 36 percent would need basic weight loss recommendations, Colombo said.

Moreover, 29 percent and 48 percent would have received similar weight loss recommendations according to total percent body fat measurements, while 21 percent and 54 percent would receive the same, according to body fat mass index.

The lead researcher, Dr. Ottavio Columbo, concluded, "Using criteria based on body adiposity (fatness) rather than body weight would result in a much greater proportion of the study population receiving recommendations for weight loss."

Yeah. We coulda told you that. But hey, it's a start.

A little question of semantics

When I showed my daughter the NYT piece on the fatosphere the other day, her only comment was, "But you're not fat."

What she meant, of course, was "You're not that fat."

Put me next to, say, Ellen Pompano, and I certainly look fat. Put me next to someone who weighs 400 pounds and I don't look fat. Or I don't look as fat.

Fat and thin are words that exist mainly in relation to each other. At the extremes of each range we can certainly identify them correctly. But in the vast middle, our judgment becomes much more relative.

Semantics plays a role in the current anti-obesity hysteria. For starters, the definitions and rules changed in 1998, when the cutoff for overweight was lowered from 27.3 to 25 on the BMI chart. Bingo--instant overnight overweight for millions.

As Paul Campos has pointed out in The New Republic, the way we talk about fat and thin, oveweight and obese and underweight, is something of a shell game.

Fat qua fat is not the problem. Because, after all, we all have fat on our bodies. What's more, we need fat. Without it, your body doesn't work well and your brain sure as hell doesn't work right. I've seen the evidence up close and personal, and it's not pretty.

Think about it the next time you find yourself saying, "But I'm so fat!" or the next time you look in the mirror. Come back and tell me how it changed your perception.

Ludicrosity

This new "study" deserves its very own made-up word--that's how utterly ridiculous and misleading it is.

It's a classic case of distortion, from the headline--"Obese? Drive at Your Own Risk!"--to the bait-and-switch of its conclusion. Based on research involving people in car accidents, it purports to look at how BMI affects your risk of dying in a car accident.

Here's how it opens:

Being obese may increase the risk of perilous diseases like diabetes, heart attack, stroke and cancer. And it can be fatal in one more way -- it enhances the risk of dying in a car crash.

What's the connection? Well might you ask. This is one of those reviews masquerading as a study, where researchers look at data--in this case, data on people involved in car accidents and their BMI.

Researchers divided over 230,000 people into groups based on their body mass index (BMI) . The rate of always wearing seat belts was 82.6 per cent for non-obese motorists (BMI less than 25), 80.1 per cent for overweight motorists (BMI 25-29), 76.6 per cent for obese motorists (BMI 30-39) and 69.8 per cent for extremely obese motorists (BMI 40 and above). The gap climbed from 2.5 per cent for overweight, to 6.0 per cent among the obese, to 12.8 per cent among the extremely obese.

Um, what we've got here is a correlation between not wearing your seat belt and dying in a car crash, along with a statistical analysis of percentage of seat belt wearers and their BMI.

As Sandy Szwarc is fond of saying correlation is not causation. Or, to put it another way: The media is willing, but the evidence is weak.

Please tell me this isn't happening . . .

At least one health insurer (and probably others) will actually be docking your paycheck if your BMI is over 30, starting in 2009.

The article's headline reads "Being Unhealthy Could Cost You--Money," but of course it should have read "Being Fat Can Cost You--Money." And that's on top of it costing you so many other things--the right to adopt a child, a seat on an airplane, a job. . . .

I wish I were a lawyer so I could start researching all the ways in which this is illegal. A nice big lawsuit--maybe a class action suit--might nip this repulsive idea in the bud.




**Thanks to BFB for posting on this first.

"Fitnessgrams" for kids

My 11-year-old daughter's report card came in the mail today. Along with the usual list of academic subjects and grades came another piece of paper with a big orange bar at the top. In blue blue letters it read FITNESSGRAM. Below was a graph of how my daughter had performed on a series of fitness tests, including a one-mile run, abdominal curl-ups, trunk lifts, push-ups, and flexibility. Then there was another little box labeled "Body Mass Index," showing her past and current BMIs plotted against a bar graph. Her scores were in the green "healthy fitness zone." To the right was a large red area--danger! fatsos coming!--labeled "Needs improvement." That's where your bar graph ends up if your BMI is "too high." To the left was a tiny red box labeled "very low," which is, I suppose, where your bar graph ends up if you're anorexic.

I guess this is supposed to be a cute, non-threatening way of communicating with parents, a kind of casual, unofficial, "Say, did you know your kid's in great shape?" or "Hey, by the way, your kid's kinda fat!"

This is insulting on any number of levels, of course, but let's just pick one: the suggestion that it's better to be too skinny than too fat, which as we know is not supported by any actual science.** Why isn't the "too skinny" area labeled something like "needs medical attention now!"? Why isn't the "too fat" area labeled "plenty of nutritional reserves!"?

My daughter was more upset about the fake activity pyramid on the back of the fitnessgram, modeled after that most famous of irrelevancies, the USDA food pyramid. At the bottom, the widest section was labeled "lifestyle activity," and it listed walking, biking, skateboarding, housework, yardwork, dancing, and playing active games. The next level held two smaller squares labeled aerobic activity and aerobic sports. One level up, another two squares were labeled muscular activity and flexibility activity. The smallest section, the point of the pyramid, was labeled "rest," and it included schoolwork, homework, reading, computer games, TV, videos, eating, resting, and sleeping.

Clearly these are the things you're supposed to do as little of as possible. My daughter was outraged. "I wonder what the teachers would think about this!" she cried. "You're not supposed to read?"

Imagine boot camp. Then imagine a sergeant from boot camp running the schools. "You there, cadet, stop wasting time with your nose in a book and give me 50 on the floor!" Never mind the fact that kids are supposed to be developing their intellectual capabilities at this (and every) age; in the new Fitness World, only activities that burn calories are sanctioned. Even by schools.

I feel like we're living in a Kurt Vonnegut story. And it's only gonna get worse.


** Calorie reduction (CR) nutcases notwithstanding.