When BMI Doesn’t Measure Up
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When BMI Doesn’t Quite Measure Up
Last month, we did a “Friday Mythbusters” edition of 10almonds, tackling many of the misconceptions surrounding obesity. Amongst them, we took a brief look at the usefulness (or lack thereof) of the Body Mass Index (BMI) scale of weight-related health for individuals. By popular subscriber request, we’re now going to dive a little deeper into that today!
The wrong tool for the job
BMI was developed as a tool to look at large-scale demographic trends, stemming from a population study of white European men, who were for the purpose of the study (the widescale health of the working class in that geographic area in that era), considered a reasonable default demographic.
In other words: as a system, it’s now being used in a way it was never made for, and the results of that misappropriation of an epidemiological tool for individual health are predictably unhelpful.
If you want to know yours…
Here’s the magic formula for calculating your BMI:
- Metric: divide your weight in kilograms by your height in square meters
- Imperial: divide your weight in pounds by your height in square inches and then multiply by 703
“What if my height doesn’t come in square meters or square inches, because it’s a height, not an area?”
We know. Take your height and square it anyway. If this seems convoluted and arbitrary, yes, it is.
But!
While on the one hand it’s convoluted and arbitrary… On the other hand, it’s also a gross oversimplification. So, yay for the worst of both worlds?
If you don’t want to grab a calculator, here’s a quick online tool to calculate it for you.
So, how did you score?
According to the CDC, a BMI score…
- Under 18.5 is underweight
- 18.5 to 24.9 is normal
- 25 to 29.9 is overweight
- 30 and over is obese
And, if we’re looking at a representative sample of the population, where the representation is average white European men of working age, that’s not a bad general rule of thumb.
For the rest of us, not so representative
BMI is a great and accurate tool as a rule of thumb, except for…
Women
An easily forgotten demographic, due to being a mere 51% of the world’s population, women generally have a higher percentage of body fat than men, and this throws out BMI’s usefulness.
If pregnant or nursing
A much higher body weight and body fat percentage—note that these are two things, not one. Some of the extra weight will be fat to nourish the baby; some will be water weight, and if pregnant, some will be the baby (or babies!). BMI neither knows nor cares about any of these things. And, this is a big deal, because BMI gets used by healthcare providers to judge health risks and guide medical advice.
People under the age of 16 or over the age of 65
Not only do people below and above those ages (respectively) tend to be shorter—which throws out the calculations and mean health risks may increase before the BMI qualifies as overweight—but also:
- BMI under 23 in people over the age of 65 is associated with a higher health risk
- A meta-analysis showed that a BMI of 27 was the best in terms of decreased mortality risk for the over-65 age group
This obviously flies in the face of conventional standards regards BMI—as you’ll recall from the BMI brackets we listed above.
Read the science: BMI and all-cause mortality in older adults: a meta-analysis
Athletic people
A demographic often described in scientific literature as “athletes”, but that can be misleading. When we say “athletes”, what comes to mind? Probably Olympians, or other professional sportspeople.
But also athletic, when it comes to body composition, are such people as fitness enthusiasts and manual laborers. Which makes for a lot more people affected by this!
Athletic people tend to have more lean muscle mass (muscle weighs more than fat), and heavier bones (can’t build strong muscles on weak bones, so the bones get stronger too, which means denser)… But that lean muscle mass can actually increase metabolism and help ward off many of the very same things that BMI is used as a risk indicator for (e.g. heart disease, and diabetes). So people in this category will actually be at lower risk, while (by BMI) getting told they are at higher risk.
If not white
Physical characteristics of race can vary by more than skin color, relevant considerations in this case include, for example:
- Black people, on average, not only have more lean muscle mass and less fat than white people, but also, have completely different risk factors for diseases such as diabetes.
- Asian people, on average, are shorter than white people, and as such may see increased health risks before BMI qualifies as overweight.
- Hispanic people, on average, again have different physical characteristics that throw out the results, in a manner that would need lower cutoffs to be even as “useful” as it is for white people.
Further reading on this: BMI and the BIPOC Community
In summary:
If you’re an average white European working-age man, BMI can sometimes be a useful general guide. If however you fall into one or more of the above categories, it is likely to be inaccurate at best, if not outright telling the opposite of the truth.
What’s more useful, then?
For heart disease risk and diabetes risk both, waist circumference is a much more universally reliable indicator. And since those two things tend to affect a lot of other health risks, it becomes an excellent starting point for being aware of many aspects of health.
Pregnancy will still throw off waist circumference a little (measure below the bump, not around it!), but it will nevertheless be more helpful than BMI even then, as it becomes necessary to just increase the numbers a little, according to gestational month and any confounding factors e.g. twins, triplets, etc. Ask your obstetrician about this, as it’s beyond the scope of today’s newsletter!
As to what’s considered a risk:
- Waist circumference of more than 35 inches for women
- Waist circumference of more than 40 inches for men
These numbers are considered applicable across demographics of age, sex, ethnicity, and lifestyle.
There are more options than just waist circumference though; we delve into them in detail here:
Take care!
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Altered Traits – by Dr. Daniel Goleman & Dr. Richard Davidson
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We know that meditation helps people to relax, but what more than that?This book explores the available science.
We say “explore the available science”, but it’d be remiss of us not to note that the authors have also expanded the available science, conducting research in their own lab.
From stress tests and EEGs to attention tests and fMRIs, this book looks at the hard science of what different kinds of meditation do to the brain. Not just in terms of brain state, either, but gradual cumulative anatomical changes, too. Powerful stuff!
The style is very pop-science in presentation, easily comprehensible to all. Be aware though that this is an “if this, then that” book of science, not a how-to manual. If you want to learn to meditate, this isn’t the book for that.
Bottom line: if you’d like to understand more about how different kinds of meditation affect the brain differently, this is the book for you.
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World Menopause Day Health News Round-Up
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In order to provide variety in this week’s round-up, not all of this is menopause-related, but it is all important:
Menopause & CVD
Untreated menopause is associated with higher incidence of heart disease, and higher mortality. People often forget about how much estrogen does for us (well, for those of us with a physiology running on estrogen, anyway; gentlemen, your testosterone is fine for you), and think it is “just” a sex hormone, but it’s a lot more.
Read in full: Menopause transition linked to increased heart disease risk
Related: What Menopause Does To The Heart
Extraterrestrial medical technology
The much lower gravity in Earth orbit has allowed for tissue engineering techniques that Earth’s normal gravity imposes limitations on. This is big news, because it means that rather than replacing a whole liver, tissue implants could be grafted, allowing the extant liver to repair itself (something livers are famously good at, but they need enough undamaged base material to work with).
Read in full: How liver tissue from the International Space Station may transform tissue engineering
Related: How To Unfatty A Fatty Liver
One thing and then another
As if endometriosis weren’t unpleasant enough in and of itself, the endothelial dysfunction inherent to it also raises cardiovascular disease risk. This is important, because while endometriosis has (like many maladies predominantly affecting women) generally been shrugged off by the medical world as an unhappy inconvenience but not life-threatening, now we know it comes with extra existential risks too:
Read in full: Understanding cardiovascular risks in endometriosis patients
Related: What You Need To Know About Endometriosis
Push-button meditation
Unlike mindfulness meditation, listening to music is a very passive experience, and thus requires less effort from the user. And yet, it has been associated with lower perceived pain levels, lower self-reported anxiety levels, less opioid use, and measurably lower heart-rate.
Read in full: Listening to music may speed up recovery from surgery, research suggests
Related: Nobody Likes Surgery, But Here’s How To Make It Much Less Bad
Cholesterol in menopause: quality over quantity
Much like previous research has shown that the quantity of LDL is not nearly so predictive of health outcomes in women as it is in men, this study into HDL and menopausal women shows that quantity of HDL does not matter nearly so much as the quality of it.
Read in full: HDL quality, not quantity, contribute to the first sign of Alzheimer’s disease in women
Related: Statins: His & Hers? ← consistent with the above, statins (to lower LDL cholesterol) generally help more for men and produce more adverse side effects for women. So again, a case of “the actual amount of cholesterol isn’t so important for women as for men”.
Take care!
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Topping Up Testosterone?
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The Testosterone Drop
Testosterone levels decline amongst men over a certain age. Exactly when depends on the individual and also how we measure it, but the age of 45 is a commonly-given waypoint for the start of this decline.
(the actual start is usually more like 20, but it’s a very small decline then, and speeds up a couple of decades later)
This has been called “the male menopause”, or “the andropause”.
Both terms are a little misleading, but for lack of a better term, “andropause” is perhaps not terrible.
Why “the male menopause” is misleading:
To call it “the male menopause” suggests that this is when men’s menstruation stops. Which for cis men at the very least, is simply not a thing they ever had in the first place, to stop (and for trans men it’s complicated, depending on age, hormones, surgeries, etc).
Why “the andropause” is misleading:
It’s not a pause, and unlike the menopause, it’s not even a stop. It’s just a decline. It’s more of an andro-pitter-patter-puttering-petering-out.
Is there a better clinical term?
Objectively, there is “late-onset hypogonadism” but that is unlikely to be taken up for cultural reasons—people stigmatize what they see as a loss of virility.
Terms aside, what are the symptoms?
❝Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like…❞
…and there we’d like to continue the quotation, but if we list the symptoms here, it won’t get past a lot of filters because of the words used. So instead, please feel free to click through:
Source: Andropause: Current concepts
Can it be safely ignored?
If you don’t mind the sexual symptoms, then mostly, yes!
However, there are a few symptoms we can mention here that are not so subjective in their potential for harm:
- Depression
- Loss of muscle mass
- Increased body fat
Depression kills, so this does need to be taken seriously. See also:
The Mental Health First-Aid That You’ll Hopefully Never Need
(the above is a guide to managing depression, in yourself or a loved one)
Loss of muscle mass means being less robust against knocks and falls later in life
Loss of muscle mass also means weaker bones (because the body won’t make bones stronger than it thinks they need to be, so bone will follow muscle in this regard—in either direction)
See also:
- Resistance Is Useful! (Especially As We Get Older)
- Protein vs Sarcopenia
- Fall Special (How to Proof Yourself Against Falls)
Increased body fat means increased risk of diabetes and heart disease, as a general rule of thumb, amongst other problems.
Will testosterone therapy help?
That’s something to discuss with your endocrinologist, but for most men whose testosterone levels are lower than is ideal for them, then yes, taking testosterone to bring them [back] to “normal” levels can make you happier and healthier (though it’s certainly not a cure-all).
See for example:
Testosterone Therapy Improves […] and […] in Hypogonadal Men
(Sorry, we’re not trying to be clickbaity, there are just some words we can’t use without encountering software problems)
Here’s a more comprehensive study that looked at 790 men aged 65 or older, with testosterone levels below a certain level. It looked at the things we can’t mention here, as well as physical function and general vitality:
❝The increase in testosterone levels was associated with significantly increased […] activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased […] desire and […] function.
The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003).
Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo❞
Source: Effects of Testosterone Treatment in Older Men
We strongly recommend, by the way, when a topic is of interest to you to read the paper itself, because even the extract above contains some subjectivity, for example what is “slightly better”, and what is “no significant benefit”.
That “slightly better mood and lower severity of depressive symptoms”, for example, has a P value of 0.004 in their data, which is an order of magnitude more significant than the usual baseline for significance (P<0.05).
And furthermore, that “no significant benefit with respect to vitality” is only looking at either the primary outcome aggregated goal or the secondary FACIT score whose secondary outcome had a P value of 0.06, which just missed the cut-off for significance, and neglects to mention that all the other secondary outcome metrics for men involved in the vitality trial were very significant (ranging from P=0.04 to P=0.001)
Click here to see the results table for the vitality trial
Will it turn me into a musclebound angry ragey ‘roidmonster?
Were you that kind of person before your testosterone levels declined? If not, then no.
Testosterone therapy seeks only to return your testosterone levels to where they were, and this is done through careful monitoring and adjustment. It’d take a lot more than (responsible) endocrinologist-guided hormonal therapy to turn you into Marvel’s “Wolverine”.
Is testosterone therapy safe?
A question to take to your endocrinologist because everyone’s physiology is different, but a lot of studies do support its general safety for most people who are prescribed it.
As with anything, there are risks to be aware of, though. Perhaps the most critical risk is prostate cancer, and…
❝In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development
For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.
Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy❞
Those are some select extracts, but any of this may apply to you or your loved one, we recommend to read in full about this and other risks:
Risks of testosterone replacement therapy in men
See also: Prostate Health: What You Should Know
Beyond that… If you are prone to baldness, then taking testosterone will increase that tendency. If that’s a problem for you, then it’s something to know about. There are other things you can take/use for that in turn, so maybe we’ll do a feature on those one of these days!
For now, take care!
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An Elegant Defense – by Matt Richtel
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In a way, Richtel got the best and worst of the publication date lottery. This book, which he’d obviously been working on for however long, was published in March 2020. Yes, that March 2020. So, it obviously got a huge boost in sales that launced it to bestseller status, and/but it doesn’t actually discuss COVID at all.
What it does discuss, is—as one might expect—the immune system. Or really, the immune systems, plural, several systems working alongside each other. How we got to have such, how our immune functions work, where all the various immune cells come from and what part they play. What pathogens can do to fight and/or confuse (or even co-opt) our immune response, and what modern medicine can do to counteract the pathogens’ anti-countermeasure countermeasures. And how it can still go wrong.
The “Four Lives” promised in the subtitle are stories, and Richtel explains the immune system through specific people’s specific battles. In particular, a friend of his who had quite a remarkable battle against cancer, which was of course terrible for him, but illustrative for us.
The style of the book is very readably journalistic. The author is a Pulitzer-winning NYT journalist, and not normally a science writer. Here at 10almonds, “we like big bibliographies and we cannot lie”, and we didn’t get to enjoy that in this case. The book contained no bibliography (nor appropriate inline citations, nor equivalent footnotes). Maybe a future addition will include this.
Bottom line: there’s a lot of “science for the lay reader” here. While the lack of references is a big oversight, the book does give a very good overview of what both sides (immune response and pathogenic invasion) bring to the battle of your body.
Click here to check out Elegant Defense, and demystify immunology!
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More Mediterranean – by American’s Test Kitchen
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Regular 10almonds readers will know that we talk about the Mediterranean diet often, and with good reason; it’s been for quite a while now the “Gold Standard” when it comes to scientific consensus on what constitutes a good diet for healthy longevity.
However, it’s easy to get stuck in a rut of cooking the same three meals and thinking “I must do something different, but not today, because I have these ingredients and don’t know what to cook” and then when one is grocery-shopping, it’s “I should have researched a new thing to cook, but since I haven’t, I’ll just get the ingredients for what I usually cook, since we need to eat”, and so the cycle continues.
This book will help break you out of that cycle! With (as the subtitle promises) hundreds of recipes, there’s no shortage of good ideas. The recipes are “plant-forward” rather than plant-based per se (i.e. there are some animal products in them), though for the vegetarians and vegans, it’s nothing that’s any challenge to substitute.
Bottom line: if you’re looking for “delicious and nutritious”, this book is sure to put a rainbow on your plate and a smile on your face.
Click here to check out More Mediterranean, and inspire your kitchen!
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Unprocessed – by Kimberly Wilson
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First, what this is not: hundreds of pages to say “eat less processed food”. That is, of course, also advisable (and indeed, is advised in the book too), but there’s a lot more going on here too.
Though not a doctor, the author is a psychologist who brings a lot of data to the table, especially when it comes to the neurophysiology at hand, what forgotten micronutrients many people are lacking, and what trends in society worsen these deficiencies in the population at large.
If you only care about the broadest of take-away advice, it is: eat a diet that’s mostly minimally processed plants and some oily fish, watch out for certain deficiencies in particular, and increase dietary intake of them where necessary (with taking supplements as a respectable next-best remedy).
On which note, a point of criticism is that there’s some incorrect information about veganism and brain health; she mentions that DHA is only found in fish (in fact, fish get it from algae, which has it, and is the basis of many vegan omega-3 supplements), and the B12 is found only in animals (also found in yeast, which is not an animal, as well as various bacteria in soil, and farm animals get their B12 from supplements these days anyway, so it is arguable that we could keep things simpler by just cutting out the middlecow).
However, the strength of this book really is in the delivery of understanding about why certain things matter. If you’re told “such-and-such is good for the brain”, you’ll up your intake for 1–60 days, depending on whether you bought a supermarket item or ordered a batch of supplements. And then you’ll forget, until 6–12 months later, and you’ll do it again. On the other hand, if you understand how something is good or bad for the brain, what it does (for good or ill) on a cellular level, the chemistry and neurophysiology at hand, you’ll make new habits for life.
The style is middle-range pop-science; by this we mean there are tables of data and some long words that are difficult to pronounce, but also it’s not just hard science throughout—there’s (as one might expect from an author who is a psychologist) a lot about the psychology and sociology of why many people make poor dietary decisions, and the things governments often do (or omit doing) that affect this adversely—and how we can avoid those traps as individuals (unless we be incarcerated or such).
As an aside, the author is British, so governmental examples are mostly UK-based, but it doesn’t take a lot to mentally measure that against what the governments of, for example, the US or Canada do the same or differently.
Bottom line: there’s a lot of great information about brain health here; the strongest parts are whether the author stays within her field (psychology encompasses such diverse topics as neurophysiology and aspects of sociology, but not microbiology, for example). If you want to learn about the physiology of brain health and enjoy quite a sociopolitical ride along the way, this one’s a good one for that.
Click here to check out Unprocessed, and make the best choices for you!
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