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.
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Take This Two-Minute Executive Dysfunction Test
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Roll For Initiative
Some of us struggle with executive dysfunction a lot; others, a little.
What Is Executive Dysfunction?
• Executive function is a broad group of mental skills that enable people to complete tasks and interact with others.
• Executive dysfunction can impair a person’s ability to organize and manage behavior
• Executive dysfunction is not a specific stand-alone diagnosis or condition.
• Instead, conditions such as depression and ADHD (amongst others) can affect a person’s executive function.
Take This Two-Minute Executive Dysfunction Test
How did you score? (8/16 here!)
Did you do it? (it honestly is really two minutes and is quite informative)
If not, here’s your cue to go back up and do it
For almost all of us, we sometimes find ourselves torn between several competing tasks, and end up doing… none of them.
For such times, compile yourself a “productivity buffet”, print it, and pin it above your desk or similar space.
What’s a productivity buffet?
It’s a numbered list of 6, 8, 10, 12 or 20 common tasks that pretty much always need doing (to at least some extent!). Doesn’t matter how important they are, just that they are frequently recurring tasks. For example:
- Tidy desk (including that drawer!)
- Reply to emails/messages
- Drink water
- Collect stray one-off to-dos into a list
- Stretch (or at least correct your posture!)
- Extend that Duolingo streak
- Read one chapter of a book
- Etc
Why 6, 8, 10, 12, or 20?
Because those are common denominations of polyhedral dice that are very cheap to buy!
Keep the relevant die to hand (perhaps in your pocket or on your desk), and when you know you should be doing something but can’t decide what exactly, roll the die and do the item corresponding to the number you roll.
And if you find yourself thinking “damn, I got 12, I wanted 7!” then go ahead and do item 7—the dice aren’t the boss of you, they’re just there to break the ice between you and your to-do list!
The Housekeeper In Your Pocket?
If you found the tidying tips (up top) helpful, but don’t like cleaning schedules because you just can’t stick to them, this one’s for you.
It’s easy to slip into just doing the same few easy tasks while neglecting others for far too long.
The answer? Outsource!
Not “get a cleaner” (though if you want to and can, great, go for it, this one won’t be for you after all), but rather, try this nifty little app that helps you keep on top of daily cleaning—which we all know is better than binge-cleaning every few months.
Sweepy keeps track of:
- What jobs there are that might need doing in each room (or type of room) in the house
- How often those jobs generally need doing
- How much of your energy (a finite resource, which it also takes into account!) those jobs will take
- How much energy you are prepared to spend per day (you can “lighter/heavier” days, or even “off-days”, too)
…and then it populates a small daily task list according to what needs cleaning and how much energy it’ll take.
For example, today Sweepy gives me (your trusty writer, hi! ) the tasks:
- Bathroom: clean sink (every 3 days, 1pt of energy)
- Dining room: clean and tidy table (every day, 1pt of energy)
- Bedroom: vacuum floor (every 7 days, 2pts of energy)
- Kitchen: clean coffee machine (every 30 days, 2pts of energy)
And that’s my 6pts of energy I’ve told Sweepy I’m happy to spend per day cleaning. There are “3 pts” tasks too—cleaning the oven, for example—but none came up today.
Importantly: it does not bother me about any other tasks today (even if something’s overdue), and I don’t have to worry my pretty head about it.
I don’t have to feel guilty for not doing other cleaning tasks; if they need doing, Sweepy will tell me tomorrow, and it will make sure I don’t get behind or leave anything neglected for too long.
Check it out (available for both iOS and Android)
PS: to premium or not to premium? We think the premium is worth it (unlocks some extra customization features) but the free version is sufficient to get your house in order, so don’t be afraid to give it a try first.
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Happy Mind, Happy Life – by Dr. Rangan Chatterjee
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Let’s start with a “why”. If happiness doesn’t strike you as a worthwhile goal in and of itself, Dr. Chatterjee discusses the health implications of happiness/unhappiness.
And, yes, including in studies where other factors were controlled for, so he shows how happiness/unhappiness does really have a causal role in health—it’s not just a matter of “breaking news: sick people are less happy”.
The author, a British GP (General Practitioner, the equivalent of what the US calls a “family doctor”) with decades of experience, has found a lot of value in the practice of holistic medicine. For this reason, it’s what he recommends to his patients at work, in his books, his blog, and his regular spot on a popular BBC breakfast show.
The writing style is relaxed and personable, without skimping on information density. Indeed, Dr. Chatterjee offers many pieces of holistic health advice, and dozens of practical exercises to boost your happiness and proof you against adversity.
Because, whatever motivational speakers may say, we can’t purely “think ourselves happy”; sometimes we have real external threats and bad things in life. But, we can still improve our experience of even these things, not to mention suffer less, and get through it in better shape with a smile at the end of it.
Bottom line: if you’d like to be happier and healthier (who wouldn’t?), then this book is a sure-fire way to set you on that path.
Click here to check out Happy Mind, Happy Life and upgrade yours!
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Veg in One Bed New Edition – by Huw Richards
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
We all know that growing our own veg is ultimately not only healthier on the plate, but also a very healthy activity. Cheaper too. So why don’t more of us do it?
For many of us, it’s a matter of not having the skills or knowledge to do so. This book bridges that knowledge-gap.
Richards gives, as promised, a month-by-month well-illustrated guide to growing a wide variety of vegetables. He does, by the way, assume that we are in a temperate climate in the Northern Hemisphere. So if you’re not, you may need to make some adjustments.
The book doesn’t assume prior knowledge, and does give the reader everything we need from an initial basic shopping list onwards.
A particular strength of this book is that it’s about growing veg in a single raised bed—this ensures keeping everything very manageable.
Bottom line: if you have ever thought it would be good to grow your own veg, but didn’t know where to start and want something practical for a beginner, this is an excellent guide that will get you going!
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Easy Ways To Fix Brittle, Dry, Wiry Hair
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Dr. Sam Ellis, a dermatologist, specializes in skin, hair, and nail care—and she’s here with professional knowledge:
Tackling the problem at the root
As we age, hair becomes less shiny, more brittle, coarse, wiry, or gray. More concerningly for many, hair thinning and shedding increases due to shortened growth phases and hormonal changes.
The first set of symptoms there are largely because sebum production decreases, leading to dry hair. It’s worth bearing in mind though, that factors like UV radiation, smoking, stress, and genetics contribute to hair aging too. So while we can’t do much about genetics, the modifiable factors are worth addressing.
Menopause and the corresponding “andropause” impact hair health, and hormonal shifts, not just aging, drive many hair changes. Which is good to know, because it means that HRT (mostly: topping up estrogen or testosterone as appropriate) can make a big difference. Additionally, topical/oral minoxidil and DHT blockers (such as finasteride or dutasteride) can boost hair density. These things come with caveats though, so do research any possible treatment plan before embarking on it, to be sure you are comfortable with all aspects of it—including that if you use minoxidil, while on the one hand it indeed works wonders, on the other hand, you’ll then have to keep using minoxidil for the rest of your life or your hair will fall out when you stop. So, that’s a commitment to be thought through before beginning.
Nutritional deficiencies (iron, zinc, vitamin D) and insufficient protein intake hinder hair growth, so ensure proper nutrition, with sufficient protein and micronutrients.
While we’re on the topic of “from the inside” things: take care to manage stress healthily, as stress negatively affects hair health.
Now, as for “from the outside”…
Dr. Ellis recommends moisturizing shampoos/conditioners; Virtue and Dove brands she mentions positively. She also recommends bond repair products (such as K18 and Olaplex) that restore hair integrity, and heat protectants (she recommends: Unite 7 Seconds) as well as hair oils in general that improve hair condition.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
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The Diabetes Drugs That Can Cut Asthma Attacks By 70%
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Asthma, obesity, and type 2 diabetes are closely linked, with the latter two greatly increasing asthma attack risk.
While bronchodilators / corticosteroids can have immediate adverse effects due to sympathetic nervous system activation, and lasting adverse effects due to the damage it does to metabolic health, diabetes drugs, on the other hand, can improve things with (for most people) fewer unwanted side effects.
Great! Which drugs?
Metformin, and glucagon-like peptide-1 receptor agonists (GLP-1RAs).
Specifically, researchers have found:
- Metformin is associated with a 30% reduction in asthma attacks
- GLP-1RAs are associated with a 40% reduction in asthma attacks
…and yes, they stack, making for a 70% reduction in the case of people taking both. Furthermore, the results are independent of weight, glycemic control, or asthma phenotype.
In terms of what was counted, the primary outcome was asthma attacks at 12-month follow-up, defined by oral corticosteroid use, emergency visits, hospitalizations, or death.
The effect of metformin on asthma attacks was not affected by BMI, HbA1c levels, eosinophil count, asthma severity, or sex.
Of the various extra antidiabetic drugs trialled in this study, only GLP-1 receptor agonists showed a further and sustained reduction in asthma attacks.
Here’s the study itself, hot off the press, published on Monday:
JAMA Int. Med. | Antidiabetic Medication and Asthma Attacks
“But what if I’m not diabetic?”
Good news:
More than half of all US adults are eligible for semaglutide therapy ← this is because they’ve expanded the things that semaglutide (the widely-used GLP-1 receptor agonist drug) can be prescribed for, now going beyond just diabetes and/or weight loss 😎
And metformin, of course, is more readily available than semaglutide, so by all means speak with your doctor/pharmacist about that, if it’s of interest to you.
Take care!
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10almonds Tells The Tea…
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Let’s Bust Some Myths!
It’s too late after puberty, hormones won’t change xyz
While yes, many adult trans people dearly wish they’d been able to medically transition before going through the “wrong” puberty, the truth is that a lot of changes will still occur later… even to “unchangeable” things like the skeleton.
The body is remaking itself throughout life, and hormones tell it how to do that. Some parts are just quicker or slower than others. Also: the skeleton is pulled-on constantly by our muscles, and in a battle of muscle vs bone, muscle will always win over time.
Examples of this include:
- trans men building bigger bones to support their bigger muscles
- trans women getting smaller, with wider hips and a pelvic tilt
Trans people have sporting advantages
Assuming at least a year’s cross-sex hormonal treatment, there is no useful advantage to being trans when engaging in a sport. There are small advantages and disadvantages (which goes for any person’s body, really). For example:
- Trans women will tend to be taller than cis women on average…
- …but that larger frame is now being powered by smaller muscles, because they shrink much quicker than the skeleton.
- Trans men taking T are the only athletes allowed to take testosterone…
- …but they will still often be smaller than their fellow male competitors, for example.
Read: Do Trans Women Athletes Have Advantages? (A rather balanced expert overview, which does also cover trans men)
There’s a trans population explosion; it’s a social contagion epidemic!
Source for figures: The Overall Rate Of Left-Handedness (Researchgate)
Left-handed people used to make up around 3% of the population… Until the 1920s, when that figure jumped sharply upwards, before plateauing at around 12% in around 1960, where it’s stayed since. What happened?! Simple, schools stopped forcing children to use their right hand.
Today, people ask for trans healthcare because they know it exists! Decades ago, it wasn’t such common knowledge.
The same explanation can be applied to other “population explosions” such as for autism and ADHD.
Fun fact: Mt. Everest was “discovered” in 1852, but scientists suspect it probably existed long before then! People whose ancestors were living on it long before 1852 also agree. Sometimes something exists for a long time, and only comes to wider public awareness later.
Transgender healthcare is too readily available, especially to children!
To believe some press outlets, you’d think:
- HRT is available from school vending machines,
- kids can get a walk-in top surgery at recess,
- and there’s an after-school sterilization club.
In reality, while availability varies from place to place, trans healthcare is heavily gatekept. Even adults have trouble getting it, often having to wait years and/or pay large sums of money… and get permission from a flock of doctors, psychologists, and the like. For those under the age of 18, it’s almost impossible in many places, even with parental support.
Puberty-blockers shouldn’t be given to teenagers, as the effects are irreversible
Quick question: who do you think should be given puberty-blockers? For whom do you think they were developed? Not adults, for sure! They were not developed for trans teens either, but for cis pre-teens with precocious puberty, to keep puberty at bay, to do it correctly later. Nobody argues they’re unsafe for much younger cis children, and only object when it’s trans teens.
They’re not only safe and reversible, but also self-reversing. Stop taking them, and the normally scheduled puberty promptly ensues by itself. For trans kids, the desired effect is to buy the kid time to make an informed and well-considered decision. After all, the effects of the wrong puberty are really difficult to undo!
A lot of people rush medical transition and regret it!
Trans people wish it could be rushed! It’s a lot harder to get gender-affirming care as a trans person, than it is to get the same (or comparable) care as a cis person. Yes, cis people get gender-affirming care, from hormones to surgeries, and have done for a long time.
As for regret… Medical transition has around a 1% regret rate. For comparison, hip replacement has a 4.8% regret rate and knee replacement has a 17.1% regret rate.
A medical procedure with a 99% success rate would generally be considered a miracle cure!
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