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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Bell Pepper vs Onion – Which is Healthier?
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Our Verdict
When comparing bell pepper to onion, we picked the bell pepper.
Why?
First, you might remember that different color bell peppers have different nutritional profiles. So, you might be wondering why we didn’t specify the color.
The reason is: the things that differ from one color to another are important differences between the respective bell peppers, but they make no difference to this comparison, as for any given nutrient that changes from one color to another, it doesn’t change the outcome, because the numbers are still on the same side relative to onions.
With that in mind…
It was close!
In terms of macros, everything in these “mostly water with enough fiber to hold them together” foods is close enough to call this first round a tie.
In the category of vitamins, things are a little clearer; bell peppers have lot more of vitamins A, B1, B2, B3, B6, C, E, and K, while onions have slightly more of vitamins B5 and B9, yielding to bell peppers an 8:2 victory here.
Looking at minerals, bell peppers have more copper, iron, magnesium, and potassium, while onions have more calcium, phosphorus, selenium, and zinc, for a 4:4 tie in this round.
Adding up the sections makes for a modest overall win for bell peppers, but by all means enjoy either or both, as diversity is best!
Want to learn more?
You might like:
Which Bell Peppers To Pick? A Spectrum Of Specialties ← for the differences between the different colors
Enjoy!
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Nutrition To Combat Lymphedema & Lipedema
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Dr. Kelly Sturm is a rehab specialist (Doctor of Physical Therapy), and also a certified lymphedema therapist. Here’s what helps her patients with lymphedema and lipedema:
Don’t fan the flames
Lymphedema and lipedema are inflammatory lymphatic diseases affecting mostly women. As such, an anti-inflammatory diet will be important, but there are other factors too:
- Anti-inflammatory diet: this is to reduce the chronic inflammation associated with lymphatic diseases. This means eating plenty of fruit and vegetables, especially berries and leafy greens, and avoiding things like sugar, alcohol, caffeine, and processed foods. And of course, don’t smoke.
- Intermittent fasting: this also helps by giving the body a chance to correct itself; when the body isn’t digesting food, it has a lot more resources to devote to its favorite activity: maintenance. This results in lower inflammation, and better fat redistribution.
- Weight loss: not a bandwagon we often get on at 10almonds as it’s rarely the most important thing, but in this case it is of high importance (second only to dealing with the inflammation), as excess weight around the lymph nodes and vessels can lead to dysfunction and swelling. Thus, reducing the weight can ease that and allow the body to heal.
For more details on all of the above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Eat To Beat Inflammation ← also some non-dietary advice in there too
- Ask Not What Your Lymphatic System Can Do For You…
- Lose Weight, But Healthily ← more useful than just trying to run a calorie deficit
Take care!
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Most People Try The Wrong Way To Unshrimp Their Posture (Here’s How To Do It Better)
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Many people try to correct posture by pulling the shoulders back and tucking in the chin, but that doesn’t work. Happily, there is a way that does! Kinesiologist Kyle Waugh demonstrates:
Defying gravity
The trick is simple, and is about how maintaining good posture needs to be unconscious and natural, not forced. After all, who is maintaining singular focus for 16 waking hours a day?
Instead, pay attention to how the body relates to gravity without excessive muscle tension, aligning the (oft-forgotten!) hips, and maintaining balance. The importance of hip position is really not to be underestimated, since in many ways the hips are a central axis of the body just as the spine is, and the spine itself sits in the hips.
A lot of what holds the body in poor posture tends to be localized muscle tensions, so address those with stretches and relaxation exercises.
For a few quick tests and exercises to try, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
6 Ways To Look After Your Back ← no video on this one, just 6 concepts that you can apply to your daily life
Take care!
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The Surprising Place Fat Can Accumulate To Shrink Your Brain
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.
Popular belief: body fat is bad for the health
Counterpoint: body fat is necessary for health
Nuance: not all fat is created equal, and nor does it stay that way depending on where it goes
Let’s get metabolical
Fat (in the human body) has several purposes, including:
- Store energy for use later
- Provide thermal insulation
- Provide physical padding against injury
That latter may seem trivial, by the way, but it’s really not. Aside from subcutaneous fat cushioning certain parts of us in visible ways, the much-maligned fat of our viscera is important too, for it helps prevent damage to our organs—until we get too much of it, and then it can cause its own problems, which we wrote about here:
Visceral Belly Fat & How To Lose It
Another place fat can get stored that’s not ideal is the liver. This tends to happen when our glucose metabolism gets overloaded, and the body has to start stuffing glycogen wherever it can, and the result is overtaxing the liver, and that’s what happens in the case of what what used to be called non-alcoholic fatty liver disease (NAFLD) and is now called metabolic dysfunction-associated steatotic liver disease (MASLD).
Attentive readers may have noticed that there appears to be a D missing from the acronym. We noticed that too, and were not able to find any explanation of why it’s not MDASLD.
However, you can read about why the change was made, and how the decision was agreed upon, here: A multisociety Delphi consensus statement on new fatty liver disease nomenclature
Anyway, whatever we want to call it, it’s a problem, and we wrote a practical guide to fixing it, here: How To Unfatty A Fatty Liver
Further, when it comes to even just subcutaneous fat (i.e. the kind that lives just under your skin, that you can squish, unlike visceral fat or hepatic fat, which you can’t. Or if you can, then you have bigger problems, such your abdomen being open), there are some places it can go that are healthier than others.
For what’s best and worst in that regard, see: How To Make Your Body Fat Heart-Healthier
And, for that matter: Can We Do Fat Redistribution?
Sometimes, it’s the type of fat that makes a difference!
See: The BAT-pause! ← the title here refers to the production of highly beneficial brown adipose tissue (BAT) slowing down during the menopause, if we’re not careful—but there are things we can do to convert white adipose tissue to yellow and brown.
Sometimes, it isn’t!
See: The Fat That Fuels Alzheimer’s Disease
And today, it’s…
Pancreatic fat
No surprises that this should be an issue (the pancreas is where insulin is made, after all, unless you have Type 1 Diabetes, anyway), but it’s not much talked-about, and not well-known.
Recently, researchers (Dr. Miao Yu et al.) examined whether where fat is stored in your body matters for brain health more than overall weight or BMI, and their analysis used MRI and health data from 25,997 participants in the UK Biobank.
What they found, in few words, is that two previously unrecognized fat distribution patterns were most strongly linked to brain shrinkage, faster brain aging, cognitive decline, and higher neurological disease risk.
One of them was the well-known “skinny fat” pattern: this profile affects people who don’t appear fat, but carry a high proportion of fat relative to muscle, with fat tending to accumulate in the abdomen. There’s a lot of cross-over with what we talked about above, in terms of visceral fat, and also waist-centric subcutaneous fat distribution.
The other was pancreatic-predominant fat: this pattern involves unusually high fat in the pancreas, often without high liver fat, and showed particularly strong associations with negative brain outcomes. For example, people in this group had about 30% fat in the pancreas, which is two to three times higher than most other fat patterns, and up to six times higher than in lean people.
Which is a problem, because pancreatic fat appears to pose a greater neurological risk than fatty liver, but it’s often overlooked in routine imaging.
In the words of one of the researchers, Dr. Kai Liu,
❝From the perspectives of brain structure, cognitive impairment and neurological disease risk, increased pancreatic fat should be recognized as a potentially higher-risk imaging phenotype than fatty liver.❞
You can read the paper in full, here: Association of Body Fat Distribution Patterns at MRI with Brain Structure, Cognition, and Neurologic Diseases
Want to learn more?
Check out:
Why We Get Sick – by Dr. Benjamin Bikman ← this is about insulin resistance as the driver of much disease, long before blood sugar management becomes an issue, and this has pancreatic health at its core.
Take care!
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How does the hair-loss drug finasteride work? Can it affect my mental health?
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For many men the gradual thinning of hair is about more than just their appearance. Finasteride, a drug widely prescribed for the treatment of male pattern baldness has been used effectively for many years for this deeply personal problem.
Yet, behind its use are growing concerns about its link to the development of depression, anxiety, and even suicidal thoughts.
There is now critical discussion among both users and health-care professionals about the potential hazards associated with its continued use.
So how does the drug work? And what does the evidence say about the risk of developing a mental health problem?
agrobacter/Getty How does finasteride work?
Finasteride is used to treat androgenetic alopecia, also known as male pattern baldness. It works to regrow hair and prevent the further loss of hair.
One of the key causes of pattern baldness is the production of a hormone called dihydrotestosterone which the body makes from testosterone. When it binds to the follicles of hairs, it initiates a process called hair follicle miniaturisation. This is where the growth cycle of the hair becomes progressively shorter, resulting in thinner and weaker hair.
Finasteride works by blocking the enzyme that converts testosterone to dihydrotestosterone. By blocking the enzyme, dihydrotestosterone concentrations can be reduced by around 60–70% for the majority of men.
Finasteride was first approved in the late 1990s as a prescription-only medicine and is taken as a daily 1 milligram oral tablet. Medications available at a higher 5 mg daily dose are not used for baldness, but as a treatment for non-cancerous prostate enlargement.
This medication is not indicated for women, even though they can also have this type of hair loss.
How can it impact your mental health?
Changes in mental health are not listed as an established side effect in Australian guidance given to health-care professionals.
Based on clinical trials, the most common effects include:
- decreased libido
- erectile dysfunction
- reduced semen production.
The guidance also describes an increased risk of prostate cancer and a potential risk for breast cancer. Yes, men can get breast cancer too.
While initial clinical trials conducted to obtain approval for the drug didn’t demonstrate mental health concerns, monitoring of patients using the drug has since indicated a potential increased risk of depression and suicidal thoughts. But as this is based on patients self-reporting symptoms, according to the guidance there is no definitive link.
However, in May 2025, the European Medicines Agency safety committee stated suicidal thoughts was a confirmed side effect of finasteride. The European Union also advises patients that finasteride can cause a depressed mood and depression.
Similarly, in a warning about compounded finasteride, the United States Food and Drug Administration stated in April 2025 that topical formulations of the drug has similar side effects to the oral version. These include depression, anxiety and suicidal thoughts.
What should you do if it is affecting your mental health?
If you notice changes in your mental health while taking the drug, try not to handle significant mood changes by yourself. If you’re feeling unusually low, anxious or emotionally unstable, check in with a doctor so they can help you figure out whether finasteride is contributing to your mood and what support you may need.
If the symptoms are mild, they may suggest pausing finasteride to see whether things improve, or continuing with additional mental health support. If your symptoms are more severe, stopping the medication and getting prompt medical review may be appropriate.
If you are taking finasteride and are worried about its side effects, it is safe to stop immediately. Most side effects ease once the medication is out of your system, although a small number of people have reported symptoms that persist.
If you do decide to stop, this will mean that your hormone levels will gradually return to baseline and the hair growth seen with the drug will be lost over time.
If finasteride is not the right fit for you, there is another evidence-based alternative.
Topical minoxidil is a first-line treatment that can be used on its own or with other treatments and is available from pharmacies over the counter. It only works while it’s being used and may irritate the scalp, but its effectiveness is well-established and widely recommended.
While depression and anxiety are associated with minoxidil, the incidence is much lower because of their topical application.
There is also a medication called dutasteride. However, as it works in a similar way to finasteride, it may also increase your risk of developing mental health problems. So it is best to avoid dutasteride if finasteride is not suitable for you.
If this story has raised any issues for you, please contact one of the services below:
- Lifeline: 13 11 14 or lifeline.org.au
- Suicide Call Back Service (ages 15+): 1300 659 467 or suicidecallbackservice.org.au
Nial Wheate, Professor, School of Natural Sciences, Macquarie University and Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How to Prepare for Your First Therapy Session
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Everyone (who ever has therapy, anyway) has a first therapy session. So, how to make best use of that, and get things going most effectively? Dr. Tori Olds has advice:
Things to prepare
Questions that you should consider, and prepare answers to beforehand, include:
- Why are you here? Not in any deep philosophical sense, but, what brought you to therapy?
- What would you like to focus on? Chances are, you are paying a hefty hourly rate—so having considered this will allow you to get your money’s worth.
- How will you know when you’ve met your goal? Note that this is really two questions in one, because first you need to identify your goal, and then you need to expand on it. If you woke up tomorrow and all your psychological problems were solved, how would you know? What would be different? What does it look like?
If you have a little time between now and your first session, journaling can help a lot.
Remember also that a first therapy session can also be like a mutual interview, to decide whether it’s a good match. Not every therapist is good at their job, and not every therapist will be good for you specifically. Sometimes, a therapist may be a mismatch through no fault of their own. Considering what those reasons might be can also be a good thing to think about in advance, to help find the best therapist for you in fewer tries!
For most on these ideas, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
Don’t Forget…
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