Training & Nutrition - BMI Revisited

Many of us have gotten bitten by the "BMI Mania"

Seems it happens to many "athletes."

http://aolsvc.news.aol.com/sports/article.adp?id=20050309141809990030

interesting article.

when I was in the army, we had a couple of bodybuilders in the unit that had to get medical exceptions to avoid being tagged as overweight. They were the fittest 2 people in the unit, but according to the Army's chart they were obese.

From the article:


"The value of the BMI for the (general) population is it's a good first step, and I underline 'first step,'" says Dr. George Bray of the Pennington Biomedical Research Center in Baton Rouge, La.

"No one has ever suggested it's the only criterion to use, because it clearly is not."



Wrong. It is used as the "ultimate arbiter and criterion" all the time by insurance companies, medical doctors, etc. Happened to me just two months ago when the doc said my BMI was too high. I pointed out that I have lifted heavy weights for 15 years, and while, yes, I could lose a few pounds, I am by no means "obese." Didn't make any difference to him! It is a SACRED NUMBER and we all know that numbers don't lie.

Well, you know it's kinda ridiculous when men and women have the same numbers to adhere to... and everyone knows men carry more muscle weight than women. Oh well, being a woman (and not very buff), I have no real excuse for not trying to live within its range.

That's why there's such a big spread in weight range. The lower ends are generally for women while the high end is usually men. But that would seem to me to mean that a woman at the high end is actually overweight and a man at the low end is underweight. They are, of course, averages like MHR tables.

BMI is so inaccurate for anyone who moderately works out. I am heavy into lifting weights, and I always have been, so I'm always classified as obese. Insurance companies look at all my other test results (low heart rate, low blood pressure, excellent cholesterol levels, etc.), which are always excellent, then look at my BMI and put me at a higher premium because they say I'm obese. It makes no sense, because if I were obese, then my other blood results would reflect that fact. They know I am an aerobics instructor, and they know I go to the gym every day, and they know I lift weights regularly, yet they take advantage of the BMI to deliberately charge a higher premium. No insurance wants to acknowledge the BMI is bunk, because then they'd lose all that money they make from healthy, fit people who now are paying a higher premium.

When I changed doctors, I went for my physical, and after my weigh in, she came in and lectured me about weight. I invited her on a century ride I was doing later that week. She shut up. Since that visit, she's very aware of my fitness schedule, and she doesn't say anything anymore when I arrive at the office slightly heavier (I'm building on weights until summer, when I switch mostly to riding and cut back substantially on the weights) from my muscle gain.

I don't have life insurance right now because I feel like I'm getting ripped off. My financial advisor is in the process of finding me a life insurance company that doesn't take BMI into account. It's been about 3 months, and so far, he hasn't found anything for me. It's ridiculous.

Insurance companies will never change... BMI is their excuse to charge as many people as they can with higher premiums.

Koffee

From the article:



Wrong. It is used as the "ultimate arbiter and criterion" all the time by insurance companies, medical doctors, etc. Happened to me just two months ago when the doc said my BMI was too high. I pointed out that I have lifted heavy weights for 15 years, and while, yes, I could lose a few pounds, I am by no means "obese." Didn't make any difference to him! It is a SACRED NUMBER and we all know that numbers don't lie.Do you really feel comfortable being treated by a doctor that would say something like that? I think I'd find a different one that perhaps has a sports/fitness background if possible. I had one old codger give me a bottle of acid for warts!! Not kidding. He was our so called "family" doc so my parents kept insisting I go back to him. What a quack. The medical profession is full of them.

I had one old codger give me a bottle of acid for warts!!

I don't think thats uncommon. The Dr. Scholl's stuff for plantars warts at the store is acid in a bottle.

I am 5"10' 204 pounds and whenever I go to the doctor and even when I mentioned this to a cardiologist I saw recently that I would like to lose 10 pounds they look at me like I am nuts. I am not a weightlifter and have a bit more around the middle than I would like, but I am very large framed (big bones I guess) and do at least an hour of hard cardio a day (in winter) and 1-4 hour rides in road season pretty much everyday. And I swim 2km at a time when I get in the mood (I like biking better).

Don't know if being in Canada makes any difference as far as doctor attitude about weight.

I still would be happier losing 10 pounds, but I would have to cut back big time on the food. I eat the right food, just too much of it too often. To me hard workouts and food intake reduction would be the definition of hell. Last cardiologist I saw to make sure I wasn't going at it too hard told me the latest research showed that level of fitness was more important than BMI.

BMI is only a rough guide, all it is is weight in kg divided by the square of height in meters. Anyone can clearly see that if there's any other reason for being heavy for height the BMI will be high e.g large muscle mass. It's not a perfect measure, it's really just weight adjusted for height and NOT adjusted for anything else. It's foolish to read too much into it, though as a rough guide it is very useful.

BMI is only a rough guide, all it is is weight in kg divided by the square of height in meters. Anyone can clearly see that if there's any other reason for being heavy for height the BMI will be high e.g large muscle mass. It's not a perfect measure, it's really just weight adjusted for height and NOT adjusted for anything else. It's foolish to read too much into it, though as a rough guide it is very useful.

Tell that to the insurance companies. They take it as seriously as they come. The sad thing is, they wouldn't even take the results of my performance test or my last physical with my doctor as an indication that I am in better health than the majority of the population.

Koffee

Tell that to the insurance companies. They take it as seriously as they come. The sad thing is, they wouldn't even take the results of my performance test or my last physical with my doctor as an indication that I am in better health than the majority of the population.

KoffeeYup. BMI is the modern equivalent to a witch hunt. Insurance companies love it because they can raise rates or deny coverage based upon unrealistic ideals. We can't all look like fashion models no matter how much we would like to look like Fabio. :D


That was a joke in case nobody caught it.

Tell that to the insurance companies. They take it as seriously as they come. The sad thing is, they wouldn't even take the results of my performance test or my last physical with my doctor as an indication that I am in better health than the majority of the population.

Koffee

Insurance companies do many stupid things. Prejudice is in a sense the nature of their business (judging the one by the group). The misuse of a measure doesn't mean it's not valid, they just don't get it. Tough for those caught up in their stupidity. There's a lot fewer on the cycling forum with high BMI for ANY reason than in the general population.

I know.... but it doesn't do much for people who are weightlifters. Or for the matter, people who are doing regular weightlifting sessions and focus on mass gaining.

At 5' 1 1/2", the lowest weight I've ever been was 150 pounds. At 150, I was a solid walking wall of muscle. I looked like the Terminator. I don't think I would ever want to get to that point again, but I do like to lift... a lot. I lift regularly, and I lift more than most of the men that are in the gym. I've always been into weightlifting, and I don't think I'm going to stop. I certainly don't think I should be forced to stop just because the insurance company feels like I'm at the top end of the BMI for women of my height and age. Bleah. They can kiss my butt.

Koffee

BMI is so inaccurate for anyone who moderately works out. I am heavy into lifting weights, and I always have been, so I'm always classified as obese. Insurance companies look at all my other test results (low heart rate, low blood pressure, excellent cholesterol levels, etc.), which are always excellent, then look at my BMI and put me at a higher premium because they say I'm obese. It makes no sense, because if I were obese, then my other blood results would reflect that fact. They know I am an aerobics instructor, and they know I go to the gym every day, and they know I lift weights regularly, yet they take advantage of the BMI to deliberately charge a higher premium. No insurance wants to acknowledge the BMI is bunk, because then they'd lose all that money they make from healthy, fit people who now are paying a higher premium.

When I changed doctors, I went for my physical, and after my weigh in, she came in and lectured me about weight. I invited her on a century ride I was doing later that week. She shut up. Since that visit, she's very aware of my fitness schedule, and she doesn't say anything anymore when I arrive at the office slightly heavier (I'm building on weights until summer, when I switch mostly to riding and cut back substantially on the weights) from my muscle gain.

I don't have life insurance right now because I feel like I'm getting ripped off. My financial advisor is in the process of finding me a life insurance company that doesn't take BMI into account. It's been about 3 months, and so far, he hasn't found anything for me. It's ridiculous.

Insurance companies will never change... BMI is their excuse to charge as many people as they can with higher premiums.

Koffee


Insurance companies are merely risk arbitrators. The fact is, high BMI is associated with increased mortality. It may be true that "big but fit" individuals are at lessser risk, but so far there's no evidence to back that up, and lots of evidence pointing to the increased health risks associated with high BMI's.

FWIW, your situation is not different than someone who has a family history of heart disease and/or has elevated cholesterol levels. That's my situation...my insurance rates were jacked up because my dad died at age 47 from a heart attack, and my cholesterol was moderately high (before treatment). This despite the fact that I ride 4000+ miles per year, and have BMI of 23.4. Oh well, life's not fair...so it goes.

From the article:



Wrong. It is used as the "ultimate arbiter and criterion" all the time by insurance companies, medical doctors, etc. Happened to me just two months ago when the doc said my BMI was too high. I pointed out that I have lifted heavy weights for 15 years, and while, yes, I could lose a few pounds, I am by no means "obese." Didn't make any difference to him! It is a SACRED NUMBER and we all know that numbers don't lie.

What's your body fat percentage? No offense, but from the pics on your website, you look "Overweight" (though not "Obese") to me.

What's your body fat percentage? No offense, but from the pics on your website, you look "Overweight" (though not "Obese") to me.

No offense taken. I have lost considerable weight from those pictures (I guess I should retake them so they don't give a false impession).

This is about how I look right now:

http://www.members.aol.com/dnvrfox/hrtbrk1.jpg

As I stated in my original post, I need to lose more. But I am in no way "obese" as the doc tried to tell me., I don't know my body fat percentage absolutely, as my Tanita is not "absolutely" accurate, and I don't have the "athletic" model, and IMHO it is only useful to show trends.

My trend, however, shows that I have lost 6 percentage points in the past few months. My wife says I look like Bruce Willis!

But, my body fat percentage, and for that fact, my personal BMI is not the major issue here. The issue here is the whole concept of trying to reduce someone's fitness and health to a single number (BMI) which is seemingly worshipped by the medical and insurance and health industries.

I do bench press 220 pounds, do 25 full body dips in a row, do bar bell curls of 50 pounds, do 30 raised leg pushups, etc. In other words, I carry a lot of muscle.

I know you are the "guru" of BMI on the forum. (Don't you have a financial connection to the acceptance of the BMI through your software?). And I know that it can play an important role in fitness. The problem with a single number to define one's health (intended to do so or not, it is used that way) is that it is NOT possible to do that. Can you at least admit that?

It is sort of the same with age. Folks automatically assume there are things about someone who is 20 or 65 or 70 or 80 that are common to all those the same age. Not true enough to be a valid indicator, IMHO.

And, yes, I have shed that particular doc.

...I do bench press 220 pounds, do 25 full body dips in a row, do bar bell curls of 50 pounds, do 30 raised leg pushups, etc...What's a raised leg pushup? 25 dips is pretty impressive.

Between you and me, anyone that gives any credece to BMI whatsoever is a myopic bureaucrat. Who cares what they think? Live your life and be excellent to one another!!! :D

As I stated in my original post, I need to lose more. But I am in no way "obese" as the doc tried to tell me., I don't know my body fat percentage absolutely, as my Tanita is not "absolutely" accurate, and I don't have the "athletic" model, and IMHO it is only useful to show trends.

My Tanita has the "athlete" mode. But, that mode is only for folks who work out a *lot* (>10 hours per week, according to the Tanita documentation). My actual body fat percentage is generally somewhere between the "regular" mode and the "athlete" mode settings. FWIW, you can get a good idea of your body fat percentage from this web page http://www.he.net/%7Ezone/prothd2.html (just ignore their recommendations for "ideal" weight and protein requirements).



But, my body fat percentage, and for that fact, my personal BMI is not the major issue here. The issue here is the whole concept of trying to reduce someone's fitness and health to a single number (BMI) which is seemingly worshipped by the medical and insurance and health industries.

Unfortunately, they have to "play the averages", and most overweight folks are not fit enough to reduce the health risks of their size.

Ideally, the health and insurance industries would come up with other health and fitness measures to go along with BMI. The Defense Department does this - if a soldier is "too large" per the BMI standards, they then get tested for body fat percentage (using the "Navy" test method). That allows "bodybuilder" types to pass their fitness standards.

I too would benefit from this sort of additional testing...the fact that I can ride my bike up Alpe d'Huez should (in a perfect world) reduce the increase in my insurance rates due to the fact that my father (a heavy smoker) died of a heart attack at age 47. Unfortunately, additional testing like this (which could include things like treadmill stress tests) are expensive and time-consuming.



I know you are the "guru" of BMI on the forum. (Don't you have a financial connection to the acceptance of the BMI through your software?).

I'm not really a "guru", but I have done quite a bit of research on it, especially how it changes with age, and how it relates to health risks. And, I have attempted to incorporate that research into my WeightWare program.

FWIW, the best web site I've found that explains the history of BMI and its limitations is the halls.md site (Dr. Halls granted me permission to use some of his propietary formulas in one of my programs). Here are a couple of pages that are the best (IMO): http://www.halls.md/body-mass-index/bmi.htm http://www.halls.md/body-mass-index/bmirefs.htm



The problem with a single number to define one's health (intended to do so or not, it is used that way) is that it is NOT possible to do that. Can you at least admit that?

I agree that it is overused, but I also understand why. For most folks, BMI is a pretty good predictor of "fatness", and it can be very easily calculated. But, there are clearly exceptions (people who are large and fit) who may be mis-characterized by BMI. Hopefully, as more research is done on "big, fit" folks, additional measures will be incorporated to assess risk.

Personally, I'd love to see an insurance company that would reduce rates for folks who can pass a treadmill stress test (unfortunately, if that same company found out that I spend 250 hours per year playing in traffic on my bike, they probably wouldn't insure me anyway
:( :) ).

Unfortunately, they have to "play the averages", and most overweight folks are not fit enough to reduce the health risks of their size.

No, they DON'T "have to" play the averages.

I sold life and disability insurance for 13 years, and found that I could influence the decisions of some companies by providing additional information. But this is not true of all companies, and likely less true than in the past.

Please don't continuously apologize for the insurance companies' ineptitude.


My Tanita has the "athlete" mode. But, that mode is only for folks who work out a *lot* (>10 hours per week, according to the Tanita documentation).

Well, I walk intensely about one hour per day, I ride my bike several hours per week, I lift weights about 6 hours per week - do I qualify?

No, they DON'T "have to" play the averages.

I sold life and disability insurance for 13 years, and found that I could influence the decisions of some companies by providing additional information. But this is not true of all companies, and likely less true than in the past.

Please don't continuously apologize for the insurance companies' ineptitude.



Well, I walk intensely about one hour per day, I ride my bike several hours per week, I lift weights about 6 hours per week - do I qualify?

Hard to say...as I noted, the regular mode seems to overestimate my body fat, and the athlete mode produces results that are way too low (single digits). I've just done 3 estimates for my body fat, as follows:

My Tanita on "regular" mode: 15.5%
My Tanita on "athlete" mode: 7.6%
The "Navy" test: 15.2% body fat.

So, in my case I think regular mode on the Tanita is OK (does that mean I'm not an athlete? :( ). However, I'm a bit dehydrated this morning, and that typically causes lower readings on the Tanita. At other times, I've seen the Tanita regular mode report >20%, when the Navy method reports 15-17%.

Have you tried the Navy test, to compare it to what your Tanita is reporting?

As for the insurance companies - what would you propose that they do differently? With the cost of health care going through the roof, it only makes sense that they would try to screen for health status and adjust their rates accordingly. Do you have some other methods that they could employ?

As for the insurance companies - what would you propose that they do differently? With the cost of health care going through the roof, it only makes sense that they would try to screen for health status and adjust their rates accordingly. Do you have some other methods that they could employ?

Yes, as I have already suggested. Allow the opportunity for additional factors, such as Body Fat %, amount of exercise, regularity of medical care, following of medical advice, etc. when making their yes/no/rated/exclusion decisions. Again, I have seen this work successfully in life insurance and disability insurance decisions. These decisions are not made by faceless bureaucrats. I knew who my underwriters were, they knew me, and they trusted me as an agent. Has the world grown so cold that we can not provide for individual decisions and factors? I hope not.

As I stated in my original post, I need to lose more. But I am in no way "obese" as the doc tried to tell me., I don't know my body fat percentage absolutely, as my Tanita is not "absolutely" accurate, and I don't have the "athletic" model, and IMHO it is only useful to show trends.


The current healthcare/insurance/government health nannies have simple redefined what the word "obese" means. I guess for a few more years it will irritate people to be called obese, but then the word will simply mean "overweight."

As far as the insurance companies go, they use it because it BMI is highly correlated with health. Notice that correlated just means that it's more closely related than picking random numbers. Anyone who works with those numbers knows that there are lots of outliers. As I understand the current research, the amount of exercise you get is more strongly correlated---there's actually a high incidence of heart attacks in people whose metabolism keeps them thin without exercise, but it's very hard to actually measure that sort of thing. BMI is easy to measure.

Bruce

BMI is easy to measure

Exactly. That is why it is so prevalent. Numbers don't lie!

Yes, as I have already suggested. Allow the opportunity for additional factors, such as Body Fat %, amount of exercise, regularity of medical care, following of medical advice, etc. when making their yes/no/rated/exclusion decisions. Again, I have seen this work successfully in life insurance and disability insurance decisions. These decisions are not made by faceless bureaucrats. I knew who my underwriters were, they knew me, and they trusted me as an agent. Has the world grown so cold that we can not provide for individual decisions and factors? I hope not.

That's a good question...I'm not an insurance agent or underwriter, so I don't presume to know the answer. But, given the litigiousness of US society, I assume they want to stick to science-based, objective measures only. Otherwise, person A could get a good rate because they were friends with the agent, while person B would get a bad rate because the agent didn't like the way they looked.

As for your suggestions:

Body Fat Percentage - I do think it would be a very good idea to use some form of body fat percentage test as a fallback test for those with high BMI (the US Dept of Defense does this with their personnel fitness evaluations). Unforunately, there's no standard test, and all are estimates.

Amount of Exercise - and how would one document this? If my insurance rates were based on how much I exercised, I'd have a financial incentive to lie about it.

Regularity of Medical Care - ?? - If I only see a doctor once every year or two (because I don't need to), does that mean my rates would be higher due to the lack of "regularity"?

Following of Medical Advice - ?? - This too would be difficult to measure, and might violate medical records privacy laws.


Personally, I'd like to see a three-part test:

1) BMI (preferably, with age and gender considered in the interpretation).

2) Body Fat Percentage (via, bioelectric impedance, or the Navy method).

3) Treadmill Stress Test

These three tests would provide a pretty good, quantifiable picture of an individual's "fatness" and "fitness".

Unfortunately, tests #2 and #3 add additional testing time and costs, and probably add very little meaningful information as to health status for the majority of people.

Perhaps these tests could be implemented as "you pay" fallbacks. So, if your BMI is "too high" per insurance company standards, you could get your rates lowered by providing them with the results of tests #2 and #3 (though you would have to pay for those tests yourself).

That's a good question...I'm not an insurance agent or underwriter, so I don't presume to know the answer. But, given the litigiousness of US society, I assume they want to stick to science-based, objective measures only. Otherwise, person A could get a good rate because they were friends with the agent, while person B would get a bad rate because the agent didn't like the way they looked.

As for your suggestions:

Body Fat Percentage - I do think it would be a very good idea to use some form of body fat percentage test as a fallback test for those with high BMI (the US Dept of Defense does this with their personnel fitness evaluations). Unforunately, there's no standard test, and all are estimates.

Amount of Exercise - and how would one document this? If my insurance rates were based on how much I exercised, I'd have a financial incentive to lie about it.

Regularity of Medical Care - ?? - If I only see a doctor once every year or two (because I don't need to), does that mean my rates would be higher due to the lack of "regularity"?

Following of Medical Advice - ?? - This too would be difficult to measure, and might violate medical records privacy laws.


Personally, I'd like to see a three-part test:

1) BMI (preferably, with age and gender considered in the interpretation).

2) Body Fat Percentage (via, bioelectric impedance, or the Navy method).

3) Treadmill Stress Test

These three tests would provide a pretty good, quantifiable picture of an individual's "fatness" and "fitness".

Unfortunately, tests #2 and #3 add additional testing time and costs, and probably add very little meaningful information as to health status for the majority of people.

Perhaps these tests could be implemented as "you pay" fallbacks. So, if your BMI is "too high" per insurance company standards, you could get your rates lowered by providing them with the results of tests #2 and #3 (though you would have to pay for those tests yourself).

For large amounts of life insurance, stress tests are (were) routinely used, at the insurance companies expense.

When you sign for insurance, you give them full access to your medical history.

When we had folks who were hypertensive, the frequency with which they visited the doc, and the readings at the docs were considered as part of the decision.

We asked questions about smoking and tobacco and alcohol use. They would pull driving records to check for DWI and similar.

We even asked about exercise.

If you lie, you are going to have a hard time getting that claim padi, at least for the first 2 years.