• November 16, 2018

STONE: Health shouldn’t be measured by height and weight alone - Odessa American: Levi Stone

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STONE: Health shouldn’t be measured by height and weight alone

Levi Stone is the chief nursing officer at ORMC. Contact him at levi.stone@steward.org

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Posted: Monday, June 11, 2018 4:30 am

Many facets of society are shaped off “cookie cutter” ideology.  A one-size-fits-all logic is evident from the goods, services, and products offered to consumers down to the clothes we wear. But, here’s the thing…there’s no absolute “one-size-fits-all” approach that truly captures the individuality of an entire population. Businesses tend to invest in products that sell quickly and move off shelves just as fast. 

It’s playing to the law of averages, but the general population is anything but.  For instance, a clothing store creates apparels based on their definition of a particular “universal” size. The reality is, these garments more than likely fit differently among every customer who tries them on. Unfortunately, healthcare often takes the same “one-size-fits-all” approach … particularly in the way patients are measured to assess general health.  Among the worst is the Body Mass Index, commonly known as BMI.

Since its well-intended inception in the early 1980’s, BMI has been the standard for recording obesity statistics by the World Health Organization. BMI was designed to help objectively quantify tissue mass such as fat, muscle, and bone in an individual to categorize that person as being either underweight, normal weight, or overweight. 

The calculation is simple by dividing body mass by the square of the body height. The results class underweight, normal weight, overweight, and obese as BMI ranges of under 18.5 18.5-25, 25-30, and over 30 respectively. While its simplicity and worldwide acceptance may seem great, it can be very misleading and even inaccurate in many cases.

Take me for example.  At a height of 5’ 11” and weight of 189 pounds, my BMI of 26.4 lands me in the “overweight” category. Stereotypically, when we think of being “overweight”, this images of the classic “dad bod” come to mind.  You know, the one Homer Simpson sports as he munches on donuts and guzzles Duff beer. The reality is, I don’t have a Homer Simpson physique. My body is lean, toned, and muscular by following a meticulous regimen of eating clean, as well as incorporating high intensity interval and strength training 5 to 6 days a week. I work my tail end off to stay fit, so how can a 42 year old male, with a 31” waist line be considered overweight?

With any weight gain, does that mean our bellies grow too? Not in the case for muscle since its cells are denser than fat cells. Visualize a pound of packing peanuts. The kind used to fill boxes to protect shipping contents from being damaged. Now, picture a pound of marbles. Each weighs one pound, but what’s the difference? If we equate the packing peanuts as “fat” and the marbles as “muscle” you begin to see the difference in terms of surface area.  More fat equals larger waistlines, whereas more muscle equates to a leaner, slimmer waist. Now, back to the whole BMI thing. With this tool two people, both weighing the same and equal in height, but have entirely different body compositions (large waistline versus lean waistline) are both equal by being considered “overweight.” This is exactly why BMI is not an effective test for overall health.

In fact, many deemed “overweight” or even “obese” using the BMI metrics are actually healthy. Unfortunately, many insurance companies use BMI as indicator in assessing potential risk factors of their customers to establish costs for coverage. This means New York Yankees slugger Aaron Judge, whose 282 pound chiseled, athletic build on a 6’ 7” frame and a BMI of 31.8 would pay the same premiums on insurance as Homer Simpson (with a 6’ donut and beer fueled 239 pound BMI of 32.4 would. One is certainly not the other, so why is this archaic method still widely used?

The better solution is finding a measure reflecting a far more accurate measure of general health compared to BMI. The famed Mayo Clinic may have just the answer.  Around this time last year, they released the Body Volume Indicator (BVI) which creates a measurable ratio based on body mass and circumference of the waistline. Studies upon studies are showing a correlation between poor health and larger waistlines. People with waists of 34.5” and higher have a higher prevalence of diabetes and cardiovascular disease to those who don’t.  Fat carried around the abdomen paints a much clearer clinical picture than just overall weight and height alone. In addition to height and weight, BVI uses information on waist-to-hip ratio, total body fat percentage, and abdominal volume to determine a score.

Not only does BVI provide a more systemic approach to measurement, it can also ascertain a level of accountability and motivation for patients to set and achieve healthier lifestyles. Abdominal girth is what really need to be concentrated on and not take the easy pass BMI has to offer. It’s time to finally ditch BMI and go with a better system. A system shifting away from the fixation on weight lost and gained, but instead focusing on managing the shape our bodies are in … both inside and out. 

Odessa, TX

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