15 Feb Too Much Weight on BMI

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Too Much Weight on BMI
By Laura Cipullo, RD, CDE
A few weeks ago I was asked to share my thoughts on Michelle Obama’s “Let’s Move” initiative with radio host Rita Cosby. I researched the campaign at length while watching the boys play soccer, and what I came up with is that the movement is generally positive. I do believe that a bit of tweaking is in order, however, and that certain ideas could be rephrased. (Check out the complete podcast here.) As I continue to think about America’s “obesity epidemic” I think the measurement called Body Mass Index is overrated and has the potential to misdiagnose ourselves and our kids.
At the end of the day, it always comes back to this same question: “What can we as parents do to prevent disease?” This includes obesity-related disease.
I recognize we need measurements for statistic purposes and possibly diagnostic tools. However, I think BMI should be emphasized less and instead we can focus on behaviors and a cluster of measurements. BMI is only one measure, and it’s not always reflective of a person’s state of health.
BMI is based solely on height and weight. (You can read the official definition from the NIH here.) Weight can be a funny subject though. After all, the number on the scale is not always reflective of how healthy a person is. Therefore, one’s body mass index is not going to accurately reflect a person’s health status.
As parents, healthcare facilitators and makers of change, we must remember that obesity does not always equate with overeating, high cholesterol and/or inactivity. A dear client of mind, for example, has a BMI that would qualify her as overweight, and yet she is a shining example of good health. She runs marathons, eats a balanced intake of food, and has an ideal cholesterol ratio.
Let me let you in on a little secret: I, too weigh more than the black and white number recommended for my height, otherwise known as my “ideal body weight.” Me—a registered dietitian, certified diabetes educator and “paragon of health (by all other measures)”!
Granted, there is a ten percent range above and below IBW. I fall into the range above my IBW, as many people do. That being said, you can see how easy it can be for someone above their IBW to assume they are overweight, even when it’s not true. I’m by no means overweight, rather I am the weight that is appropriate for me.. If someone were to slap a label on me based on weight alone, or to use Weight Watchers’ recommended weight, I would be over my goal number.  Well, I don’t need to lose weight, so the point is, using these means to determine a person’s health with a Body Mass Index are somewhat antiquated and inaccurate.
Remember that muscle weighs more than fat. Otherwise, most hyper-muscular football players (even Tom Brady!) would be considered overweight too, if only by their BMIs. Some people are also more densely built than others. My nephew, who is visually lean and bony, qualifies as obese according to his doctor, though if anything, he could stand to gain a few pounds.
Whether lean and dense or round and curvy, we are all decidedly beautiful. We must remember that BMI is not a measure of self-worth. Rather, it’s merely one tool that aims to measure health—and a flawed tool at that.
On the flip side, I also work with a number of clients who have extremely low BMIs. These individuals are struggling with their health.  They may use unhealthy behaviors such as skipping meals or starving themselves to keep their weight down and or BMI low. So you see, a low BMI may not be indicative of health either. What we need to be sure of is to take our focus away from the body mass index and to instead consider healthy behaviors as a whole.
So if weight isn’t the ultimate measure of health (nor is one’s appearance), then what is? Blood pressure, liver function, Total Cholesterol/ HDL ratio, endurance, energy and other daily habits are much better ways to gage a person’s physical condition. As parents, political pundits and health care professionals, we must move toward size-acceptance, promoting confidence and self-esteem in our children. I propose to start with the following:

• Foster a positive opinion of food in the household.
• Feed your children a balanced intake of whole grains, lean proteins and heart healthy fats.
• Tell your children you love them. Have them look in the mirror and tell themselves they are loved. Tell them they are  more than a number.
• Encourage healthy behaviors by setting an example.
• Focus on your children’s efforts and behaviors, not on outcomes or measures. Praise them for trying a vegetable or sport rather than for being a veggie eater or a great baseball player.