Episode Transcript
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Hey Rebels, welcome toBlasphemous Nutrition.
Consider this podcast yourpantry full of clarity,
perspective, and the nuanceneeded to counter the
superficial health advice sofreely given on the internet.
I'm Aimee, the unapologeticallycandid host of Blasphemous
Nutrition and a double degreednutritionist with 20 years
experience.
(00:22):
I'm here to share a more nuancedtake.
On living and eating well tosustain and recover your health.
If you've found most healthadvice to be so generic as to be
meaningless, We're so extremethat it's unrealistic, and you
don't mind the occasional Fbomb.
You've come to the right place.
From dissecting the latestnutrition trends to breaking
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down published research andsharing my own clinical
experiences, I'm on a mission tofoster clarity amidst all the
confusion and empower you tohave the health you need to live
a life you love.
Now let's get started.
Welcome back to blasphemousnutrition.
(01:03):
I'm your host, Aimee and I likemixing a little chili with my
chocolate.
Today.
I want to talk about the BMI.
I made him reference to the BMIback in my episode on slow
weight loss talking about how itwas utter bullshit.
And I want to come back andrevisit this topic to explain
myself and also to give you somehigher quality tools to work
(01:26):
with when assessing your ownhealth risks.
Now the BMI has been thepopulation standard that we have
used to assess heightened weightproportionality since the late
nineties.
I have been in the field longenough that I remember when this
switch was made and how, aghastso many people were to suddenly
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discover that they went frombeing within normal weight, per
insurance data, which waspreviously used to being
overweight.
All of a sudden overnight, thegovernment decided that these
people.
Who were normal weight yesterdayare now fat There was a little
bit of a shit show and a lot oftears.
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Let me tell you.
Now we legitimately abandonedusing insurance data to assess
weight problems and disease riskin part, because that data did
not take into account thesignificant confounding variable
of smoking.
Which was clearly an issue assmokers tend to be leaner, but
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are certainly not without risk.
So in this transition to BMI,not only did we all suddenly
become fatter over night,according to our health
officials, but we also made whatwas ultimately a lateral move,
which is again, relying on thesimplicity of overall mass to
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project health outcomes.
Now the results of this havebeen lackluster and
disappointing.
Because taking data that tendsto be helpful in assessing
health risk at a populationlevel does not quite translate
well to the individuals sittingin front of you.
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I know it's astonishing.
Isn't it?
The BMI was developed in thelate 18 hundreds as a way of
assessing current weight versusideal weight at a population
level.
It was never intended to be usedto assess individual ideal
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weight.
In fact, the Belgianmathematician and sociologist
who created it.
And I'm totally gonna butcherhis name.
Cause I am not Belgian Lambert.
Adolf jock, quit.
Let.
Even stated this as such.
But humans, crave simplicity,and these important details got
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lost in the game of telephone,so here we are 150 years later
and we have this nonsense that'sgoverning our insurance
premiums, our access to surgicalprocedures and probably a lot
more.
So, yeah, we see thisassociation of a high BMI at a
population level beingindicative of increased risk of
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cardiovascular disease,diabetes, and other chronic
disease.
However it should not be used toassess an individual's personal
health risk.
The BMI does not take intoaccount other stronger
individual factors thatincreases disease risks such as
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ethnicity.
Individuals of Asian orSoutheast Asian descent often
develop type two diabetes at alower BMI than those of Western
European descent from whom thisoriginal data was taken.
Right.
The BMI is based mostly onWestern European.
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Individuals.
There have been some adjustmentsmade over time due to these
discrepancies.
But that doesn't negate theoverall like foolishness of
using this to assess individualhealth risk.
There are also individuals whoare of a heartier stock,
Northern European Germanic folkswho my grandmother would have
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referred to as big boned.
These individuals have a genetictendency to have more bone mass,
more muscle mass than thegeneric average person whom the
BMI is based off of.
And so they will not ever fallwithin a normal BMI unless they
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are very ill or on starvationrations.
The BMI is just too generic tobe used how it is being used in
healthcare.
There are actually no reallyprecise ways to quickly.
Efficiently assess anindividual's health risk.
However, a waist hipcircumference measurement can be
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used to ascertain risk of anyextra visceral fat around the
abdomen.
Which does put us at increasedrisk of chronic disease.
Another potentially promisingmeasurement is the visceral fat
calculator from the LuxembourgInstitute of health.
It also relies uponcircumference measurements to
estimate visceral fat.
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Now the challenge with measuringtape is of course, high risk of
user error.
I think if one is well under orwell over that marker of 0.85 or
less for women and 0.9 or lessfor men with regards to the
waist, hip circumference, orsignificantly under or
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significantly over 130centimeter squared for the
visceral fat calculator it maybe less of an issue, but even
variances such as whether or notyou're slouching, whether or not
you're bloated can put you in acategory that you don't actually
belong in.
Much like the stress of sittingin traffic before seeing a
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doctor can in and of itselfcause your blood pressure to
increase to the point that thatdoctor might encourage you to go
on a beta blocker.
Now I put my own health datainto the visceral fat calculator
and did the calculation, andthen compared it to my DEXA scan
results, which I'll talk aboutin a moment.
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but the two results are nottransferable.
Because the DEXA estimates,visceral fat and pounds.
And the visceral fat calculatorestimates in centimeter squared.
So I can't compare one againstthe other for accuracy, but
again, we have that limitationof user error.
When it comes to takingcircumference measurements to
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consider as well.
Now the DEXA scan is a morecostly and less accessible
option, but it is now consideredthe gold standard by many.
The DEXA scan has historicallybeen used primarily to assess
bone mineral density and as adiagnostic tool for
osteoporosis, but it has theadvantage of also giving a
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precise and less invasive way ofmeasuring body fat than the dunk
tanks of old.
For those of you who areunfamiliar with dunk tanks, this
former gold standard that wecould use in the public domain.
It involved getting into aswimsuit.
And exhaling all of the air outof your lungs before submerging
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yourself underwater in this, youknow, tank of water for as long
as possible.
In the research and in clinicalsettings, it is called
hydrostatic weighing.
So imagine this.
You have the self-consciousnessof being in a swimsuit.
The discomfort and hassle ofgetting totally soaked.
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And then whatever emotionsemerge to entertain you while
you are wholly submerged with noair in your lungs, sitting and
waiting patiently.
Now once the reading was taken,the presiding professional who
is conducting the test wouldknock on the tank to let you
know that you could come up forair.
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This dunk would typically berepeated three times for the
sake of accuracy.
Now I'm certain, you can thinkof a whole host of reasons why
this gold standard would be ahard sell for many.
The three readings of waterdisplacement that occurred while
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you were submerged would be thenput into a formula to ascertain
lean mass and fat mass.
And I mean, this was the goldstandard for generations.
But everybody was happy to letthat technology fall to the
wayside in favor of the DEXA.
Now the DEXA scan is an equallyprecise, but far less
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troublesome way to assess bodyfat with the added bonus of
measuring muscle mass and bonedensity as well.
The DEXA scan uses two very lowdose x-ray beams at different
energy levels.
And these different energylevels pass through the body and
are absorbed by differenttissues.
Our bone, our muscle, our fat atdifferent rates.
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It takes about 10 minutesoverall to do a scan.
But the results are very precisemeasures of muscle, bone, and
fat mass within your body.
So while you can still accessDEXA from within the medical
community, more and more, I havebeen seeing direct to consumer
DEXA services available to thepublic.
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And this is what I will oftenrecommend to my clients in order
to get their baseline, to assessbone, muscle, and fat mass.
They can usually reassess asdesired if utilizing a direct to
consumer company.
Although I don't recommend morethan once a quarter, unless
there has been significantlyrapid weight loss.
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And that's mainly to make surethat there hasn't also been
significant muscle loss alongwith that total weight loss.
Now a bioelectrical impedancescale is much more accessible,
but less precise.
If your scale at home tells youyour body fat percentage, it is
using BIA or bioelectricalimpedance analysis technology.
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BIA measures the resistance orthe impedance of body tissues to
a small electrical current.
Now this current travels moreeasily through muscle and other
lean tissue, which contains morewater and more electrolytes than
it does through fat, which isless conductive overall, but a
major limitation of home BIAmeasuring devices is that they
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only measure half the body.
A scale is only going to measureyour lower half, which is why it
overestimates a woman's body fatpercentage and can underestimate
a male's body fat percentage.
Or you can get a handhelddevice, but that will only
measure the upper part of thebody.
The most precise.
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scales will include hand leversas well as a scale that you step
on.
However, other factors such asunder hydration or over
hydration, having exercisewithin a couple hours of
measuring or even having a mealbeforehand can skew the
readings.
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So if this is the method to beused, it is really important to
be mindful of these limitations.
And to use it as a means totrack change over time, rather
than relying on it as a precisemeasurement of where you are
currently.
So each of these means havelimitations, but the height,
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waist ratio and the visceral fatcalculator and the full body.
B I, a scale is a more preciseway to measure then a BMI.
And it's fairly low cost and lowinvasive enough to be used in
the medical system by trainedprofessionals.
Now, none of these measurementsare best utilized alone as an
(13:31):
obesity diagnostic tool butrather to support certain
treatments and additionaltesting to ascertain or rule out
diagnoses associated withobesity and excess to visceral
fat, such as fatty liverdisease, cardiovascular disease,
and diabetes.
I do suspect within the nextgeneration, we will see the BMI
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fall out of favor and shouldsomething more precise, but just
as simple to access come to theforefront before then maybe the
transition would occur evensooner.
Few knowledgeable and skilledprofessionals actually hold much
credence to the BMI as itpertains to the person in front
of them.
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But with.
Insurance companies in northAmerica utilizing the BMI.
And the NHS in the UK utilizingthe BMI as well as many other
government health institutionsacross the world.
Relying on this it's not likelyto be replaced anytime soon.
But we can do is use the BMI toour advantage.
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If you have insurance coverageand a BMI that is above 30, you
may have certain preventativehealth services covered.
If your BMI is being usedmedically to withhold access to
services, such as jointreplacement surgery, using other
stronger indicators of health,such as your overall
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inflammation levels of lipidpanel, blood sugar, and CBC
panels can strengthen your caseto fight for access to care.
It is worth inquiring.
And knowing if this metric isbeing used as a check mark
against you, or if you canutilize it to get access to
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services.
And if your BMI lowers fromobese to overweight or from
overweight into the normalranges, Americans may be able to
lower health insurance premiumsas well with just that piece of
data.
These are nuanced details worthknowing and asking your
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insurance brokers and yourprimary care physicians about.
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(16:44):
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(17:27):
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truth is nuanced, and any dishcan be made better with a little
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