Weight Maven

So this is going around on the tubes today:

BMI and waist circumference explain one half of all fatal and one quarter of all non-fatal cardiovascular disease in those overweight and obese in ten-year follow-up study

And apparently BMI and waist circumference does not explain one half of all fatal and three quarters of all non-fatal cardiovascular disease in those overweight and obese in ten-year follow-up study.

Yes, I admit I have an anti-BMI bias (the BMI is bogus!).

Don’t get me wrong … I am not proposing that a higher BMI is necessarily neutral or positive (not every person with a higher BMI got that way by having a disproportionate amount of muscle mass).

One of the many things that bothers me about BMI is the implicit “blame” in the actual fat mass of a given person rather than what actually caused the excess fat. It’s “Jane has a high BMI; her high BMI makes her at risk for CVD.”

Contrast that with the difference between “John is at risk because of 20 lbs of excess fat” versus “John is at risk because he has been eating excess sugar & salt, poor quality fats, etc., that have contributed to inflammation, high blood pressure, weight gain, and other metabolic syndrome factors” and so on.

So yes, while fat is not inert (and visceral fat apparently particularly problematic), the thing that irks me the most about BMI is the attention on the effect rather than the cause. Dr. Sharma calls it obesity as a clinical sign. IMO, we’re better served treating the problem, not just the evidence of it.

Otherwise, the side effects of misdirected attention are 1) you wind up with horrible policies like the one at Lincoln University, 2) people focus on weight loss rather than health, sometimes with unfortunate consequences (SlimFast anyone?), and 3) you spend resources that might better be directed at actually addressing the source of the problem.

Aye, there’s the rub. The challenge is to first understand the source of the problem. Lipid hypothesis anyone?