Dr. J will see you now: On ugly sweaters, Swedish guys and BMI
Contributor: “Dr. J”Dr. J offers his irreverent, slightly irrelevant, but possibly useful opinions on health and fitness. A Florida surgeon and fitness freak with a black belt in karate, he runs 50 miles a week and flies a Cherokee Arrow 200.
Ugly sweaters
A new trend that I just heard about is ugly sweater parties. They are especially popular around Christmastime. There is even a website where you can buy one if you are one of the two people in the country who can’t find one hidden or forgotten in the bottom of a drawer somewhere.
Swedish guys
I have a Swedish friend who is over 90 years old! He is a very fit and healthy 90-year-old. I usually see him at the gym, either in the sauna, one of his region of origin’s gifts to the world, or in the aerobic room doing a series of exercises similar to the 5BX — more popularly known as the Canadian Air Force Exercises — originally developed in the 1950s.
He broke his arm last year slipping on the ice in Stockholm during a visit with his family. He’s probably has lived in the Florida sunshine a little too long, and was out of practice. It healed up without any problems!
Speaking of Swedish guys, a new study has come out of the Karolinska Institute in Sweden on the BMI and health. The work was conducted in conjunction with Britain’s University of Bristol, and the results have just been published in the British Medical Journal (BMJ).
This was not some minor study. It seems these Swedish researchers measured the BMI and mortality among more than a million pairs of Swedes over 50 years!
Previous studies have found a positive link between BMI and higher risk of death from cardiovascular disease, diabetes and some cancers. In addition, a low BMI had been associated with increased mortality from respiratory disease and lung cancer.
These findings about health and a low BMI have been challenged, citing that the figures could be skewed by something called reverse causality, meaning that people with lung cancer, for example, which will cause significant weight loss, are being factored in as those with a low BMI. Smoking and poor socioeconomic circumstances will also induce this error.
The results
The investigators found a significant relationship between increased mortality and increased BMI. This link was especially noticeable in cardiovascular disease, for which the existing estimates may be “substantially underestimated,” according to the researchers.
There was also a positive correlation with diabetes and kidney cancer. There was, however, no evidence of an association between having a low BMI and an increased risk of respiratory disease and lung cancer mortality.
Discussion
You may disagree, not like it, think people can be healthy at any size, or fat but fit, feel statistically that the BMI is bogus, or that it falls apart on the individual level, or any other reason you may have to want to argue about the BMI measurement, but this study looked at over two million people over a 50-year period and showed that the BMI is valid. To quote Deep Thought, the computer from The Hitchhiker’s Guide to the Galaxy, “Yes I have the answer, but you’re really not going to like it!”
I’m not asking anyone to like it. I’m asking those who need it to recognize the health risks.
I understand if you are protected by youth, or good fortune, and feel that you are healthy in spite of your high BMI that, shall we say, motivation may be lacking to find the need to do anything about it. Please realize that we are concerned about the proven increased potential for early morbidity and mortality. Once you have reached that point with numerous morbidities, it is often too late to find ways to significantly help yourself.
A high BMI, with its well-proven risks to your health, is like that ugly sweater that you may want to ignore or forget about, except try as you might, you can’t take the sweater off without making some substantial healthy changes. You don’t really want to show up unnecessarily early for your funeral in that sweater now, do you?
The time to make those lifestyle changes is now!
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I sense a number of “I weigh 300lbs but I totally eat only tiny portions of nutritious foods and I do 10 hours of strenuous exercise every day, so my weight cannot impact my health in any negative way” posts coming your way.
The fit but fat/HAES people kind of remind me of the people who still believe vaccines cause autism. No matter how many studies your throw at them, no matter how many variables are accounted for, they absolutely will not believe the science.
I’m one to always take studies and research with a grain of salt- and I think that we DO have to look at EVERYTHING on a very individual level because we’re all different (how very Western of me!)- but that being said, I definitely agree with you that carrying around excess amounts of fat is very detrimental to anyone’s health. We can all benefit from eating a little better, exercising a little more, building muscle, and getting leaner!
Great analogy!!! This: is like that ugly sweater that you may want to ignore or forget about, except try as you might, you can’t take the sweater off without making some substantial healthy changes. You don’t really want to show up unnecessarily early for your funeral in that sweater now, do you?
So many people keep putting off the inevitable, make excuses, fool themselves into believing all is fine. Yes, there is fear there & I am well acquainted with fear (Friday post) BUT health is so important! That was one long study!
No, ham_soda (lol), many people may not want to believe the BMI studies, but when it unfortunately becomes their life, they will change their viewpoint.
Please know, by the way, that my job as a doctor is to present a valid message without the need for exaggeration.
I tend to either embrace studies, or reject them, Sagan. In this case we have over 2 million people over a 50 year period. It’s more like a ton of salt in my opinion.
Thank you Jody. I am trying to reach people with many different points of view and help them change for the healthier.
When I croak, I’m definitely going to have my ashes put in an urn that’s as ugly as that sweater. Hopefully someone will love me enough to let me hang out on their mantel.
My highest BMI was about 43 and no matter what people say, I was unhealthy, I was at risk for these morbid diseases, and I knew it. Now my BMI is about 21.8 and although I’m not perfect, I know that I have reduced my risk of some of those obesity related diseases by virtue of getting my weight under control.
You will probably get some flack for this post, but regardless of whether or not the BMI is a perfect tool, it has validity where I’m concerned – because I’ve been on both sides of the BMI debate.
Hey Dr. J, bet you expected me to weigh in (no pun intended :). As I think you know, I am not a BMI apologist. I don’t think that a high BMI is a free pass. But there are a number of reasons that I am troubled by an over-reliance on BMI as a measure of health.
First of all, as a math major, I don’t particularly care for the fact that people think BMI is a better measure than height and weight. It’s not. BMI gives the appearance of being a “real” number, but it’s just a fuzzy number related to weight and height. I think that Keith Devlin of NPR covers this very well on his “BMI is bogus” report:
http://www.npr.org/templates/story/story.php?storyId=106268439
Second, I’ve no doubt that a higher BMI is associated with chronic disease. But I am concerned that it gives people with a low BMI the idea that they are somehow not at risk. IMO, this is a big problem. I’m with Gary Taubes, and I think it is that what makes us fat (read: a high BMI) that is what makes us sick. But some people don’t have the side effect of a high BMI, yet they are doing the very same thing (eating too many refined sugars, bad fats, etc) that make them prone to these same chronic diseases related to lifestyle.
As this study shows, BMI does NOT explain a considerable amount of fatal and non-fatal CVD:
http://www.news-medical.net/news/20091208/One-half-of-fatal-and-one-quarter-of-non-fatal-CVD-is-linked-to-overweight-and-obesity-says-new-study.aspx
This to me supports the “what makes us fat makes us sick” … it’s just that in some, the side effect of excess weight isn’t there as a clue.
Finally, there is a very disturbing pattern in the relationship of high BMI and mortality risk that has nothing to do with the metabolic issues of excess weight. Yes, there was a recent study that showed that the idea of the “healthy” obese was problematic, but check out one reason why:
http://www.obesitypanacea.com/2009/12/obese-but-metabolically-healthy.html
Some of the mortality risk is likely due to the overweight (read: high BMI) who are being diagnosed later in their disease progression. Some of this may well be due to the overweight avoiding their drs, and some of it is because their drs are perhaps passing judgment on their overweight patients.
Anyways, for me, I think the real issue is the lifestyle factors, not the BMI. Someone who is keeping their BMI down thru crash dieting, drugs, smoking or lucky genetics (or whatever) may think they are have less risk of CVD or cancer. Me, I think they are kidding themselves.
So this is my concern. Making it all about a high BMI does two bad things IMO. First, it puts a scarlet letter on folks with a higher BMI. That’s great for the folks without, but it’s not clear that they are any healthier. And
Second, it means that we’re really not focusing on the real culprits, which are the corporate agents that are acting to both sell us foods that are problematic and also sell us the supposed “cures” to heal us.
Thanks for this thoughtful discussion of BMI – a thorny issue for sure. I respect the studies showing that increased BMI correlates with higher mortality. From a holistic viewpoint, though, BMI sometimes seems like an attempt to quantify the unquantifiable.
Instead of fixating on numbers (over a certain BMI = bad, under a certain BMI = good), I’ve found it more effective to work with clients’ physical cues such as energy, mood, sleep patterns, and digestion. These concrete symptoms are often more meaningful to people than numbers.
I love that you have no agenda, POD. I decorated that sweater :-)
Of course it has validity, Diane, as does your broader perspective on the issue.
To quote Deep Thought, the computer from The Hitchhiker’s Guide to the Galaxy, “Yes I have the answer, but you’re really not going to like it, Beth.”
I think every experienced clinician knows that numerical boundaries are blurry at best, but the BMI range does offer some leeway. I’m sure your clients appreciate and respond to your holistic approach, Eleanor.
Dr. J.!
3 things:
1) Happy, happy New Year!
2) I would NEVER wear that sweater (except to, of course, an ugly sweater party), but think it’s tacky, (the attached knick-knacks) not ugly. Then again, I am a freak for bright colors.
3) Everything Beth said, and I’m uber-impressed by all her linkage and research, and also her articulate expression of said research.
Res judicata, Ruth. Articulate does not equate with accurate.
True.
I think pursuing healthful nutrition and adequate exercise is beneficial for everyone and a point of agreement for those who dig the BMI and those who don’t, so IMO, healthy behavior should be the point of focus (with measurements of all sorts being a tool to gauge health and progress).
Happy 2010 everybody!
Of course I’m good with that Ruth. I don’t expect everyone, by any means, to
be able to reach a normal BMI number. I do hope that people make the effort to be as healthy and fit as they can be and not use an anti-BMI stance to ignore unhealthy behaviors. If everyone were perfectly healthy, I guess I would have only wanted to be an artist as a child, and missed out on all the doctor fun :-)
The issue of “fat acceptance” fascinates me. You are obviously against it, and I can’t say I disagree – as long as we never ever ridicule the fat or discriminate against them.
Thank you for your thoughtful comment, Vered!
Hmm, I think I will stay out of the BMI discussion, being too lazy at the moment to check out the study. I know earlier studies have found that merely being overweight (but not obese) does not seem to cause early mortality, but maybe this one comes to a different conclusion.
Anyway, I love hearing about your 90 year old friend and how healthy he is! Very inspirational!
Very sobering post. I’d be interested to read the study itself. I’m curious though – does it say what exactly is considered a “high” BMI? Because surely the correlation is not continuous. Did it look at obese people (BMI 30 or above) or overweight people (BMI 25-29)?
PS> LOVE any post that quotes Hitchiker’s Guide;)
My Swedish friend sets a wonderful example for the rest of us, Crabby!
This is a quote about the study, and I believe it answers your question, Charlotte! They used a BMI starting at 25.
“These conclusions have important implications for public health practice because they suggest that reducing population levels of overweight and obesity (or preventing their rise) will have a considerable benefit to population health.”
BMI is crap to a degree. I have a buddy of mine who weight 230 pounds, he is solid muscle. But his BMI indicates that he is overweight. I think each person is unique and a one size fits all tool will not work.
Thanks for your comment, Freddy! To quote Thomas Paine, “Time makes more converts than reason.”