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Medical Forum / Diseases and Disorders / Diabetes / April 2006

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Question on BMI

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JJ Jones - 28 Apr 2006 00:14 GMT
I've lost 25 pounds now since being diagnosed.  Today I crossed over
the line to become a Body Mass Index (BMI) of 29.9.  At the time of
diagnosis (mid February) I was a BMI 34.5.  That changes my official
classification from "obese" to "overweight".

The question of the day:  Let's say that I decide to remain a BMI 29.9,
but I go to the gym every day and work out for 3 hours.  I become Mr.
Universe Iron Man.  Am I just as well off, in terms of Diabetic risk
factors, as I would be if I were a skinny BMI 25?

I ask because I'm really pretty happy with being a BMI 29.9.  I don't
want to have to diet away all of my muscle mass in order to become a 90
pound weakling.  I'm willing to lose another 25 pounds if that will
really help me with Diabetes, but I would actually prefer keeping my
present weight and working out more.

In other words, if I can stay a BMI 29.9, but yet reduce my body fat
percentage to the same level that it would be if I were a BMI 25, do I
then have the same low risk factors of a BMI 25?
outsor@citynet.net - 27 Apr 2006 23:46 GMT
"The question of the day:  Let's say that I decide to remain a BMI 29.9,
but I go to the gym every day and work out for 3 hours.  I become Mr.
Universe Iron Man.  Am I just as well off, in terms of Diabetic risk
factors, as I would be if I were a skinny BMI 25?"

What is more important is fat distribution for you at this point.  
Assuming the usual diabetic fat belly the risk factors remain high,
insulin resistance is promoted, the fat cells are pumping out hormones
which contribute to the metabolic syndrome and other factors.  The best
predictor of problems is bmi plus belly circumference.  It is not muscle
mass that is the most of your present bmi, it is fat.  By reducing carbs
and increasing lean protein one can best avoid muscle loss when losing
weight; along with the well advised course of weight based exercise you
propose.
JJ Jones - 28 Apr 2006 14:26 GMT
> What is more important is fat distribution for you at this point.
> Assuming the usual diabetic fat belly the risk factors remain high,
[quoted text clipped - 5 lines]
> weight; along with the well advised course of weight based exercise you
> propose.

Thanks for reminding me about my belly.  I definitely have more work to
do on that.  Even tho I've tightened my belt by 3 notches, I'm still
about a 42" waist, and I know that anything over 40" is heightened
risk.  I'd actually like to get down to about 38".

I've done crunches and sit-ups for years, but that doesn't seem to
reduce my waistline.  It just makes my abs firmer.  It seems like the
only way to get my waistline down is thru diet.

So that reminds me that I DO need to lose more weight, which kind of
answers my question.

However, its good to know that I don't have to follow BMI too
slavishly.
Susan - 28 Apr 2006 15:01 GMT
>>What is more important is fat distribution for you at this point.
>>Assuming the usual diabetic fat belly the risk factors remain high,
[quoted text clipped - 20 lines]
> However, its good to know that I don't have to follow BMI too
> slavishly.

http://www.cmaj.ca/cgi/content/full/174/3/308

Waist to hip ratio is a strong indicator of CVD risk.

Susan
bittersweet - 28 Apr 2006 16:57 GMT
>http://www.cmaj.ca/cgi/content/full/174/3/308
>
>Waist to hip ratio is a strong indicator of CVD risk.
>
>Susan

That link was a little disheartening for me, especially this part:

"Using waist-to-hip ratio rather than BMI as a measure of obesity and
hence risk for CVD makes a considerable difference to the proportion
of people considered at risk of myocardial infarction. The researchers
estimate that a waist-to-hip ratio cut-off of 0.83 for women and 0.9
for men would result in a 3-fold increase in population attributable
risk for myocardial infarction."

I went from a BMI of over 40 down to 20 or 21.  I have lost all the
weight I can without looking emaciated... The jeans I am wearing right
now are a size 3.  I've never had much of a butt or hips at all,
though, so my waist-to-hip ratio is 0.85.  If they decide to use that
ratio rather than BMI as a definition of obesity, I'd be in the obese
category even though I'm only 112 pounds.

--bittersweet
Roger Zoul - 28 Apr 2006 18:47 GMT
:: On Fri, 28 Apr 2006 10:01:34 -0400, Susan <nevermind@nomail.com>
:: wrote:
[quoted text clipped - 20 lines]
:: use that ratio rather than BMI as a definition of obesity, I'd be in
:: the obese category even though I'm only 112 pounds.

Those are just guidelines, not hard and fast rules....and there are always
outliers.
Priscilla H. Ballou - 28 Apr 2006 19:05 GMT
> >http://www.cmaj.ca/cgi/content/full/174/3/308
> >
[quoted text clipped - 17 lines]
> ratio rather than BMI as a definition of obesity, I'd be in the obese
> category even though I'm only 112 pounds.

I was wondering something similar.  I'm no 112 pounds, but I've never
had a noticeable waistline, and when I was skinny (way long ago in my
youth) I was basically one size between my shoulders and my thighs.  So,
is there an exception for body-type, or is body-type symptomatic?

Priscilla
Roger Zoul - 28 Apr 2006 19:37 GMT
:: In article <79e452hutsv9ne8j4t601h8i0u51rapk0f@4ax.com>,
:: bittersweet <bittersweet@spamless.invalid> wrote:
[quoted text clipped - 28 lines]
:: youth) I was basically one size between my shoulders and my thighs.
:: So, is there an exception for body-type, or is body-type symptomatic?

Of course there is....these are guidelines, not hard-and-fast rules.  You
can also ask yourself how much fat your carrying around your middle.  Plus,
there are other indicators, too.

:: Priscilla
Priscilla H. Ballou - 28 Apr 2006 20:28 GMT
> :: In article <79e452hutsv9ne8j4t601h8i0u51rapk0f@4ax.com>,
> :: bittersweet <bittersweet@spamless.invalid> wrote:
[quoted text clipped - 32 lines]
> can also ask yourself how much fat your carrying around your middle.  Plus,
> there are other indicators, too.

Replying to "is it A or B" with "yes" is less than helpful.  But I
understand what you're trying to convey.

Priscilla
Roger Zoul - 29 Apr 2006 13:50 GMT
:: In article <1254o6vc73qgtb7@news.supernews.com>,
:: "Roger Zoul" <rogerzoul2@hotmail.com> wrote:
[quoted text clipped - 42 lines]
:: Replying to "is it A or B" with "yes" is less than helpful.  But I
:: understand what you're trying to convey.

Sorry, Priscilla.  It just seems so obvious to me, that's all.
Chris Malcolm - 29 Apr 2006 11:45 GMT
>> >http://www.cmaj.ca/cgi/content/full/174/3/308
>> >
[quoted text clipped - 17 lines]
>> ratio rather than BMI as a definition of obesity, I'd be in the obese
>> category even though I'm only 112 pounds.

> I was wondering something similar.  I'm no 112 pounds, but I've never
> had a noticeable waistline, and when I was skinny (way long ago in my
> youth) I was basically one size between my shoulders and my thighs.  So,
> is there an exception for body-type, or is body-type symptomatic?

I'm very disappointed that instead of developing the interesting and
useful ideas about body type of Sheldon (ectomorph, endomorph,
mesomorph), doctors are being bullied by time pressures into
"evidence-based medicine". "Evidence based medicine" sounds wonderful,
but given the poor understanding of statistics of most of those who
use them, is turning medicine into one-size-fits-all statistical risk
management. You're given a pill on the basis that if you're the average
person with those blood test results, this pill will be good for you.

The big question is whether it's going to be possible to fix
institutionalised medicine by a process of gradual change, or whether
we're just going to have to call in the revolutionaries.

Signature

Chris Malcolm cam@infirmatics.ed.ac.uk +44 (0)131 651 3445 DoD #205
IPAB,  Informatics,  JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

Roger Zoul - 29 Apr 2006 13:49 GMT
:: I'm very disappointed that instead of developing the interesting and
:: useful ideas about body type of Sheldon (ectomorph, endomorph,
[quoted text clipped - 9 lines]
:: institutionalised medicine by a process of gradual change, or whether
:: we're just going to have to call in the revolutionaries.

Please, call in the revolutionaries.  NOW!

:)
Joe Negron - 28 Apr 2006 19:54 GMT
>>What is more important is fat distribution for you at this point.
>>Assuming the usual diabetic fat belly the risk factors remain high,
[quoted text clipped - 13 lines]
>I've done crunches and sit-ups for years, but that doesn't seem to
>reduce my waistline.  It just makes my abs firmer.

"Spot   reduction"  (e.g.,  reducing  one's  waist  by  doing  exercises
targeting the waist) is a myth.  People accumulate fat in an order which
is  particular to them; for some, they may first put fat on their waist,
then legs, then butt.  In order to lose that fat you must burn the  fat.
In  order  to burn the fat, you must cut your intake of calories so that
it's less than the amount you're burning.  Do this long enough  and  you
should  lose  the  fat  in reverse order (in the aforementioned example,
butt, then legs, then waist).

>It seems like the only way to get my waistline down is thru diet.

Are you increasing your intake of calories, particularly carbs, when you
do your exercises?  That's pretty much what I've  done.   My  weight  is
staying  fairly constant but my body fat percentage is decreasing - IOW,
I'm replacing the fat with muscle.

>However, its good to know that I don't have to follow BMI too
>slavishly.

It can be a useful, though imperfect, metric.

--
------------------------------------------------------------------------
I'm proud of the fact that I never invented weapons to kill.

--Thomas A. Edison
------------------------------------------------------------------------
Joe Negron from Sheepshead Bay, Brooklyn, NY, USA
Roger Zoul - 28 Apr 2006 01:13 GMT
BMI is a pretty arbitrary and useless metric.

Yes, you can reduce body fat and keep and/or build muscle mass, have a high
BMI, and assuming you control your BG and have good lipid results, you ought
to be fine.  Of course, there are no guarantees.

:: I've lost 25 pounds now since being diagnosed.  Today I crossed over
:: the line to become a Body Mass Index (BMI) of 29.9.  At the time of
[quoted text clipped - 15 lines]
:: percentage to the same level that it would be if I were a BMI 25, do
:: I then have the same low risk factors of a BMI 25?
Nicky - 28 Apr 2006 13:00 GMT
> I ask because I'm really pretty happy with being a BMI 29.9.  I don't
> want to have to diet away all of my muscle mass in order to become a 90
> pound weakling.  I'm willing to lose another 25 pounds if that will
> really help me with Diabetes, but I would actually prefer keeping my
> present weight and working out more.

It's not your BMI that's the issue, but how much truncal fat you're carrying
around. Your body fat percentage would be more useful; but perhaps the
simplest measure of all would be to get your waist measurement down to
normal. Dunno what it is for you males, you'll have to look that up yourself
: )  I got a marked improvement in all diabetic fronts when I hit that
target.

Nicky.

Signature

A1c 10.5/5.4/<6  T2 DX 05/2004
1g Metformin, 100ug Thyroxine
95/74/72Kg

LizardQueen - 28 Apr 2006 20:10 GMT
Congrats on changing categories! That's one of my near-term goals - to
move from from Obese to the merely Overweight.

I have either 1.7 or 2.6 BMI points to go to get there, depending on
which leg I measure my height on (I broke one as a child and it's
shorter than the other!).

IMHO, BMI is just a rough guideline and not a  tool that works for
everyone.  Some folks with large frames and lots of muscle are "Obese"
by BMI terms but have a much lower percentage of body fat than the BMI
score would indicate.
And some very small framed people may have their body fat
underestimated for the opposite reason.

A friends son who is a solid block of muscle got dinged on a physical
for having a too-high BMI even though his six pack has so much
definition you could ski down it like moguls :lol:.

A more accurate way is something they do pretty much only at research
places and schools - I think they weight you then dunk you in water and
figure out your volume and calculate from there.  It's hard to find
someone to do it, though.

Anyway, the more muscle and less visceral (abdominal fat, around the
organs) fat you have the better.

How is your waist measurement, and can you "pinch an inch" or more?

Don't starve yourself, eat enough protein to keep that muscle in good
shape, and continue to work out and the fat will be replaced with
muscle eventually.

Your BMI may not end up in the "optimally low" category but, in my
mind, if I had a choice between a higher BMI and more muscle and a
lower BMI with less muscle, I'd go with the higher/higher as long as I
was sure that what was increasing the BMI *was* truly muscle and not
fat.

Some books have ways of calculating % body fat by using a combo of
measurements, heights, and constants.  I think the Zone Diet book has
that in, as well as maybe Protein Power. I don't know how accurate that
is but it could be worth a look-see.

LQ
 
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