Asymmetrical Information

I think, when considering our ideal weight, it doesn't help that current medical advice -- though perhaps accurate -- is a little alarmist.

I am concerned about my health, so I have a pretty rigorous routine two out of every three days. I'm 5'10 1/2 and weigh 178 lbs. I look healthy and I feel healthy.

Yet, under current medical standards, I am on the cusp of being overweight. It sounds ridiculous to me, but still it creates some anxiety. For me to reach my ideal weight and BMI would require a commitment to good diet and exericse that would nearly eliminate pleasure from my life. And I'm a regular gym goer. Think of the fear information like this inflicts on the more sedentary.

I think doctors should perhaps separate the idea of ideal weight from the idea of a good living standard. Patients should be informed of the increased risks of heart disease, diabetes, and the rest, from being "overweight" but also emphasize that ideal weight can only be reached through significant and unrealistic changes in lifestyle. By setting the bar lower, we'll find it easier to meet goals and lead healthier lifestyles, without having to constantly worry about reaching a stupidly ridiculous BMI of 20.

BMI's are not ridiculous for everybody. They are preposterous for me because of my build; at a BMI of 25 I have a sunken look (both my face and my body). OTOH, if my wife ever hit a BMI of 25, she'd be in a size 12 or 14.

As long as you get plenty of aerobic exercise, keep the weight mostly under control, and aren't Pacific Islander, American Indian, or African-American, you're fine. Those three groups all have to stay rail-thin to avoid diabetes.

They also left off some other important advice: don't be hypoglycemic. I've known a few of them, and they can't lose weight because they have to eat every two or three hours - and it's hard to get something small enough at mealtime (imagine having a 200 calorie budget for dinner, e.g.).

BMI is applicable only over a fairly specified and "middle of the curve" range, since it is built on broad demographics. The most obvious example of its limited applicability is the fact that professional athletes in many sports (corner backs, point guards, middle-weight boxers, quarterbacks -- we're not talking 350-lb linemen) are all in the danger area indicated by BMI. The reason, of course, is that they are not average, and they work very hard at staying that way. It doesn't necessarily follow that they aren't healthy, it just means that BMI is not a good measure of 'healthy weight' for them -- they have much more than the "average amount" of muscle and show up as too heavy (too much mass) for their height.

Yes, but . . . most people aren't muscled like professional athletes. I hear this objection over and over, and we're talking about a fraction of one percent of the population. It also doesn't work well at extremes of height, but that's another tiny fraction. It is an imperfect, but fairly accurate, measure for the rest of the population.

Stop Drinking Soda: Over the course of a year, one can of regular cola a day, at 140 to 150 calories, adds up to more than 50,000 calories, or about 15 pounds.

But calories alone are not what make beverages so insidious. Liquid calories have the potential to do more damage in terms of weight gain because they don't make you feel as full. The body simply doesn't "notice" calories that you drink as much as it does calories from solid foods -- so you end up consuming far more calories than you would otherwise. (Liquid diets don't pose the same problem because the drink is intended as a replacement for other food.). . .

What about diet soda? It usually says 0 calories on the can or bottle but does that mean it might still be bad for weight loss because of some other effect?

"For dieters, though, variety is trouble. The more choices you have, the more you will eat."

I learned this lesson the hard way. Because of some stomach problems I was having, I had to eat nothing but broiled chicken and boiled white rice, with no seasoning except a bit of salt, for five days, then add one food every three days.

I lost 5 pounds in those first five days, and I learned (unfortunately not permanently) the difference between hunger and appetite. If eating means facing another bowl of white rice, you don't do it unless you are hungry; you don't eat just out of boredom. I continued to lose as I added foods. (The first food I added was citrus. I craved orange juice something awful. Anyone who knows me would think I would want to add chocolate right away, but the body just doesn't work like that.)

Although this was not a weight-loss diet, it had the same results. I lost weight, but then after a few weeks I just couldn't take it anymore. (I also suspected a certain food and tried just eliminating it, and that seemed to do the trick.)

So, variety is bad for weight loss, but people can't sustain a diet without it.

Hey, I was just contributing -- of course professional athletes are a tiny percentage of the population. So are really tall people.

"I hear this objection over and over ..." Lighten up -- it was just a comment. I'll bring the stats next time (I'm a statistican, as it happens) -- all I was trying to contribute is that if you aren't "average" in some easily identified way, then BMI might not work for you.

You've probably heard that "over and over," too.

Curious about whether the study differentiated weight training and cardio from cardio alone. My experience and observation has been that cardio alone won't produce long term weight loss. Adding weight training makes a world of difference. My wife swears it enhances metabolism and the added muscle seems to help smooth out big meals that used to bloat her, etc.

I'm sorry if I sounded testy -- but you can't imagine the number of "yes, but what about Michael Jordan?" emails/stories/posts I read when I was blogging about diet and Atkins, as if we should all plan our lives around Michael Jordan as the average. ;-)

Stan -- good question. Strength training does increase metabolism, from what I've read.

Another factor, time exercising is time not eating. I teach water aerobics, and some people come to just splash around a little bit and socialize instead of working as hard as they could. I figure at least that's 2 hours (by the time you count changing, showering and driving to the Y) that they're not on the couch eating Doritos.

I also cringe at anything that might discourage exercise. It does change your body, even if it doesn't show on the scale. (I know the article talks about the other benifits, but people want to be thinner, and exercise helps.)

I'm drinking a lot of diet soda these days, since almost all are zero calories and zero carbs. There are some Adkins advocates who claim that NutraSweet is somehow metabolized into carbohydrates by the body (they love Diet Rite brand because it uses a different sweetener) but I have managed to keep the weight off by drinking diet beverages instead of sweetened ice tea, sports drinks and fruit juices that I used to drink.

And I agree on the value of weight training. It increases metabolism in two ways: 1.) the body has to keep burning calories for a couple of days after a weight training session in order to rebuild muscle fibers that are torn down and 2.) each additional pound of muscle requires somewhere on the order of 50 calories a day just to sustain itself.

I'd also point out that this article might not be the best advertisement for buying a subscription to WSJ. :) I mean, virtually everything here is either such obvious common sense (well, gee, you should fill yourself up on food that has low calories so that you're not hungry rather than tiny portions of very high calorie foods) or repeated everywhere (don't drink regular sodas, small portions, etc.). Maybe I just read a lot of articles on the subject (including having had a Men's Health subscription for years), but most of this is well known.

The interesting thing here, in that it is contrary to almost all the advice given, is the idea that you should not eat a variety of foods. The logic here is hard to dispute--you'll get bored more quickly and be less likely to overeat. The problem is that this makes it essentially a fad diet. People will get tired of the diet very quickly, crave all the foods they're having to skip, and cheat like hell until finally going off it to begin with. If they were disciplined enough to eat nothing but boiled chicken and steamed carrots, they wouldn't be little lard-butts to begin with. . .

Heh.

I think body fat % is a much better indicator than
BMI.

James, Shawn Phillips says that common sense doesn't mean common practice. Sometimes reading what seems obvious can help get motivated.

BMI is horrible!!!

and body fat is great as a measure! especially since what really matters is how many fat pounds you have!..

one of the main reasons why bmi is bad is because it gives lanky people a false sense of security... there's lots of peope who are "fat thin"... seem thin to moderate, but have really skinny genes...

not that i have that problem.. unfortunately (large genes.. overly large body)

rather than motivation concerns, a lackadaisical approach easily leads to problems...

on ething i've seen recently is that people other than gym rats are encouraging the 6 meal a day plan... i'm lucky if i can eat two... never mind 6... how do people do it??

From Devilbunny, last paragraph:

They also left off some other important advice: don't be hypoglycemic. I've known a few of them, and they can't lose weight because they have to eat every two or three hours - and it's hard to get something small enough at mealtime (imagine having a 200 calorie budget for dinner, e.g.).

People eating every two or three hours most certainly can lose weight. I normally eat five or six times daily and have no problem losing weight when I want to. It's my understanding your metabolism will increase by eating more often. It does require planning to eat this way, but it can be done; I conditioned myself to start eating this way about five years ago.

Not many statistician is this group of commenters, no? Who cares what YOU think about BMI? The stats show it correlates/predicts cancer.
Oh, but YOU think this or that? Glad to hear it.

For the serious, check out info on Calorie Restriction / Optimal Nutrition. This is the not so new idea (though new to me) that if you eat 30% - 40% less than "normal" you'll live 30%-40% longer.

There are clear and undeniable correlations to food consumption and health, regardless of individual opinion.

Having recently "dieted" off 20 pounds -- in tandem with a once-again-gorgeous Better Half who simultaneously "dieted" off 30 pounds -- I'd like to toss in a few observations of my own.

First, any diet that's regarded as a diet -- that is, as a temporary, curative program to be terminated at the attainment of some goal -- is overwhelmingly likely to fail. We learned that the hard way. So we switched over from a "diet" mindset to a "health regime change" mindset.

Second, there's a tendency to put too much emphasis on what the scale says to you, and too little on how you feel, your overall energy level, and what you want your body to do for you. When we defined our goals in terms of target weights, we made little progress. When we defined our goals in terms of particular abilities we wanted to regain, and used the scale only to make a parallel record of our campaign, we got where we wanted to go.

Third, there is nothing that disturbs the progress of a physical-improvement campaign as much as dining out. This is part psychological, as the restaurant experience seems to persuade the diner that the rules have been suspended, and part physiological, as most restaurant food is much higher in fat and salt than what you'd normally eat at home. The WSJ article's observations about portion size also apply.

Fourth, it's an immense help to any physical-improvement campaign to have someone who'll do it with you. That, of course, is Weight Watchers' ticket to riches; they offer access to a supportive community that a lot of would-be dieters can't get another way. Does it always work? No. But it improves the odds, especially if you and your "diet buddy" eat most of your meals together and do most of your exercising together.

Fifth: Minimize your intake of alcohol. Not only is it high in calories; it also depresses the metabolism, reducing calorie consumption. One glass of wine at night is a prudent limit.

There! I've done my pro-social act for the day. Now to pour another Manhattan and have a big slice of this magnificent Nesselrode pie. Perhaps I can squeeze in a nap before lunch, too.

doug,

BMI may correlate with cancer. It may well be a easy substitute for a body fat measurement which is reasonably approximate for a lot of people.

But you cannot deny that the methodology has tremendous flaws. If anyone goes to the gym regularly for a few months and drops 5 lbs of fat and puts on 10 lbs of muscle, his risk of cancer, heart disease, etc. will drop. He will be substantially healthier.

And yet, his BMI will be higher.

David -

I meant people who are trying to eat meals with other people. I was aware that many small meals is a great regimen; I'm just talking about people who have to eat every few hours.

And Doug, you have no idea what you're talking about. BMI is used by the medical community because it relies on data that are already collected. Everybody knows it's useless for a fair percentage of people, but it's the only thing we've got. Read the abstract on that NEJM study you're talking about; they talk about people with an over-40 BMI (remember, "overweight" starts at 25 and "obese" at 30) and still only manage to pull up a relative risk of 1.5 or 1.6. That's statistically significant, but it doesn't mean much in real life (generally, relative risks or odds ratios below 2 are considered not a big deal).

For those who aren't familiar with BMI: a 6-foot-tall person with a BMI of 20 (the lower limit of "normal") weighs 139 lbs; at 25, the upper limit of "normal", he or she weighs 174 lbs; at 30, the beginning of "obese", 209 lbs; at 40, the lower end of what that study claims, 279 lbs.

According to the table I'm on the borderline between normal and overweight at 6'1" and 185, a BMI of 24.4. Another couple of pancakes, 190, would push me over.

I think it's a good measure for people who are completely sedentary--the vast majority of the US population--but isn't very useful for people who do even a moderate amount of weight traiing.

The most scientific method of gauging my weight and health that I've found is the "jeans and three flights of stairs tests." I have a pair of jeans that I try on occasionally. If they fit with no problem, I'm okay. A little loose, and I need to hit the gym and do some weights and eat some more. A little tight, and I've overindulged. As to cardiovascular health, can I jog up three flights of stairs without collapsing in a heap at the top? If yes, then I'm doing okay.

My point to the rambling above: every statistic and method you read about is not adjusted to your body. You've lived with it since you've been born -- you know it best, or you should. Simplistic? Yes. Does it work? Yes.

To Devilbunny: Point taken.

Stan,
Agreed, in that specific example, that person would be better off. However, with respect to BMI, I think the majority of people think they are the exception. But I think the fact is,
most people, myself included, before (I went on a calorie restriction diet) are very close to being overweight.
Doug

James Joyner, I think you're exactly right. From personal experience, I've done very well on the Atkins diet, losing 54 pounds in spite of the no conscious portion control. But, after a while, I found it extremely hard to stick with b/c I just got bored eating meat all the time.

As far as exercise goes, I've always found I do better at losing/maintaining weight when I'm exercising fairly frequently than I do when I'm not. Even if it does take four weeks to lose one pound through walking, that's still 12 pounds over the course of a year, isn't it? Seems to me that's better than the ole goose egg...

Gotta make a point about the downplaying of exercise in successful weight loss.

What burns calories and fat? MUSCLE. Progressive weight training, and any other anaerobic exercise (i.e., high speed running) builds muscle, and muscle burns calories and fat.

Why the continued obsession with steady-state aerobic (i.e., "cardio") excercise?

Too many people are trapped in the thought that calories burned while exercising are the measure of fat burning effectiveness. No. It's what happens to your body AFTER you excercise that really counts.

Show me somebody who puts on 10 pounds of muscle, and I'll show you somebody whose burning more calories and fat even when they're sleeping.

Gotta make a point about the downplaying of exercise in successful weight loss.

What burns calories and fat? MUSCLE. Progressive weight training, and any other anaerobic exercise (i.e., high speed running) builds muscle, and muscle burns calories and fat.

Why the continued obsession with steady-state aerobic (i.e., "cardio") excercise?

Too many people are trapped in the thought that calories burned while exercising are the measure of fat burning effectiveness. No. It's what happens to your body AFTER you excercise that really counts.

Show me somebody who puts on 10 pounds of muscle, and I'll show you somebody whose burning more calories and fat even when they're sleeping.

When I first read about the BMI measurement about 8 years ago, it included your waist measurement in the calculation. Calculating BMI in this manner put me at a healthy BMI. The current method of calculating BMI relies on body weight and height but excludes waist size. The current formula puts me at an unhealthy BMI that does not reflect my physique and activity level. I think they removed the waist measurement to simplify the calculation of BMI at the expense of accuracy.

Anybody remember what the old formula for BMI was?

"We're born with a better ability to listen to bodily signals than we're later exhibiting," says Dr. Rolls. "Between three and five, kids are getting rewired for cleaning their plates."

For at least three generations it has been regarded as bad behavior not to eat everything put before you. And kids who responded to a parental line like "Starving children in [place] would love to have that" with the common-sense rejoinder "Then let's send it to them" were more likely to be punished than not.

BMI - well, as a quick-and-dirty first take it is a start. But it has become enshrined, even by some doctors, as THE measurement, with no other considerations looked at. Sort of like seeing someone with "a yellowish cast to the complexion" and immediately diagnosing malaria (or typhus, or liver failure, anemia, or whatever your pet disease-of-the-week...).

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"I am NOT overweight, I am UNDERheight! My weight is perfect for a man of 7`9``!" Victor Buono

Did wonder about sources for the idea the exercise does not do much for weight loss. A couple of the obesity docs I know say, over coffee, that exercise doesn't work because people don't do it.

I'm on the MD program, too. Additionally, as long as there's a dog around, I can fail to clean my plate without worrying about wasting food.

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