Agreed. This one year I went from 110 lbs. to 140 lbs. In a single year. Did I mention that during that year I was working out twice a day, six days a week, and counting calories? When I showed up for the physical, I was supposed to check of a list of any medical problems I had in the past year, including “gained more than 15 lbs.”, which I checked. When I got my physical results and she told me I needed to lose weight, I was in tears. That little bit of information did me no good without an accompanying explanation as to what I was doing wrong.
This. Exactly. A doctor (or other medical professional) who lectures a patient about being overweight, without offering solutions, is just wasting the time of everyone involved.
And if I know that a doctor is going to give me a lecture on my weight, or is going to tell me that I need to read my Bible daily (yes, that’s happened), or otherwise is going to ignore my main complaint, I’m going to pay exactly as much attention to his/her comments as s/he pays to my complaints…that is, I’m not going to listen. And I’ll find another doctor.
Now if I go in and comment that my blood sugars have been running high, then I DO want the doctor to talk about my diet and exercise program, and to think about adjusting my dosages. Or if my lab work comes in, and the results aren’t good, then I want the doctor to discuss that with me. But I don’t want a lecture.
Did you ever find out what was wrong? That’s awful. I would have cried too.
I’ve never had a doctor acknowledge I was overweight, even when losing weight it would help me directly with the problem I was there to seem them for.
Yesterday I went to the doctor for a checkup (and for referal for bloodtests for my dietician, whom I’ve just started seeing, so I can lose weight!) and mentioned that I’ve been having knee problems. I was fully anticipating her to say, “Well, once you lose those extra 25 pounds, your knees will start feeling better” or something like that. Instead, I got a prescription for meds. I had to bring up, “Gee, do you think they’ll feel better when I lose this extra weight? What sort of exercise do you recommend I do or avoid?”
IME, once a doctor knows you’re actively losing weight or at least taking steps toward losing weight, they’ll back off. They know you know and anything they say won’t make a difference.
The last time I got fussed at for my weight was last September, when I had to have some tests done. The doctor asked me what I was doing to address my weight problem. I told her that I was already on Weight Watchers and that I’d lost about 60 lbs and was continuing to lose. She backed off after that. (Had she just looked at my chart, she would have seen that I had, in fact, lost a boatload of weight.)
No. Not unless you are really overweight to the point it is affecting your health. 5# over some chart some euro idiot compiled a century ago is meaningless.
This could well have been firming up, gaining muscle mass and losing flab. If so (and your BP etc were also better), then that 15# gain is a Good Thing.
Right. I don’t give a flying fuck about some useless non-scientific chart some non MD dude came up with about two centuries ago, when science was still in its infancy. You know who came up with that chart?
wiki :*Lambert Adolphe Jacques Quetelet (22 February 1796 – 17 February 1874) was a Belgian astronomer, mathematician, statistician and sociologist. He founded and directed the Brussels Observatory and was influential in introducing statistical methods to the social sciences. *
Note lack of “dietician” “Medical Doctor” or anything to do with medical science. Your BMI is being graded as “obese” compared to the average undernourished euro commoner from 18fucking35.:eek: When over 6 feet tall was freakish due to poor nutrition and lack of knowledge about vitamins, minerals etc. So freakish it was left off the chart, as Kevbo pointed out.
Why do they still use this chart, when it has no scientific validity at all? Because dieting is a multi-billion $ a year business just in the USA. Watch *Bullshit. *
Don’t get me wrong fellow Dopers. Being very overweight can be very very bad for your health indeed. But it’s your blood sugar, BP, cholesterol and similar numbers that tell that tale. Not that BMI chart.
Ignore the chart. Listen to the other numbers. Listen to your body- can you walk up two flights of stairs without huffing and puffing? (I am good for two, at 3 I am a trifle winded, at 5+ I am sucking air like a madman:D) Can you do a brisk 30 minute walk without tiring out or stopping for rests?
Put down the damn chips, go for a walk.
Some more stuff from wiki"The medical establishment has acknowledged major shortcomings of BMI.[19] Because the BMI formula depends only upon weight and height, its assumptions about the distribution between lean mass and adipose tissue are inexact. BMI generally overestimates adiposity on those with more lean body mass (e.g., athletes) and under-estimates excess adiposity on those with less lean body mass. …
Mathematician Keith Devlin and a restaurant industry association The Center for Consumer Freedom argue that the error in the BMI is significant and so pervasive that it is not generally useful in evaluation of health.[20][21] University of Chicago political science professor Eric Oliver says BMI is a convenient but inaccurate measure of weight, forced onto the populace, and should be revised.[22]
A study published by JAMA in 2005 showed that “overweight” people had a similar relative risk of mortality to “normal” weight people as defined by BMI, while “underweight” and “obese” people had a higher death rate.[23]
In an analysis of 40 studies involving 250,000 people, patients with coronary artery disease with “normal” BMIs were at higher risk of death from cardiovascular disease than people whose BMIs put them in the “overweight” range (BMI 25–29.9).[24] In the “overweight”, or intermediate, range of BMI (25–29.9), the study found that BMI failed to discriminate between bodyfat percentage and lean mass. The study concluded that “the accuracy of BMI in diagnosing obesity is limited, particularly for individuals in the intermediate BMI ranges, in men and in the elderly. …These results may help to explain the unexpected better survival in overweight/mild obese patients.”[18]
A 2010 study that followed 11,000 subjects for up to eight years concluded that BMI is not a good measure for the risk of heart attack, stroke or death. …
BMI is particularly inaccurate for people who are fit or athletic, as the higher muscle mass tends to put them in the “overweight” category by BMI, even though their body fat percentages frequently fall in the 10-15% category, which is below that of a more sedentary person of average build who has a “healthy” BMI number."
No, although as DrDeth accurately conjectured, I was doing a good deal of weight lifting. If you look at pictures of me from after all the weight gain, it’s clear that I have a good deal more muscle. I was lifting kind of heavy, so I had an increased appetite, and while I was counting calories, I wasn’t always succeeding in staying within that allotment.
Oh and also I used to weight 140 when I was younger, and I’ve heard that it’s easier to gain weight if you’ve been heavy before.
I was 30# over for many years and am 40# over now. I gained 56 pounds when I was pregnant. I have never, not once, heard a peep about my weight. I’ve seen many different doctors, too.
I guess it’s because my BP and cholesterol are good.
DrDeth,
The microscope was invented centuries before the BMI was developed and also by non-medical people. Is it also worthless?
The BMI was developed to determine what was normal in a statistical sense and using a long term view of normal populations it has worked quite well for that purpose. The last several decades seen that statistical normal shift and such has not occurred as a result of so many becoming so much more well muscled. During that time health problems associated with obesity have increased dramatically.
The BMI was not developed to determine normal from a best health POV. It is indeed unclear where BMI should be for that (high normal to mildly “overweight” may be statistically “better” than low normal) and in fact it may vary across populations. So for populations it is a limited tool. Still it correlates pretty well with adiposity and both “underweight” and “obese” are clearly at statistically greater risk than “normal” and near normal “overweight.”
It has even more limitation when applied to individuals some of whom may be well muscled. It is no more perfect than it is worthless. It is however pretty decent screening tool, similar to taking a temperature. An elevated temperature is not a diagnosis, it is a sign. It could be normal for that individual or it could represent a mild problem or a serious one. It requires further assessment. Likewise with BMI. A healthcare provider who jumps from “BMI says” to lecture number 34 is being lazy; one who fails even to note it is being negligent.
I could not disagree more with the idea that the issue should only be adressed after someone is really overweight to the point it is affecting their health. Prevention is much more effective. As a pediatrician I use BMI in preschool years to identify kids who are rising early and to hopefully help those families recognize the need early to provide a healthier nutritional and exercise family environment. (Juiceboxes are pediatric crack.) The BMI curve can also help older kids who have been working on their habits visualize their improvement even as they gain weight with growth.
Indeed some docs are lazy and go from “BMI says” to lecture. Some are even lazier and don’t even note the BMI and just pretend the issue does not exist. Some are well intended and just lack the skills and/or the toolkit. (I am trying to improve on both for myself all the time.) Those limitations can and should be addressed. Throwing out an imperfect but decent screening tool does not address those limitations however.
I feel like I could stand to lose 15-20 pounds to be at ideal weight and I’ve never had a doctor say a word, even during annual physicals for the past several years. Possibly because I’m otherwise healthy, or they just don’t bother, or maybe I’m just not that overweight compared to the rest of their patients.
I am a bit curious what people consider “lecturing,” though. Is merely mentioning that you’re overweight and recommending you try to lose some “lecturing”?
Not exactly the same scenario, but when I went to my OB intake, the nurse told me that I should aim to gain 25-35 pounds during my pregnancy. I pointed out that I was having twins and I should be gaining 35-50 pounds. She said that I was incorrect and that they had many healthy twins born to mothers who only gained 25 pounds and even under that. First of all, every single reputable source suggests gaining about 10 pounds with each addition multiple. Secondly, with multiples, early weight gain is more important than single births, so I should’ve been gaining more than I was at that point. Thirdly, lecturing me about weight gain and eating healthy when my chart shows that I’m still in the negative tells me you have no idea what you are doing.
I asked my doctor about gaining more weight and he told me to just add on additional calories instead of eating things like hamburgers. I have started drinking whole milk and eating pizza and hamburgers and I’m still only at 3 pounds weight gain despite the fact that I should have gained at least 14. I’m seeing a new, specialist OB in a week and if s/he can’t help me gain weight, I’m demanding a reference to a nutritionist.
I think that prevention AND EDUCATION could do a lot. My daughter took JROTC in high school instead of health/PE classes. In college, she took a couple of basic health classes…and changed the way she ate, permanently. Apparently, when I said that we weren’t going to have fast food burgers for dinner every night, it was just Mama being weird. But when she heard that from another adult, all of a sudden it made sense to her.
Yes, yes, another example of What We Should Be Teaching In Schools…but I think that we really do need to start teaching kids, from a pretty early age, how to make healthier choices. And that cookies are a sometimes food.
And truth be told that multi-pronged approach (school based education, media messaging, physician awareness along with skill building, and parents hearing the message from a variety of sources as well) is making headway: the increase in pediatric obesity at least has stopped and in some subgroups has reversed course. But that is what it takes, treating it as a systems problem and hitting at multiple levels of that system. And we have a long way to go.
If we are talking about using van Leeuwenhoek’s original model, then yes, I’d say it was worthless.
I understand we are in some agreement here and much of your post makes sense. BUT!
BMI is not a screening tool. It is simply a average of heights and weights of the undernourished euro commoner from 1835. When malnourishment, like rickets and scurvy were common, and where kids often died because they didn’t get enough food. As a tool to compare modern Americans it is complete and utter bullshit.
Would you use Quetelet’s figures to tell a parent that their kid was too tall and needed to start smoking and eat the wrong food to stunt his growth? Or tell them the kid is too short, and thus a daily session on the rack is in order? The chart simply tells someone that at this height a peasant from 1835 would be about so tall. Or contraiwise, that a 1835 Belgian peasant that weighed so much should be about that tall. Note that it was never intended to tell dudes that at a certain height that the **SHOULD **weigh so much, just that the average Belgian commoner DID weight about that much.
It’s a useless tool from the days of “humours” and leeching. One whose numbers have nothing whatsoever to do with todays American kids, whose problem is usually getting too much food, not enough food.
Unless the weight is a problem, weight loss should not be the issue. Activity and eating right should be. Those should lead to a healthier lifestyle, and yes, often weight loss.
When I was about 19 my doctor told me I should lose weight because I was borderline obese with a BMI just under 25. I never heard a word about my weight again from subsequent doctors, even when my BMI went over 30.
It wasn’t until I had suspected PCOS that I was advised to lose weight because when you have PCOS, any extra weight you carry can increase the hormonal imbalance and make it more severe. Even then, when I told my doctor I was aiming to get my BMI down to around 22, he said that I didn’t need to go that far and that BMI doesn’t take your frame into account.
No really it is a screening tool. Or at least only has great utility on the individual level as such. And despite your image of it being based on undernourished European commoners it was very good model of the normal (statistical sense) distribution up until very recent decades. The use of it as a medical tool dates back really just to the 70’s when Ancel Keyes analyzed multiple potential indices and determined that
It clinical use in the office is of even more recent vintage, dating back only to 1985 when the NIH decided to promote cut-offs of 85%ile as at-risk (27.8 for men and 27.3 for women) and made it easier for healthcare providers to use a few years later, in 1998, by declaring 25 as “overweight” and 30 as “obese” for both men and women. Not for us in Pediatrics however as BMI changes with age, so we use graphic normograms that represent percentiles from a couple decades back. Our use places over 95% of those curves as “obese” and 85%ile as “overweight.” The fact that currently roughly 15% of kids are as heavy for height as were previously the top 5% and another 15% are between 85 to 95%ile of those historic norms is explained purely by a greater frequency of excess adiposity … even if on an individual level some at 95% are girl gymnasts with barely an ounce of visible fat. Following those curves tells us a lot. If you click you can see, for example, that there is a leanest point that occurs between 4 to 7 with increases in BMI after that. That point is called “the adiposity rebound.” Kids who have an early adiposity rebound are at much greater risk of later obesity than those with later ones. So on. These are not tools from days of humours and leeching; they are data collected over the last decade or so and have everything to do with today’s kids in America and in the rest of the world.
In fact I do use height normograms as well. A child growing more slowly than is normal is a flag that needs to be investigated as well; less commonly so is a child who is getting taller faster than normal. The tool identifies a problem to investigate. What should be done about it, if anything, depends on the results of that investigation.
Agreed that defining overweight and obesity by those measures is stupid and using the BMI in that manner is ill-advised. And that such is even encouraged by the NIH in its poor assessment that simplicity is that important.
Also agreed that the lifestyle choices matter much more than what the scale or the BMI curve states. I have argued strongly on these boards that a focus on the scale, or even percent body fat, is usually counterproductive. But accepting the limits of the BMI, arguing that its limitations should accepted by more who use it and promote its use, does not equal declaring it completely useless.
My doctor always lectured me to lose weight (I weighed as much as 280, 6’ 1/2" tall). Then I did. Now he sends me for abdominal ultrasounds because it worries him that I have lost weight (now around 195). I did it a year ago and all was normal, but I ignored his instructions this time. It would be one thing if I hadn’t been starving myself (no snacks, as I have explained elsewhere) or if I had lost my appetite (I can still pig out). When I weighed 240, he still nagged me. I don’t know if that answers the original question.