Obese Boy Scouts not allowed to attend Jamboree. Fat discrimination or common sense?

In My Humble Opinion
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Sorry for the late reply: I actually had to do some work. :wink:

Algher, your earlier post implied that only those participating in the high adventure activities were required to get a physical exam (and I was lazy and didn’t check the link you provided); I am VERY glad to see that is not the case. (Although the official webpage does have me wondering how exactly they are accommodating the wheelchair-bound kids, or if they are in fact unable to attend the Jamboree because they can’t meet the mobility requirements of the site, despite being technically allowed to come. That bit’s unclear.)

Troppus, here’s a quick primer on BMI and why I have problem with the way its being used here.

BMI is simply the number you get when you divide a person’s weight by the square of their height. It’s in essence just a fancier version of those old height/weight charts. It does NOT measure fitness (obviously - how could it?), and it can be quite misleading when it comes to adiposity. A person who’s in fantastic shape, with tons of muscle and a very lot bodyfat percentage, can measure as obese (potentially even morbidly obese) on those BMI charts the CDC uses. Far more problematically, someone who has little muscle mass can have an excessively high percentage of body fat (including visceral body fat, which is metabolically the most dangerous stuff) and measure in the normal range on the BMI chart. (Remember those weak and wobbly elderly birders you referred to in one of your previous posts? This is where they fit!) For this reason, BMI should NEVER be used alone as a measure of obesity or fitness. It’s strictly a quick-and-dirty screening tool, and should never be used on its own to diagnose either obesity or “healthy weight.”

Now, here’s where things start to get really interesting. The old thinking was that obesity itself (defined by excess adiposity, not BMI) was causative of all sorts of nasty health problems. But newer research has has shown that it’s more an indicator of other underlying problems than a direct cause of problems itself. It’s quite possible for someone to be fat but physically fit - and those folks don’t seem to have any greater risk elevation for heart attack, stroke, diabetes, etc., than the “normal weight” folks, oddly enough. More alarmingly, thin people who are sedentary DO have increased risk - and recently a condition known as “normal weight, metabolically obese” has been identified in seemingly thin people. These folks, though thin, have all the parameters of metabolic syndrome (especially insulin resistance), have a greatly increased risk of cardiovascular problems and diabetes, and when you do an MRI scan on them, they have high levels of visceral fat (which is invisible to the naked eye). Despite how they look, they are very unhealthy! (And they represent about 25% of the “normal weight” adult population, so their numbers are not small.)

So when people focus on BMI, they are focusing on the wrong thing. What matters most of all is fitness. As a pathologist I don’t have the opportunity to sign off on those permission forms, but you can query Dseid (who specializes in pediatric obesity treatment) and you’ll see he’ll back up what I’ve said. In kids, I’d look for underlying cardiac problems via an EKG, and I’d check blood pressure and a metabolic panel to look for signs of metabolic syndrome - but I’d focus especially hard on fitness (rather than fatness, or the lack therof). Most fat kids are going to be unfit, but not all. And you’ll find a surprising number of skinny kids who are unfit as well, and shouldn’t pass the physical for this sort of trip.

If Kid A plays on his school soccer team, goes mountain-bking every weekend, and his Scoutmaster reports he completed a tough 10-mile hike two weeks ago with no problems, he’s fit. Who cares what his BMI is? And who cares what his weight is (as long as it doesn’t exceed the load limits of any necessary safety equipment)? He’ll have no problems at a high adventure camp, so to Hell with his BMI, let him go.

If Kid B’s favorite activities are reading and videogames, and his Scoutmaster says he struggled on the troop’s 5-mile hike two weeks ago, he’s unfit. (If his metabolic tests come back abnormal, he may have elevated long-term health risks as well.) Again, who cares what his BMI or his weight is? He needs to be limited to less-strenuous activities until he gets his fitness up, whether his BMI is 25 or 45.

Now, you might say that using BMI as an imperfect proxy for fitness does no harm, but that’s not the case. We desperately need to get people to focus on improving their fitness, as a sedentary lifestyle is known to be unhealthy, and this growing focus on BMI as the be-all and end-all does the exact opposite. It falsely reassures people who should be worried, and worries people who actually have no cause for alarm. So why do it?

(The other, lesser issue is that Jamborees have traditionally been designed as inclusive gatherings, not Outward-Bound style “test yourself to the limits” gatherings - that was Philmont. So switching Jamborees over to Philmont-style events is a big change in Scouting tradition, but if the Scouts want to do that, that’s their prerogative. Still, it seems to me to be a bit like me saying I’d like to hold a Dopefest and would like a representative group of Dopers to come - and I’ve arranged for us all to gather at Phantom Ranch in August. The venue and the goal for the gathering don’t match up.)

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In my opinion? (And again, I’m not a physician.) Body fat percentage. Unfortunately, it’s harder to figure out body fat percentage than it is BMI. For BMI, all you have to do is plug in height and weight on a handy calculator on the Internet.

I myself am in much better physical condition than I was a year ago. You can see muscle definition in my legs and my upper body is coming along nicely. Last year I was tired after a couple of miles on a bike. A couple of weeks ago, I did 32 miles straight on roads and trails and could have done more if I’d had time. I’ve dropped several pant sizes. My cholesterol dropped 80 points in 6 months.

My weight? Didn’t change that much. My BMI didn’t move that much either. For me, BMI is a pretty crappy indicator of overall health.

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Here’s a short blog entry from a Canadian physician who specializes in obesity treatment that says what I just said more eloquently: Why I don’t Like BMI.

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And here’s another good blog article on the subject (by the same physician):How BMI Obfuscates Public Health and Clinical Approaches to Obesity.

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So do you think there are people with a BMI of 40, bigger than 98% of American men, who are not obese and are in “fantastic health?”

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I bet we have no idea. :wink:

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Thank you for the thoughtful reply and links, artemis.

This was BigT’s point, as evidenced by several American football linemen and bodybuilders. Who also willingly subject themselves to rigorous training, optimum physician care and probably aren’t using their resources to live on Dorito’s and McNuggets. I can’t imagine any child between the ages of 6 and 18 with a BMI of 40+ following such an exercise regimen. It’s just so unlikely that the comparison to adult professional athletes and bodybuilders just doesn’t fly.

I’m guessing the same complaints about using weight alone to assess overall health is what prompted the invention of the Body Mass Index? And you’re suggesting a metabolic panel, EKG, and a fitness test for all children and adults instead of the BMI? That sounds cost prohibitive, and entirely unnecessary for the average sized child or adult with no apparent health problems. Will parents pay out of pocket for that health assessment for these BMI 40+ kids? Because I doubt most insurance companies would say “Sure, the kid wants to go to camp. Go ahead and perform all these expensive tests on our dime.” Although I can imagine that the insurance industry, already overtaxed with obesity related problems like diabetes and failing joints might soon require yearly fitness tests for everyone insured. But we’re not there yet, and for whatever reason the powers that be, the experts who have reams of research to back up these guidelines, have decided that BMI is a more effective measure of overall health than mere weight, and I see no reason why businesses should ignore these recommendations in favor of a few anecdotes.

But I read your reply and the links you provided, and I’ve followed an awful lot of DSeid’s posts. I get it, and I agree that BMI isn’t a perfect measure of overall health, but I see nothing wrong with employers, businesses, and the layman using the guideline to make decisions regarding health concerns and liability. The health concerns lurking beneath that kind of bulk are invisible and scary, I don’t believe we can trust kids to report problems or concerns promptly if at all, and I see no reason why businesses should be bullied to accommodate a scant handful of people who refuse to meet the guidelines to participate. No smokers, no drinkers, no chronic overeaters. If it isn’t discrimination against alcoholics and smokers, it isn’t discrimination against chronic overeaters.

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No, probably all they need to do is adjust their schedule so that kids can opt out of the most strenuous activities and choose less strenuous activities. At the very worst, it means expanding whatever campground and facilities are used for Scouts in wheelchairs.

I’m not sure about that, since it’s difficult to compare a trivial financial burden with a psychological burden. In any event, the scouts dropped over 300 million on this new facility.

Yes, and in fact I linked to it earlier in the thread.

Yes, and I also linked to a video of the same guy – it looks like he not only did not lose weight, he gained it too. Actually, it is likely he is over the 40 BMI cutoff based on his appearance.

It depends on the situation. The purpose of the military is to fight wars. The purpose of the Boy Scouts is to foster cameraderie, instill good values, and to encourage boys to improve themselves.

I’m not sure what your point is here. The purpose of businesses is to make money. If they can make more money by accommodating fatties, that’s fine with me.

There is a difference between a policy which is narrowly tailored, like excluding pregnant women from certain activities, and a blanket exclusion even from activities which are safe.

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You’re welcome.

It was designed in the early 1800 by a Belgian mathematician, to be used in epidemiological studies, because it was believed to give a more accurate single-number representation of human body shape than just height or weight alone.

Not cost-prohibitive for the BSA; possibly for some of the the parents and Scouters, yes - but if you’re serious about wanting to keep people safe while engaging in strenuous activities in wilderness, it’s what should be done. Remember that word “apparent” in your sentence! The problem is that some very serious health issues (especially cardiac ones) can’t be detected in any other way. The typical presentation of Long QT Syndrome, for instance, is a seemingly healthy and fit kid abruptly dropping over in full cardiac arrest while in the middle of an athletic activity that elevates his heart rate. Now if that happened at a suburban high school football game where there are EMTs standing by with an AED and an Emergency Room 5 minutes away, that kid might live. (Emphasis on the word “might”). If it happens during a backcountry hike, that kid is dead. You don’t even need to bother with CPR in that situation: there is simply zero possibility that the necessary medical help will arrive in time to resuscitate him. And the situation is even worse as far as the Scout Leaders go, because middle aged men are far more likely to have occult cardiac problems than kids are.

(Sad but true story: I once did an autopsy on a darling little 6-year old boy who got up one morning for school, happily walked out of his house clutching his lunchbox, and dropped dead at the bus stop. His heart was nearly the size of a cow’s: 600 grams! Now in his case, the fact that he was suffering from an inherited hypertrophic cardiomyopathy was already known, so his death wasn’t a complete surprise. His chart showed him to be on several big-gun heart medications (including Amiodarone), and he was on a heart transplant list. But anyone looking at his little body lying on my autopsy table would have seen nothing wrong externally with him at all. On the outside, he seemed a perfect picture of health - well, apart from being dead, that is.)

They’ll have to, if they want their child to go to the Jamboree. And remember, everyone’s already paying for a basic physical anyway, according to the links you and Algher posted, because the BSA is requiring it as part of their registration requirement for the Jamboree. Adding a metabolic panel and EKG to that basic exam won’t increase the costs hugely, fortunately.

Even though BMI isn’t an effective measure of health at all on its own? Remember the old saying “For every problem there is a solution that is quick, easy, and wrong”? That describes using BMI evaluate an individual’s health and fitness perfectly!

Even when it results in some individuals being unfairly excluded, and others being included who shouldn’t be (thus endangering them)? Would you feel that way if you were the one being excluded for no sensible reason?

Then you’ve missed the point. There may not BE any health concerns lurking beneath that bulk - and there may be dire ones lurking under the skin of that seemingly toned body. Why not look for real problems, like lack of fitness and elevated blood pressure, instead of faux ones like “being too big”?

Except that there is no evidence that obesity is caused by chronic overeating. Frankly, we don’t know WHAT causes it, and we certainly don’t know how to reverse it. But we do know that regular exercise, adequate sleep, and a healthy, nutritious diet are good for everyone. So why not focus on promoting those things instead of worrying about BMI?

Two more worthwhile links to end this long reply:

There is No Universal Causal Theory of Obesity.

Class 1 Obesity: Don’t Worry, Be Happy? (The second-to-last paragraph in this post is particularly noteworthy.)

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And this is why I dislike using BMI to predict anything about individuals. You may be an outlier; I am too (underweight BMI of 17, but all my health markers are good. I just have low body fat, a small frame, and I have squatted 160 at 105 lbs). But we exist, and our weight in pounds when referenced to our height in inches are a piss-poor predictor of our lean mass, strength, fitness, agility, blood pressure, etc.

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Heh, yeah, I’m a bodybuilder fer chrissakes and my BMI is only 18.5 (on account of these skinny lil legs; so I guess that doesn’t count. Hahaha).

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But we know for certain that the issues associated with obesity such as cardio-vascular and joint problems are far more likely to occur in individuals at the upper end of the BMI range than the healthy weight range, right? Using stats like these are how insurance companies make risk assessments, and how doctors use the BMI calculator to decide if a patient needs further testing. BMI 40+ is far more likely to suffer obesity related illness than the average patient with a BMI of 26.

Argument for another thread, I suppose, but people in third world countries with limited resources simply aren’t suffering from obesity at the rate of this country. There may be plenty of reasons why people don’t feel full, why they overeat, and why they suffer cravings, but ultimately fewer calories means less weight. And I’m not sure who is worrying about BMI, doctors use the measure to assess possible health problems associated with underweight and overweight. The individual may vary, but we rely on statistics to tell us who is at risk for certain problems in order to test for those problems. It’s risk assessment, plain and simple.

And there’s pretty much no way you can argue that the morbidly obese patient’s joints will wear the same as someone of normal weight. The associated heart and breathing problems may be miraculously absent from a kid with a BMI of 40, but his long term health and mobility will suffer if he doesn’t reduce that number. Our frames are not meant to take that kind of weight without a corresponding amount of vigorous exercise.

So you’re what, one point below the healthy range? That isn’t comparable to 11 points *above *the healthy weight range.

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Yes, it’s just a few pounds, compared to a hundred pounds. But it’s worth noting that my BMI group has higher mortality than every group except the morbidly obese. Both very heavy and very skinny people are more likely to have certain health issues and to die young (it’s not a cause and effect thing, or just eating too much or starving yourself - a lot of health issues cause weight gain or loss, a lot of medications do too) . However, there are plenty in those groups, like me and artemis, who have zero risk factors for any health problems except our weight in pounds, and we are both fitter than the average woman I know (who can barely lift 10 lbs, and does so as infrequently as possible), so to exclude us from just about anything on the basis of our BMI is ridiculous.

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Joint problems, yes. But something that somehow never gets mentioned when obesity is discussed is that it is actually protective against osteoporosis. And the fractured hips that happen all too often when an osteoportic elderly person falls can put a permanent end to that person’s mobility, and sometimes their life. Why is one a health crisis, but not the other?

In my old age I may well need knee replacements, but I am unlikely to suffer from painful spinal compression fractures or break a hip in a fall. In your old age, you probably won’t need any knee replacements, but you may well end up with a broken hip. Which is better? (If you ask me, both options suck - but that’s aging for you. It pretty much sucks by definition.)

Until they switch to a Western diet. Then they, too, begin to gain weight.

Short of developing a Star Trek replicator which doles out to each of us our perfectly balanced daily food allotment and won’t allow any additional calories beyond that, I don’t know how to avoid that problem. People in general are hardwired to prefer the taste of fat, sugar, and salt (which made sense in the environment we evolved in, where all three of those were hard to get). In the typical Western diet, all three of those ingredients are present in abundance, and combined in artful ways to produce food that is actually hyperpalatable. The result is predictable, but we don’t seem to be willing to place any restrictions on the market to prevent those completely predictable consequences.

When people feel hungry, they will eat if there is food available. If there is a choice of food, they’ll pick what tastes best to them. And they won’t stop eating until they feel full. Those are the biological facts we’re stuck dealing with (or not dealing with, as the case may be).

Yes, but since we currently lack any effective ways to reduce peoples’ cravings and/or improve their feeling of satiety, “fewer calories means less weight” is useless information unless we’re either willing to start food rationing or to make large-scale changes in the composition of our food supply. And I don’t see us doing either.

Well, the BSA seems to be worrying about it. And increasingly, so are other entities which are less ignorable (like insurance companies and employers). And since BMI is actually a poor indicator of fitness or health when applied on an individual (as opposed to a population) level, that’s a problem.

Would you like to have your insurance premiums go up or lose your job because you are several inches below some arbitrarily-defined “ideal height”? Would you like to constantly be told “You need to grow taller, you puny shrimp” even though there’s literally nothing you can do to increase your height?

But weight is different, because people can control that, right? Wrong. WEIGHT IS AS HERITABLE AS HEIGHT! (The correlation coefficient for each is around 0.7, as I recall.)

By and large, a person can’t control what he weighs. But he CAN control what type of diet he eats, how much exercise he gets, and whether he deal promptly with any “hidden” health issues like hypertension. That’s why those are the things we should be focusing on, not BMI.

That’s the key! EVERYONE, regardless of their weight, needs a reasonable amount of exercise if they want to remain healthy. But we’ve so divorced movement from our everyday activities that getting that exercise is very problematic for many people. Again, there are society-wide changes we could make which would help decrease that problem, but we don’t seem to want to make those either.

It’s much easier to scapegoat “the fatties” than to deal with the actual issues. Which may be fine if you’re not a fattie, and you aren’t a normal weight, metabolically obese person who doesn’t realize that he’s unhealthy even though the number on the scale looks fine. But if you ARE in one of those two categories, it sucks.

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And I’m right there with you, artemis, on nearly every point, except I’m with the Scouts on encouraging those with a BMI of 40+ to lose a bit of weight and prepare for the Jamboree instead of lowering standards and expectations. For two reasons: the kids with horrible habits will be better off, which supports the Scouts goal of self-improvement and lifelong good habits, and because lowering expectations for 2% of kids is profoundly unfair for the kids who have worked hard to reach those goals.

The Scouts have made some stupid social decisions in the last couple years, but this one is sound and reasonable.

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…and cardiovascular fitness tests for all aspiring Jamboree participants equates to “lowered expectations” how, exactly?

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And full metabolic panel. If a kid exists who is physically fit at a BMI of 40 and above, whose parents are willing to pay the full cost of medical tests that demonstrate this, who can find a doctor willing to accept the liability of signing a release that states such a kid is fit enough to keep up with his typically developing peers and that rare kid is denied access, that kid should be in the program after signing a hold harmless document excusing the scouts from all liability and civil action if he gets hurt, sick, or dead.

Or the same kid could demonstrate some drive and self control and prepare himself for the course next year by losing a little weight. Whichever is the more sensible and prudent solution.

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Because one is easy to administer, has factual basis and is easy to prove, while the other is not?

I don’t understand why you’re so fired up about giving someone, who has at least some form of control over their condition the same accommodations as a person who doesn’t.

At some point should the obese kid just have to “own” the problem, and do something about it? And again, we’re not talking just a little overweight here - a BMI of 40 is just freaking massive

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Because contrary to popular opinion, people have much less control over their body size than we generally think? And THAT is what BMI is measuring - body size.

People do have a lot of control over their fitness level in most cases, though. And fitness is what is relevant to safe participation in strenuous activities, not body size.

Does the obese kid even have a problem to own? Unless we look at parameters other than body size, we can’t answer that question. It IS possible to have a BMI of 40, excellent cardiovascular fitness, and a normal metabolic panel (although this is rare). Such a person is healthy but unusually large (just as some people are healthy and freakishly tall). Why should such a person change anything?

But in most cases, someone with a BMI of 40 or higher has a poor diet and lacks fitness, and may have metabolic syndrome. Those people should improve their fitness and their diet, and if necessary take medications to control any underlying physiologic problems, for the sake of their long-term health. But doing those things doen’t mean their BMI will necessarily change much. We’re talking about a 10% weight loss to get the health benefits. Anything more will probably not be sustainable long-term. And that may still leave the person with a very high BMI. If such a person has worked hard and achieved a level of fitness which is sufficient for participation in activity X, should they be excluded from participating?

No, it isn’t necessarily. I have a BMI around 40, but I look more slender than several of my colleagues who have lower BMIs than I do, because I’m carrying more muscle while they are carrying more fat. They may have lower BMIs than me, but I am fitter than hey are.

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You seem confused about what I’ve actually claimed. I’ll state it very simply:

Consuming fewer calories than you use will result in lower body weight.

This is not pseudoscience; this is basic science. I don’t care how hungry a person is. I smoked for a decade, then quit because it was bad for me. I wanted (and occasionally want) to fill my lungs with delicious, carcinogenic smoke. I don’t because it would probably lead to a shorter, less healthy life. This is called willpower, and no matter how hungry a person feels they can always choose not to gorge themselves with Big Macs and milkshakes. Perhaps that is unpleasant for some people, but life is sometimes inconvenient, and feleing more hungry than the next guy is pretty low on the scale of potential hardships. No sympathy.

As for your bizarre comments about energy conversion, that your body doesn’t take up nutrients like the next guy’s is not relevant. The “caloric model” is not relevant. I can easily restate the argument without it: “Eat less.” If that doesn’t work, then they’re still eating too much. I’d add “Work out.” to that, but the former is adequate just to lose weight.

Also, your attempts to draw equivalence between racism and pointing out the fact that fat people are fat because of their own decisions would be laughable if they weren’t so offensive. Genuinely offensive, I mean, not offensive in the “fat acceptance” sense that one feels unhappy when others point out their unhealthy behaviors.

So that extra 50, 100, 200 pounds people haul around is due to ~magic~? Did a wizard do it?

Let’s get serious. It’s not complicated. There is no way a person can help but lose weight if they take in less energy than they use.

The overweight always seem to have these studies on hand, but few own and use a food scale and log book. Those that do tend to find themselves overweight no more and no longer citing abstracts to justify their bulk.

With that attitude you’re right, but you don’t have to be. Do something about it. Go here: http://brainoverbrawn.com/get-the-book/ It’s completely free, and it works. I have no affiliation with the site or author, by the way.

For what it’s worth, I don’t much care for BSA, nor do I hate the obese. It’s just a shame that people go through life limited by their bodies when it’s correctable. It’s not easy, but it’s worth it for the increased quality of life and sense of accomplishment. Frankly, if I were running the BSA I would implement a Jamboree prep program to work with heavy scouts (not just >40 BMI) to get into better shape.