Romanian press still uses outdated way of measuring obesity

I am not doing this to defend Resident Rump.   I am doing this because yet another article in the Romanian media uses the height-weight ratio as a means of telling whether someone is obese or not.  And it’s not the first.

This ratio, on its own, is meaningless.  Even if you add age and sex into the equation, it is still meaningless.  It creates a BMI (body mass index), which can be a starting point, but it ignores other factors.

Now, the US army uses BMI as a starting point to decide if a recruit is fit for duty.  Men and women have different charts, because men are naturallly heavier, on average*.  If you have too high a BMI, or your weight is too high for your height, then they do a second test, which is measuring your neck compared to your waistline.  Why?  Because you could have a high BMI due to high muscle mass or high bone mass.  The ratio of neck to waistline is one way to correct for that.  So, many of the US soldiers who serve in Romania have a high BMI (and thick necks.)

If you’ve been in Cluj for long enough, you’ve probably met someone from Herbalife.  Herbalife gives supplements, after doing a health check.  The initial health check measures your BMI, but they also have a tool to measure the percentage of bodyfat you have.  Like the neck-to-waist ratio, this tool can correct the BMI test for other factors, such as what might make you weigh so much.

This neck-to-waste ratio was used in the last millenium, because people already knew it was out of date then.  I’m sure many of Ceausescu’s doctors knew that BMI was not enough to determine whether someone had a healthy weight or not.

I’ve tried all kinds of tests in the past, including something that pinches your arm.  With new technologies, like MRI, we can find more accurate ways of measuring internal fats and other substances.

If you have larger than average bones for your gender, or more muscle mass, relying on BMI could lead to anorexia or other eating disorders.

On the other hand, you could have a deceptively “healthy” looking BMI if you are small boned and have too little muscle mass, yet have a lot of fat.  Likewise, someone who is large boned but underweight might seem healthy if the only factor you use is BMI.  The weight range is only a starting point, a guide, and it doesn’t demonstrate obesity, health, or underweightness.

But yeah, looking at Rump’s neck, and the way his belly protrudes, I doubt he’d pass the army fitness exam.  Does that mean he’s physically obese?  I don’t know and I don’t really care.  That’s between the Resident and his doctors.  This article is not about one individual, but about a dangerous way of measuring obesity that is prone to inaccuracy.

But none of this answers ‘why?”  If other measures, more accurate measures, have existed for decades (and perhaps before you were even born, unless you’re very old), then why does the Romanian press, and so many others, still rely on BMI?

Nature magazine hints at one answer.  With all the scaremongering about rising obesity, there is a rising demand for obesity drugs.  And, perhaps, for other expensive quick-fix tools that are aimed at “losing weight” rather than maintaining muscle mass, improving diet and exercise, or other healthier solutions.  We see that even those who live off commission for MLMs like Herbalife want to make sure they don’t misdiagnose you just to sell a few grams, but medtech is big money.  Extreme greed leads to extreme measures.

So, where did BMI come from?  According to Nature, it all started in Belgium, land of frites, high calorie beer, and sugar waffles.

“The origins of BMI had little to do with health. About 200 years ago, the Belgian astronomer and mathematician Adolphe Quetelet obsessed over characterizing the ‘average man’. He recorded measurements of the human body — primarily in Western European men — and he found that weight roughly correlated with height squared. Dividing the two numbers to describe weight relative to height became known as Quetelet’s index.”

Nature quotes “Eknoyan G. Nephrol. Dial. Transplant. 23, 47–51 (2008).” as a source for this piece of history.

But BMI became a medical standard after 1972 when an American, Ancel Keys, took Quentelet’s index and found that it did help predict how thick your body fat was.  Just as Americans renamed Cosmonauts to astronauts, Keys renamed Quetelet’s index to BMI.

Nature quotes Keys himself on that story, “Keys, A., Fidanza, F., Karvonen, M. J., Kimura, N. & Taylor, H. L. J. Chron. Dis. 25, 329–343 (1972).”

However, by the end of the 20th century, people were already questioning BMI.  Normal people were, anyway.  It can be used to indicate changes in the population in general, but it isn’t a great measure for individual health.  At best, it’s a good measure for “more are tests needed.”  But just as all skin discolorations are not cancer, so all high BMIs are not indications of obesity.

But yes, even in the medical profession, BMI is still used.  However, more accurate measures are widely used.  In the words of Berlin based doctor Arya Sharma, BMI “tells me how big you are,” but, “It doesn’t tell me how sick you are.”  Sharma created a “five step” evaluation called the “Edmonton Obesity Staging System (EOSS).”  In 2020, Canada adopted the EOSS into it’s testing system.

“Sharma, A. M. & Kushner, R. F. Int. J. Obes. 33, 289–295 (2009).”

According to Nature, Ireland and Chile are among other countries that have adopted the EOSS.

But if you are overweight, what can you do?  Aim for fitness, not for weight loss.  Measure your waist to neck ratio, and use real tools to measure your actual body fat percentage if you are concerned.  Then find an enjoyable exercise routine, which might include walking, hiking, sports, callisthenics, gym membership, and/or social activities.  And check with a real doctor, not your uncle who obsesses over BMI.