Monthly Archives: July 2015

BMI and Recent Article about Weight Loss — Poppycock

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If you read the news reports of a recent UK Study, “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records”, American Journal of Public Health, Fildes et. al., July 16, 2015, and are overweight, you are probably hearing that you should be heading straight to your surgeon and get bariatric surgery since you cannot otherwise get down to a normal weight, and if you do lose the weight, you will never be able to keep it off.  Exhibit 1 that is untrue are my own experiences, so all hope is not lost.

Above is a picture of me from 2008 when I weighed in the 430’s, and had a superobese BMI (much greater than 45, actually in the 60’s), and the adjacent picture is from 2012, when I  weighed in the low 190’s, yet still had a “overweight” BMI of around 26 (an overweight BMI is considered between 25 and 29.9) — more on that classification later. Since 2012, I have kept the weight off, and I never had bariatric surgery, or took any medications, and relied on exercise, better eating habits and behavior modification to achieve and maintain my weight loss.

Before discussing the problems with this survey, and its conclusions, it is important to understand what BMI is, how it is calculated, and what are the problems with BMI.  Body mass index (BMI) is a measure of body fat based on your weight in relation to your height, and applies to most adult men and women aged 20 and over. The formula is as follows: your weight in pounds (multiplied by 703) divided by the square of your height in inches (for metric measurements, it is your weight in kilograms divided by your height in meters squared). BMI does not measure body fat directly, but there is thought to be a correlation between one’s actual body fat and BMI.  Actual body fat can be measured directly by various means, two of the best methods are underwater weighing, and dual-energy X-ray absorptiometry (DXA), with the latter being the gold standard of measurements. What BMI does not take into consideration is one’s bone structure, muscle mass, and weight of your organs. So, if you are an athlete, your BMI calculation can have you believe have a fair degree of fat, and are overweight, whereas you may in fact have a very low amount of body fat, and be perfectly normal.

Example 2, I had a DXA scan, and it showed I had less than 10% body fat, and for my age category, normal body fat is considered between around 22% to 26% — the scan indicated that my bones, organs and muscles themselves weighed 178 lbs.  So for me, BMI is horrible indicator of my body fat. It is also important to note that BMI says nothing about your overall health, but just tries to estimate you body fat based upon your height and weight.

So now that we understand BMI a little better, let’s look at this study. First off, the study admits that “[o]ur research was part of a larger study to evaluate the use of bariatric surgery” and excluded participants who received such surgery. That to me indicates a potential bias (pushing surgery),  and I also found it interesting that the mean age of the male participants was 55 years old. I am now 55, and can tell you it is not easy to maintain a level of exercise and activity, than when I was 50, so I can maintain my weight loss, whereas I would think that for someone in their 20’s, 30’s and 40’s, it would be much easier. Another curiosity of the study is that off all the groups they looked at (simple obese, severe obese, morbid obese, and superobese), the superobese were second best of those groups in obtaining a normal BMI, and the best at obtaining a 5% reduction in body weight. Again, it is important to note that the worst of the groups, the one’s with largest weight problem, seemed to do best, and they are not using surgery.

Here is what I think, if you are already in good shape, it is more difficult to lose weight since your body’s metabolism has adjusted to your level of activity, so it takes a much greater effort to lose those last few pounds. Isn’t that what we have all experienced?

So in conclusion, I firmly believe, contrary to the study, that you can lose and maintain weight loss through exercise, diet, and behavior modification, without the need for surgery, but it takes vigilance. As I have discussed in other blog entries, I constantly monitor my weight every day, and make changes to my food intake and exercise level to make sure I maintain a steady weight. And what the survey does not discuss is the danger and side effects of surgery, and how some patients still cannot maintain their weight loss even after surgery. For me, finding that inner drive to make the changes yourself, rather than relying on surgery, is better way in that you learn good and healthy habits, and it provides you with a sense of achievement which you would not otherwise experience. And to me, this survey’s dismissal of weight management strategies, seemingly in favor of surgery, is just poppycock.

Commuting, Unhappiness and Weight Issues

6 photoI have a round trip commute of at least two hours to get to my job, and if traffic is bad, it can be much longer. Before I focused on losing weight, and maintaining that loss, I used to eat in my car both going and coming back from work. What I have learned over the years is that commuting long distances raises issues about burnout, unhappiness, and weight gain, which need to addressed.

One of the first articles that brought this to my attention was in the AAA’s Car & Travel Magazine, March 2011, entitled “Angst, Lethargy, Unhappiness/All in a Day’s Commute, by Tom Vanderbilt.  In that article, it pointed out that many surveys show that people with longer commutes are less happy, and suggests that ones that have a shorter commute tend to happier, and that it helps not to pay so much attention to how long the commute is taking. In that article, they suggest listening to a book, or music on the radio, and not focusing on the traffic reports broadcast over the radio, were good practices to lessen the negative effects of commuting. Although listening to traffic reports was discouraged, watching the traffic information on your car’s navigation system was deemed to be OK, since it gave you alternate routes, real-time traffic, and provided you with an accurate ETA.

I can also tell you, from personal experience, that eating in a car is not good, and it tends to involve fattening items (sandwiches, candy bars, chips, etc.), which tend to be those items that can be eaten with one hand as you drive. In addition, you tend to overeat, since you tend to eat throughout the trip, rather than at one discrete time — another practice that encourages overeating. Also, if you drink soda, they have a lot of calories, and even if it is sugar-free and reduced calorie soda, studies have shown how these items promote further eating.

So what I do is wait to eat breakfast once I arrive at my office (breakfast is a must have meal since it sets the tone for the whole day), and on my return trip, I will eat something before I leave the office. The reason for not eating breakfast at home is that after a long car journey, I tend to get hungry, and I want to limit myself to just one meal, rather than a continuation of smaller meals. On the way home, a good choice before my trip is something with protein like nuts or peanut butter. As for beverages, I do not drink coffee, so I have either unsweetened ice tea, or water. I also keep breath spray in my car, so if my mouth is feeling dry with a bad taste, and I use the breath spray.

Another article on commuting comes from Université de Montréal, entitled, “You’re driving yourself to burnout, literally.” 26 May 2015. In that article, based upon research at the University of Montreal’s School of Industrial Relations, it discusses how commuting length, distance, and means are stress factors, and that a correlation exists between commuting stress factors and the likelihood of suffering from burnout. The research shows that the risk of burnout increases significantly when a commute lasts more than 20 minutes. One way to address this issue, besides moving closer to work, it more telecommuting. Fortunately, my present employer does allow some telecommuting, and that has helped me to address some of the complications from commuting.