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You're listening toLifeKit.
FromNPR.Hey, what's upeveryone?
Andrew Limbong here in For MarylSeguera.
27.4. That is my current body mass index orBMI.
This is the number that fordecades, health experts have used to classify people asunderweight, normalweight, overweight orobese.
Like right now you can hop on to the NIH website and find out yourBMI.
Or maybe don't because a growing number of researchers and physicians think it's time for a new metric because that number doesn't actually tell you all thatmuch.
But if not BMI thenwhat?
What numbers can we use to help us track our health to make sure we're achieving whatever health goals we might have inmind?
In this episode ofLifeKit, I talk with NPR HealthCorrespondent, AlessonAubrey, about the history and shortcomings of BMI and also this relatively new way of getting a fuller picture of that your ownbody.
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HeyAllison.Hey, good to behere.
Allright, so what is BMI and how is itcalculated?
Sure. BMI is basically a medical screening tool and it's pretty simple tocalculate.
It's based on twonumbers.
Your weight and yourheight.
Now the use of BMI goes wayback.
Back in the 1830s orso, a Belgian mathematician ran some numbers to establish height and weight normsfor, quoteunquote, the normalman.
And then life insurance companies began using this weight height ratio as a factor in assessingrisk.
If somebody had a very high BMI or something way off thenorm, that was considered arisk.
So sometimes you'll hear peoplesay, oh BMI is based on European whitemales.
And this is why some of these original calculations and norms were from Europeanmales.
And typically in the early mid1900s, most people buying life insurance were men of Europeandescent.
Oh,interesting. So I've heard the term being banded about andstuff.
How is it actually usedtoday?
Well, it's still widely usedtoday.
It's on almost every medical record because it's very easy tocalculate.
Dr. doesn't need to examine you to calculate aBMI.
They just need your weight and yourheight.
So it's more of a screeningtool.
And here's howDr. RichardJoseph.
He's a physician at Brigham and Women's Hospital who specializes in metabolichealth.
Explainsit. They're pretty crudemetric.
And so it really doesn't have any utility truthfully and understanding people's underlyinghealth.
And he says since a lot of the original data came from European men as we justdiscussed, it can beflawed.
So it really doesn't apply broadlyto, youknow, the diversepopulations, youknow, people who are of Asian descent often can be skinnier and have underlying metabolic disease that you wouldn'tsee.
If you just look at their BMI and same thing for folks forAfrican-American, they can like carry weight in different ways aswell.
Sobasically, we're all just different in the way we carry ourweight.
So what he's saying is that like using that as astandard, it doesn't really work for people of differentbackgrounds.
Yes, that's exactlyright.
Imean, people can be a normalweight, but have low muscle mass and high bodyfat, while others have higher bodyweight, but are muscular andlean.
And a scale won't tell you the difference and neither willBMI.
Huh, youknow, it'sfunny.
So when I was in my early tomid-20s, I was kind of living like a dirt bag 20-year-oldlife.
You know what Imean? Doing all the dirtbag.
Okay, wellnow. And myBMI, I'mfive,seven, I think I was likeweighing, youknow,155-ish.
And I was like within the quoteunquote, likegood, normal BMIrange.
Now that I'm likeolder, a littlewiser, I'vetaken, youknow, I've started running doing like weights and all thatstuff.
I'm the number on myscale.
It'slike, I think I'm like170,180.
I weighmore. Ihaven't, Ihaven't, I haven't figured out how to get anytaller.
So, youknow, I'm still working onthat, but youknow,whatever.
But I'm technically overweight now by BMIstandards.
Yeah. Is thissomething?
Itseems, I don't want to saymisleading, but maybe not like the clearest picture of a person'shealth.
That'sright. Imean, let me give you anotherexample, kind of similar to the story you just shared aboutyourself.
I spoke to a woman named MannaMustatabi.
She's 38 yearsold. She told me the scale has never been herfriend.
As far back as like when she was in highschool, she was a competitiveathlete.
And her BMI put her in the overweightcategory.
At myfittest, like I ran high schooltrack, but it's because I am a musselyperson.
Like my dad always joke that I should have been awrestler.
She was always trying to get the scale tobudge.
She told me and then what she realizes now is that BMI told her very little about herhealth.
So it's never going to take into account how much muscle youhave, breasts andhips.
That's just sort of part of what weare.
Take awayone. If you're looking for more information about your bodycomposition, like your muscle mass or bodyfat, BMI won't give you thatinfo.
So try a different toolinstead.
Youknow, if the scale doesn'twork,right, you can't use thatnumber.
Then BMInumber, youknow, isn't all thatuseful.
What can youuse? What are some alternativesthere?
Well, Mustatabi now has a new way totrack.
And this is using a body compositionscan.
This is something that's offered at Orange Theory Fitness where she worksout.
The chain uses a brand of machine or device called aninbody, which measures body fat and musclemass, which are two key important metrics forhealth.
The inbody looks kind of like a metal scale with twoarms.
So you get on thescale, you're supposed to wipe your hands and feet with these special cloths that allow for a better electricalcurrent.
And the way it works is this device sends safe electrical currents through yourbody.
It's known as bio-electricalimpedance.
And the technology has been around fordecades.
I spoke to ScottBrown. He's vice president of fitness at OrangeTheory.
And he described to me how it calculates fat andmuscle.
And how fast that current is returning to the different electrodes is going to give a measurement of how much fat or muscle you have because the current travels through those body tissues at different speeds or differentrates.
Right.So, Mono Mustatabi wipes herhands, gets the electrical currents like through herbody.
So what kind of information does she get fromthat?
Well, she had her first inbody analysis back inJanuary.
She says now back then she was kind of about a shape and had resolved for a freshstart.
So all winterlong, she really hit ithard.
She was working out like four or five times aweek.
She told me she did a lot of resistance training and some cardio on a treadmill androwing.
At the end of the transformationchallenge, I had lost 10 pounds of body fat and also gained four pounds ofmuscle.
And it was just soaffirming.
Wow. So youknow, it's interesting that she she broke down those numbers because if you were to do the math and then get on ascale, I'm not sure you don't really get any information fromthere,right?
Thenumbers, but like now she's she affirmed that like she was on the right track and she's doing the rightthings,right?
Yeah, she really feels that these efforts are improving her health and now she has a way to measure what she was really excited about is to see that she had gained muscle because youknow, the evidence shows that women who weight train and build strength can expect to live longer and healthierlives.
Youknow, instead of just focusing onweight, she's now more focused on metrics that matter more to herhealth.
And the in-body scan is actually the first tool I've ever used that showed gains and to see that I could grow so much muscle as a woman just is incrediblyempowering.
So this data gave her a baseline and a way to track herprogress, which she found verymotivating.
To track your progress overtime, try a body-comskin.
That can show you more helpful metrics like muscle gains or fatloss.
So I found myself on the fitness side of TikTok where when they talk about bodycompositions, they pretty much just talk about how good they look in themirror, youknow, like the size of yourtraps.
Which I imagine isn't the most scientifically accurate way to calculate bodycomposition.
So what are their options onthere?
Well, inMRI, a magnetic resonance imaging is considered to be the goldstandard.
But that's just not practical for most people given the expense and kind of access to medicalimaging.
Dr. Joseph OrdersDexascans, which is a type of x-ray for some of hispatients.
These scans also measure bone mineraldensity, which is recommended for people 65 andup.
And what people don't always realize is that they also accurately measure body composition and fatdistribution.
Now these can cost hundreds ofdollars.
Prices have begun to come down a bit in some areas as more machines areavailable.
And there's moredemand.
But still can be a priceyoption.
And then I'd say this option that's taken off in gyms and workoutstudios, such as any timefitness.
And as I've already mentioned orangetheory, is bioelectrical impedance analysis using devices such as this in body that we mentioned or other brands such as the evil360.
And depending on the gym or the workoutplace, the scans are often free with membership or available for a smallfee.
Now these bioelectrical impedance devices are typically not as precise as an MRI orDEXA, but they have been shown to be reliable at tracking changes over time as long as people follow thedirections.
Can you get insurance to cover some of the more priceytests?
Youknow, MRIs and DEXAs are typically only covered by insurance if there's a medicalindication.
So metabolic doctors may order it forpatients.
People 65 andup, as Imentioned, could get it for bone densityscan.
But people will probably need to pay out of pocket to get the DEXA if they don't have one of theseindications.
And I think that's part of the appeal of these scales like the end body because youknow, you can basically get them sometimes for free or for a smallfee.
Take waythree. If you want even moreinformation, you could do an MRI or a DEXAscan.
Talk to your doctor if it's something you're interestedin.
Youknow, I just want to circle back real quick to something Monicasaid.
Youknow, she she was talking about how pleased she was about gaining muscle and I followed like your coverage on on women and the importance of resistance training and all ofthat.
But I'm curious how much muscle is like a realistic amount for a normal person togain.
Yeah, youknow, I'm really glad you asked this because I started asking that question in January and it took me a couple of months to to come to thisconclusion.
But Imean, onaverage, women gain less muscle at a slower rate compared to men and that's universallyunderstood.
During orangetheories, eight week transformationchallenge, men who were focused on muscle gains added about 0.83pounds.
So less than a pound of muscle over eight weeks on average compared to about a half a pound of muscle gain forfemales.
And across allparticipants, there was only about a point one pound average musclegain.
So unless you're really focused on building muscle with weight lifting and dialing up protein in thediet, you really won't see too much of a change in eightweeks.
Yeah, unless you're committed to doing the like only chickenrice, broccoli fordinner, three meals a day orwhatever.
Yeah, very highprotein.
Yeah, it can take a minute to build somemuscles.
What yousay?Absolutely.
And there's just a lot of variability from person toperson.
Imean, the ability to grow new muscles influencedby, youknow,gender, byage, bygenetics.
But I will point out the reason it's helpful to know your muscle mass is because studies show that strength is a predictor oflongevity.
Imean, sometimes when we'reyoung, it's hard to imaginefrailty.
But loss of muscle is incredibly common as weage.
Imean, there's a medical term forit,sarcopenia.
So muscle lossis,look, it increases the risk offalling, which is a top cause of death from injury among olderpeople.
It's important to focus on maintaining strength and building muscle helpsprevent, preventthis.
Yes, itdoes. Imean, and it's important to pointout, youknow, it's possible to gain muscle and lose fat without losing anyweight, which might be what happened toyou.
Imean, based on what you described forme.
So, youknow, the scale stays thesame, but body composition can change rathersignificantly.
And this is what happened to a woman I spoke to lastmonth.
Her name is KarenWhite.
She's 59 yearsold. She's a certified health coach inAlexandria,Virginia.
Over the last threeyears, she's gained about three pounds ofmuscle.
And her body fat has dropped from about26% down to22%.
She's the exact same weight after three years oftracking.
But the positive changes in her bodycomposition, she says areprofound.
We shouldn't put all this emphasis on scaleweight.
Let's put the emphasis on what is that scale weight madeof, youknow, is it is itfat?
Is itmuscle? What isit?
And I think that's where the end body is veryuseful.
So you can see in black andwhite, am I metabolicallyhealthy?
Am I in healthyranges? And when she realized she needed to build more muscle three yearsago, she started lifting weights and doing other types of resistance training about three times aweek.
And so when you when you do the body compscan, you get the numbers back um how much fat isokay?
Or you know how much fat is considered like ideal or in the healthyrange?
Yeah, this is another question that's been a little bit hard toanswer.
I mean when it comes to body fat having too much of it can increase the risk of metabolicdisease, especially visceralfat.
That's the fat that surrounds the abdominal organs like thestomach, the liver andtestants.
This is considered inflammatoryfat.
The American College of Sports Medicine sets fitness categories for body fat based on age andgender.
But there is not a universally agreed upon target for what's consideredideal.
I mean I'll point out that using these ACSM standards most Americans would be classified in the poor fitness category because the average body fat among adults in the US is33% onaverage.
Now the US military considers the healthy body fat for military fitness to be between10% and20% for young men and up to25% for middle-agedmen.
Women typically have more body fat with a healthy range from15% to30% for young women and up to38% for olderwomen.
ButDr. Joseph says look the rule of thumb here for fitness is that it is you againstyou.
I mean rather than fixate on an external benchmark it's important to look at your trends overtime.
And that's where body composition scans can behelpful.
You know I feel like the big takeaway is like even if you don't go to gym and don't have access to one of these scans or whatever you feel you don't takeone.
It does seem kind of helpful to know that the number on the scale like pains in incomplete picture right and you know maybe just you know getting some weights in doing some resistancetraining.
That's exactlyright. That's exactlyright.
I mean I think the big takeaway you boom you hit the nail in the head if you would rather not step on a scale or calculate your BMI you have a goodexcuse.
There are lots of other ways to assess your body composition that can be more helpful and give you actionableinformation.
And that's takeaway for you know there isn't a hard and fast rule for the exact amount of body fat or muscle mass you shouldhave.
What's most important is to compare your current self to your pastself.
All right thanksAllison.
Thanks great to behere.
All right time for arecap.
Take away one BMI alone might not be enough to learn about your health but there are other options like takeaway two a body composition scan can give you more info about your muscle or body fatnumbers.
In takeaway three you can get a bi-electrical impedance analysis at most gyms or talk to your doctor about an MRI or dexascan if you want to know about your bone density or other healthmeasures.
And take away four no matter what test you choose compare yourself to your past benchmarks rather than any externalstandards.
For more on life kit check out our other episodes we've got one on getting into weightlifting and another on rethinking weightloss.
You can find those at npr.org slash life kit and if you love life kit and want more subscribe to our newsletter at npr.org slash life kit newsletter and also we'd love to hear from you if you have episode ideas or feedback you want to share email us at life kit atnpr.org.
This episode of life kit was produced by Margaret Serena who was edited by Claire Mauritian Eiter and MeganKane.
Our visuals editor is BeckHarlan.
Our digital editor is MalikoGareeb.
Megan Kane is a supervising editor that Donovan is the executiveproducer.
Our production team also includes Andy Tagle and Sylvie Douglas engineering support comes from NishaHeinus.
I'm AndrewLimbong. Thanks forlistening.
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