Bollox mass index is under fire

[Suff]

Finally. Mp's are trying to stop the NHS using this patently ludicrous measure to deny treatment and shame people into ridiculous bouts of dieting.

BMI works for one body type and one body type only. It works for people with evenly distributed leg length and body length with a moderate muscle mass.

For me this is a big issue. I am stumpy. There is no other way of putting it, I have short Scottish legs on a tall powerfully built Welsh body. What makes it worse is my leg muscle mass falls into power lifter range.

Yes, I am fat and overweight, no it doesn't help, but let us have a look at this ridiculous measure for a second.

When I was 18, I was a county class athlete, I was also a member of the local youth club. In my last year before joining the Army I won silver at the County athletics for 100m, Bronze for the high jump and I also won the Lincolnshire youth club competition.

Let's be pretty clear here. You don't get on the podium of a County high jump if you are overweight. In fact I would have won silver but in that competition I also ran 100m, 200m, 100m relay and 400m. I was simply too tired to jump any higher as I came 4th in my individual's I did not podium on and we came 4th in the relay.

I was the same height then and 12.5st

If you input that into the NHS Bollox mass indicator calculator, it tells you that I was almost half a stone overweight. Yes these things are variable, but the NHS doesn't allow for it. When BMI says I'm obese, the actual overweight value is about half of what their stupid calculator says.

Just imagine, when I was prop forward in the scrum, the BMI calculator says my lowest green weight is 8st 13lb.

Whenever anyone talks BMI in the NHS l, to me, I simply hold my hand up and tell them to stop as I will not listen to them until they listen to me. As they have no intention of listening to anyone, that conversation ends right there.

Now I know that some will be saying "he just had a heart attack and he never learns" and, yes, you are entitled to that opinion. But France gives you your hospital records when you leave and I have reviewed them. My arteries, apart from the massively constricted one, are absolutely Normal. When I say normal I mean diameter, plaque deposits and cholesterol deposits. My blood sugar is totally normal, what a shock for them, as they had me pegged by BMI as sure to be borderline type2 if not actually type 2 but didn't know it. My cholesterol was within normal bounds but at the upper end but no comment on the balance, I suspect HDL was high but you need torture tools to get that out of the medical profession. So, in short, no I didn't do this to myself, the NHS did this to me by refusing to do an Angiogram. Not once but 3 times.

Why did they do that?

Bollox mass index. It was all my fault you see!

About time that changed. I look forward to it.

[Workingman]

The problem with BMI is that it is now misused. Everybody knows what it is and they can measure your height then look at a chart to tell you how bad things are, but very few can explain how it works and even fewer could work it out without the all-in-one graph. Hint: stick to metric units, the imperial formula will lose many of you.

It was originally a statistical analysis tool designed over 100 years ago to find the "average" man in a population. I think that it was a combination of the insurance industry and the Canadian military that then used it to find the mean in a range for each body type - ergonomics, uniforms etc. It was only later used to give a range of average body weights for the three main body types: ectomoph, mesomorph or endomorph - think of the concept of small, medium and large. Basically these are from tall and skinny to short and stocky - the lines can be blurred between two adjacent types. Each body type has its own range for under or overweight. I am a borderline mesomorph / endomorph: fairly tall, but also fairly stocky

The thing about the original BMI is that it says nothing at all about "health". Health was not even a consideration in its design or use, that is a recent add-on by the medical world. A person's health is largely down to lifestyle and genetics whatever their weight.

I am a bit like Suff when it comes to relevant "markers". My cholesterol level TC:HDL ratio is bang on fine at 2.3 and I have never had any difficulty getting the LDL and HDL numbers. My blood sugars after nil by mouth and 2 hours after a meal are also right in the middle of normal. Liver and kidney function tests always come back as normal and my blood pressure is always in the range of 120-125 / 70-80. These have been virtually the same since my annual check-ups in the RAF and continue now that I have the yearly OAP checks.

So why the heart problems and the stents? Who knows?

I have started using the waist to height ratio (WHtR) as a guide for my ideal weight - divide waist size by height and the number should fall under 0.5. I have some journey to make!

[cromwell]

It would be nice to think that BMI will be ditched for some operations but I can't see it.
There have been virtually no elective surgeries performed by the NHS in the last year; there has to be a backlog now.
Removing BMI will allow patients onto a waiting list who are currently barred - like me.
Can't see it happening.

[Workingman]

BMI is now embedded in the system as an absolute, even though there is little empirical evidence to support it.

BMI measures mass not fat, and nobody knows how much fat is ideal for a given person any more than they know the ideal for many other bodily functions. Fat is essential for Inuits to survive in sub zero temps for most of the year, not so good for the bushmen of the Kalahari in summer.

Do those peoples also need or get their 'essential' five a day foods - no chance, they are not available!. Another good health myth.

[medsec222]

Regarding BMI and operations, I have found when transcribing medical reports that BMI is very relevant when it comes to performing operations. If you are awaiting a kidney transplant, for example, if your BMI is high then you wont get the transplant until you have managed to get your BMI down to within the level acceptable to the transplant surgeons. The chances of a successful outcome are less when the BMI is over a certain point and it is not in the patient's interest to be offered the surgery with a high BMI.

[Workingman]

So, if I am a fit football or rugby player with loads of muscle, which is denser than fat so makes my BMI higher, and my kidney packs in I will be placed down the list for treatment over some pizza scoffing, beer swilling, sofa slob of the same height and weight, but with a slightly lower BMI because their fat is less dense (massive) than my muscle. That is so reassuring.

[Suff]

That's not the worst of it WM. I am not tall but my upper body to leg ratio sucks, I have short legs.

At 12.5 stone my BMI is overweight. At the middle of my BMI rating I would be an anorexic hospital case.

At 12.5 stone you can count my ribs just by looking at me, but, BMI say I am overweight.

So these surgeons are going to DEMAND that I become anorexic before they operate?

Worse is that it is the Nurse who take the BMI rating so even if the doctor knows about the body type, they will never be told, they will just get a number.

What WM says is absolutely correct. I carry huge muscle density even at nearly 60. When I go to the gym I finish my session by getting on the leg press, ramping it up to 550kg and see how many presses I can do with one leg. I usually mange about 20 on each leg.

When I sit down, I sit 4 inches taller than my father, who is 6 foot, I sit exactly the same height as my grandson who is 6 foot 4.

How am I ever going to have the same BMI as people with an average body balance when my body balance is all wrong, I carry far more bone than someone under 6 foot 4 because their body frame is so much shorter than mine.

If you change my height to 6 foot 4, which matches my upper body frame, my BMI is perfect at 12st7 and still green at 14st7 which Mrs S is adamant I should not go under.

I can understand the surgeons concern for someone with average body balance and average muscle mass who has a BMI over 40. I saw it with my brother who was grossly massive, but only 15kg over the weight I was at when I was standing over him at my silver wedding. Yet I then walked to the dance floor and danced a 15 minute Scottish Country dance on my toes. Something my Brother could never have even attempted a step of.

So what is my choice? Be an anorexic or hire a shyster lawyer and pound the hell out of the NHS and the private consultant for nearly killing me because of BMI based weight bias?

You can be sure that I won't be messing up my daughters budget figures so what does that leave me?

For people like me the way the NHS uses BMI is Bollox and that is the end of it.

I might have a go at finding an investigative journalist and see if they can work with me to break this bias down. I have the evidence of the hospital records in my home, I had a real physical problem and the NHS tried to kill me off due to a BMI based weight bias.

That leaves a lot of residual anger and it is not good for a post cardiac arres patient to get so mad...

[Workingman]

Then there are tales at the other end. The woman in this article cannot get treatment because her BMI isn't low enough! I have experience of this in the family.

According to the BMI scale for my height I should be between 9st 4lb and 12st 8lb - a 46lb range - that's some going!. However, I do know from living in my body for quite a few decades that if I got 'down' to anywhere near the top weight I would look like a famine victim. From adolescence up to the age of about 50 when I was still running about training a youth football team I have hovered around the 13st 9lb mark, which for my body look was ideal.

The big problem now is that the medical profession has put all its "health" eggs in the one BMI basket when there are other simple markers, which when used together can give a much more accurate description of a person's health. We have already mentioned them.... and what about the use of impedance scales to measure body fat percentage, Step on, read the numbers, step off, done.

[Kaz]

BMI has never worked for me. Like Suff I have a long body and short, stocky legs. I'm from hefty peasant stock . My BMI is currently nearly a stone over the top end of my BMI, yet at a smidge under 5ft 7 I am between a size 12 and 14. The average dress size in the UK is a 16. When I last managed to get around half a stone under the very top of my BMI I was a 10. When my previous marriage broke up I went down to the middle of my BMI range, still a whole stone over the official lower limit, and I was veering down towards a size 8 My ribs and hip bones were visible, people started asking me if I was ill, and (without weighing me) my GP asked if I had ever been anorexic

Oh and my waist measurement is under the 32" that they recommend for health. Apparently if your waist measurement is lower than half your height, you are unlikely to have an unhealthy amount of internal fat around your organs.

[cromwell]

I'm the same; long body. I realise weight is important for things like a knee operation but it is very frustrating trying to get the weight off because the worse your hip gets, the harder trying to lose weight gets as you can't move well.

Eta - I did read years ago that the "ideal weight" malarky came from America in the 1930's ie during the Great Depression. Since then people have grown bigger and heavier, so if the original tale is true maybe the way that BMI is calculated should be re-thought.