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Showing posts with label BMI. Show all posts
Showing posts with label BMI. Show all posts

Monday, April 29, 2024

Do BMI letters help?

A us state experimented with sending parents letters about their child’s body mass index in an effort to fight obesity.

SIXTH-GRADE (equivalent to Year Six) boys were lining up to be measured in the Mann Arts and Science Magnet Middle School library in Arkansas, United States.

As they took off their shoes and emptied their pockets, they joked about being the tallest. “It’s an advantage,” said one. “You can play basketball,” said another.

A taller dude can get more girls!” a third student offered. Everyone laughed.

What they didn’t joke about was their weight.

Anndrea Veasley, the school’s registered nurse, had them stand one by one.

One boy, Christopher, slumped as she measured his height. “Chin up slightly,” she said. Then Veasley asked him to stand backward on a scale so he didn’t see the numbers.

She silently noted his height as just shy of four feet, seven inches (139.7 centimetres) and his weight as 115.6 pounds (52.4 kilogrammes).

His parents would later be among thousands to receive a letter beginning, “Many children in Arkansas have health problems caused by their weight.”

The letter includes each student’s measurements, as well as their calculated body mass index (BMI), an indicator of body fat.

The BMI number categorises each child as “underweight”, “normal”, “overweight” or “obese”.

Christopher’s BMI of 25.1 put him in the range of obesity.

> Is it really useful?

In 2003, Arkansas became the first US state to send home BMI reports about all students as part of a broader anti-obesity initiative.

> But in the 20 years since, the state’s childhood obesity rates have risen to nearly 24% from 21%, reflecting a similar, albeit higher, trajectory than national US rates.

During the Covid-19 pandemic, the state obesity rate hit a high of more than 26%.

Still, at least 23 US states followed Arkansas’ lead and required height and weight assessments of students.

Some have since scaled back their efforts after parents raised concerns.

One school district in Wyoming used to include a child’s BMI score in report cards, a practice it has since stopped.

Ohio allows districts to opt in, and last year, just two of 611 school districts reported BMI information to the state.

And Massachusetts stopped sending letters home.

Even Arkansas changed its rules to allow parents to opt out.

Multiple studies have shown that these reports, or “fat letters” as they’re sometimes mockingly called, have had no effect on weight loss.

And some nutritionists, psychologists and parents have criticised the letters, saying they can lead to weight stigma and eating disorders.

BMI as a tool has come under scrutiny too, because it does not consider differences across racial and ethnic groups, sex, gender, and age.

In 2023, the American Medical Association called the BMI “imperfect” and suggested it be used alongside other tools such as visceral fat measurements, body composition and genetic factors.

Meant for awareness

All that highlights a question: What purpose do BMI school measurements and letters serve?

Nearly 20% of American children were classified as obese just before the Covid-19 pandemic – up from only 5% some 50 years ago – and lockdowns made the problem worse.

It’s unclear what sorts of interventions might reverse the trend.

Dr Joe Thompson, a paediatrician who helped create Arkansas’ programme and now leads the Arkansas Center for Health Improvement, said BMI letters are meant to be a screening tool, not a diagnostic test, to make parents aware if their child is at risk of developing serious health issues such as heart disease, diabetes and respiratory problems.

> Sharing this information with them is critical, he said, given that many don’t see it as a problem because obesity is so prevalent.

Arkansas is also a rural state, so many families don’t have easy access to paediatricians, he said.

Dr Thompson said he’s heard from many parents who have acted on the letters.

“To this day, they are still our strongest advocates,” he said.

The programme also led to new efforts to reduce obesity.

Some school districts in Arkansas have instituted “movement breaks”, while others have added vegetable gardens, cooking classes and walking trails.

One district sought funding for bicycles.

The state does not study whether these efforts are working.

Researchers say the BMI data also serves an important purpose in illuminating population-level trends, even if it isn’t helpful to individuals.

Parents are generally supportive of weighing children in school, and the letters have helped increase their awareness of obesity, research shows.

At the same time, few parents followed up with a healthcare provider or made changes to their child’s diet or physical activity after getting a BMI letter, several other studies have found.

In what is considered the gold standard study of BMI letters, published in 2020, researchers in California found that the letters home had no effect on students’ weight.

Dr Hannah Thompson, a University of California-berkeley assistant professor who coauthored the study, said most parents didn’t even remember getting the letters.

“It’s such a tiny-touch behavioural intervention,” she said.

Practical advice needed

Arkansas now measures all public school students in even grades annually, except for 12th graders (equivalent to Form Six or pre-university) because by that stage, Dr Thompson said the students are “beyond the opportunities for schools to have an impact”.

The change also came after many boys in one school wore leg weights under their jeans as a prank, he said. 

Kimberly Collins, 50, remembers being confused by the BMI letters sent to her from the Little Rock School District in Arkansas, stating that all her children were considered overweight and that one daughter was classified as obese.

“It offended me as a mama,” she said. “It made me feel like I wasn’t doing my job.”

She didn’t think her children looked overweight and the family paediatrician had never brought it up as a concern.

 Assist Prof Thompson said that’s the biggest problem with BMI letters: Parents don’t know what to do with the information.

Without support to help change behaviour, she said, the letters don’t do much. >

“You find out your child is asthmatic, and you can get an inhaler, right?” she said.

“You find out that your child is overweight and where do you even go from there? What do you do?”

Dr Kevin Gee, a professor at the University of Californiadavis, who has studied BMI letters, said the mailings miss cultural nuances.

In some communities, for example, people prefer their children to be heavier, associating it with comfort and happiness.

Or some eat foods that they know aren’t very nutritious, but are an important way of expressing love and traditions.

“There’s a lot of rich contextual pieces that we know influences rates of obesity,” he said.

“And so, how do we balance that information?” &

Collins’ daughter, now 15, said that as she’s grown older, she increasingly feels uncomfortable about her weight.

People stare at her and sometimes make comments. (Collins’ mother asked that her daughter’s name not be published because of her age and the sensitive nature of the subject.)

“On my birthday, I went to get my allergy shots and one of the nurses told me, ‘You are getting chubbier’,” she said.

“That didn’t make me feel the best.”

Collins said it pains her to see her soft-spoken daughter cover herself with her arms as if she’s trying to hide.

The teenager has also begun sneaking food and avoids the mirror by refusing to turn on the bathroom light, Collins said.

The girl signed up for tennis, but stopped after other children made fun of her, her mother said. (See From teen to adult: Weight stigma lingers on p8)

Looking back, Collins said, while she wishes she had paid more attention to the BMI letters, she also would have liked practical suggestions on what to do.

She said she had already been following the shortlist of recommended healthy practices, including feeding her children fruits and vegetables, and limiting screen time.

She isn’t sure what else she could have done.

Now everyone has an opinion on her daughter’s weight, Collins said.

One person told her to put a lock on the fridge.

Another t old her to buy vegan snacks.

Her mother bought them a scale.

“It’s a total uphill climb,” Collins said with a sigh. – KFF Health News/tribune News Service

This article was produced as a part of a project for the Spencer Education Journalism Fellowship. KFF Health News is a US national newsroom that produces in-depth journalism about health issues and is one of the core operating programmes of KFF – the independent source for US health policy research, polling and journalism. 


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Not the best for weight

 Although BMI is widely used as a measure of weight, it is not very accurate and can lead to the mistreatment of obesity and eating disorders.


Tuesday, November 8, 2022

Not the best for weight

 Although BMI is widely used as a measure of weight, it is not very accurate and can lead to the mistreatment of obesity and eating disorders.

Measuring a person’s waistline might give a better representation of their health than their bmi, as those with abdominal obesity are prone to developing certain chronic medical conditions. — Photos: TNS

 

BMI in Adults: Is Yours Healthy, and if Not, How Can You Lose ...

PEOPLE who seek medical treatment for obesity or an eating disorder do so with the hope their insurance plan will pay for part of it.

But whether it’s covered or not often comes down to a measure invented almost 200 years ago by a Belgian mathematician as part of his quest to use statistics to define the “average man”.

That work, done in the 1830s by Adolphe Quetelet, appealed to life insurance companies, which created “ideal” weight tables after the turn of the century.

By the 1970s and 1980s, the measurement, now dubbed body mass index (BMI), was adopted to screen for, and track, obesity.

Now it’s everywhere, using an equation – essentially a ratio of mass to height – to categorise patients as overweight, underweight or at a “healthy weight”.

It’s appealingly simple, with a scale that designates adults who score between 18.5 and 24.9 as within a healthy range.

But critics – and they are widespread these days – say it was never meant as a health diagnostic tool.

“BMI does not come from science or medicine,” said Dr Fatima Stanford, an obesity medicine specialist and equity director of the endocrine division at Massachusetts General Hospital in the United States. 

She and other experts said BMI can be useful in tracking population-wide weight trends, but it falls short by failing to account for differences among ethnic groups, and it can mislabel some people, including athletes, as overweight or obese because it does not distinguish between muscle mass and fat.

Still, BMI has become a standard tool to determine who is most at risk of the health consequences of excess weight – and who qualifies for often-expensive treatments.

Cut-offs for coverage

Despite the heavy debate surrounding BMI, the consensus is that people who are overweight or obese are at greater risk for a host of health problems, including diabetes, liver problems, osteoarthritis, high blood pressure, sleep apnoea and cardiovascular problems.

The BMI measure is commonly included in the prescribing directions for weight-loss drugs.

Some of the newest and most effective drugs, such as semaglutide, limit use to patients who have a BMI of 30 or higher – the obesity threshold – or a lower level of 27, if the patient has at least one weightrelated medical condition, such as diabetes.

Doctors can prescribe the medications to patients who don’t meet those label requirements, but insurers might not cover any of the cost.

While most insurers cover some forms of bariatric surgery for weight loss, they might require a patient to have a BMI of at least 35, along with other health conditions, such as high blood pressure or diabetes, to qualify.

With medications, it can be even trickier.

US national health insurance programme Medicare, for example, does not cover most prescription weight-loss drugs, although it will cover behavioural health treatments and obesity screening. Coverage for weightloss medications varies among private insurance plans.

“It’s very frustrating because everything we do in obesity medicine is based on these cut-offs,” said Dr Stanford.

Over and under

Critics say that BMI can err on both ends of the scale, mistakenly labelling some larger people as unhealthy and people who weigh less as healthy, even if they need medical treatment.

For eating disorders, insurers often use BMI to make coverage decisions and can limit treatment to only those who rank as underweight, missing others who need help, said Serena Nangia.

Nangia is the communications director for Project Heal, a US non-profit organisation that helps patients get treatment, whether they are uninsured or have been denied care through their insurance plan. 

“Because there’s such a focus on BMI numbers, we are missing people who could have gotten help earlier, even if they are at a medium BMI,” she said.

“If they are not underweight, they are not taken seriously, and their behaviours are overlooked.” 

Dr Stanford said she too often battles insurance companies over who qualifies for overweight treatment based on BMI definitions, especially some of the newer, pricier weight-loss medications, which can cost more than US$1,500 (RM7,114.50) a month.

“I’ve had patients doing well on medication and their BMI gets below a certain level, and then the insurance company wants to take them off the medication,” she said, adding she challenges those decisions.

“Sometimes I win, sometimes I lose.”

Not accurate for health

While perhaps useful as a screening tool, BMI alone is not a good arbiter of health, said Dr Stanford and many other experts.

“The health of a person with a BMI of 29 might be worse than one with a 50 if that person with the 29 has high cholesterol, diabetes, sleep apnoea, or a laundry list of things,” said Dr Stanford, “while the person with a 50 just has high blood pressure.

“Which one is sicker? I would say the person with more metabolic disease.”

Additionally, BMI can overestimate obesity for tall people and underestimate it for short ones, experts say.

And it does not account for gender and ethnic differences.

Case in point: “Black women who are between 31 and 33 BMI tend to have better health status even at that above-30 level” than other women and men, Dr Stanford said.

Meanwhile, several studies, including the long-running Nurses’ Health Study, found that Asian people had a greater risk of developing diabetes as they gained weight, compared with whites and certain ethnic groups.

As a result, countries such as China and Japan have set lower BMI overweight and obesity thresholds for people of Asian descent.

Other measurements

Experts generally agree that BMI should not be the only measure to assess patients’ health and weight.

“It does have limitations,” said David Creel, a psychologist and registered dietitian at Cleveland Clinic’s Bariatric and Metabolic Institute.

“It doesn’t tell us anything about the difference between muscle and fat weight,” he said, noting that many athletes might score in the overweight category, or even land in the obesity range due to muscle bulk.

Instead of relying on BMI, physicians and patients should consider other factors in the weight equation.

One is being aware of where weight is distributed.

Studies have shown that health risks increase if a person carries excess weight in the midsection.

“If someone has thick legs and most of their weight is in the lower body, it’s not nearly as harmful as if they have it around their midsection, especially their organs,” he said.

Dr Stanford agreed, saying midsection weight “is a much better proxy for health than BMI itself”, with the potential for developing conditions like fatty liver disease or diabetes “directly correlated with waist size”.

Patients and their doctors can use a simple tool to assess this risk: the tape measure.

Measuring just above the hipbone, women should stay at 35 inches or less, and men at 40 inches or less, researchers advise.

New ways to define and diagnose obesity are in the works, including a panel of international experts convened by the prestigious Lancet Commission, said Dr Stanford, a member of the group.

Any new criteria ultimately approved might not only help inform physicians and patients, but also affect insurance coverage and public health interventions.

She has also studied a way to recalibrate BMI to reflect gender and ethnic differences.

It incorporates various groups’ risk factors for conditions such as diabetes, high blood pressure and high cholesterol.

Based on her research, she said, the BMI cut-off would trend lower for men, as well as Hispanic and white women.

It would shift to slightly higher cut-offs for Black women.

(Hispanic people can be of any race or combination of races.)

“We do not plan to eliminate the BMI, but we plan to devise other strategies to evaluate the health associated with weight status,” she said. – Kaiser Health News/tribune News Service

Although BMI is widely used as a measure of weight, it is not very accurate and can lead to the mistreatment of obesity and eating disorders.

Kaiser Health News (KHN) is a US national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programmes at Kaiser Family Foundation (KFF). KFF is an endowed non-profit organisation providing information on health issues to the US. 

-The Star Malaysia By JULIE APPLEBY 

 

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