Obesity-Alarm bells but no-one's listening

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Re: Obesity-Alarm bells but no-one's listening

Postby dynamictiger » Sun Jun 01, 2014 8:20 am

This entire discussion and obesity thing is so interesting.

I am and will always be classified as morbidly obese. Nothing I can do about it. Even if I lost all of the 'fat' on my body being about 30% I would still be well in excess of the BMI obese factor.

Being morbidly obese I qualified for a government program for loosing weight. Which I have been attending for near 2 years in total. I think in 2 years I have lost maybe 4 kgs but that is besides the point.

As part of this program I get to attend once a week exercise classes to assist with weight management. I actually really do enjoy the classes and put 100% effort in. Often I will need to replace my water as I have already drunk it all and have done twice as much exercise in the same time as others. All good for me. Lets hear a Hurrah.

The point I am getting too is this.

I am amazed at the other fatties.

Yes I am morbidly obese. To look at me you would not be able to discern me as being different to the fatty standing next to me when we are both dressed. I do suspect it will show when we aren't wearing a shirt, but that is irrelevant.

In our class we use small weights for some exercise like bicep curls. I choose the 3 kg dumbbell as it is the heaviest they had originally and I am thinking of popping into Kmart now to get a 4 or 5. However most of the other men are using 1 or 2 kg weights...go figure. Even though many of them are taller and wider than me. My logic has always been with great weight comes proportional strength...however this logic may not be correct for all.

I think and I am somewhat shocked to say this. Most of the people in my fatties group could not move a trailer load of mulch from the front to the back yard and spread it on the garden in under 4 hours. This to me is shocking. In 4 hours I would move about 4 tons of stone.

Medically I am not that different to the other fatties.

I do have high blood pressure, controlled with medication, I do have higher than ideal cholesterol but only just marginally, bad knees sometimes and bad hands as I tend to break them now and again as I get a bit older (its alright I have got another one).

Whilst it is great all the fatties in the class have taken a step toward doing the right thing, as I say I am amazed at the lack of fitness in all of them in comparison to myself.

It does bring up another point though.

If there were 12 fatties in a room and 6 were like me and 6 weren't. If the 6 like me moved a trailer load of mulch onto the garden and the other fatties saw us doing it. Would they then assume they could do it too? Why wouldn't they? In this instance then if we asked the six that could if they were obese chances are they would probably respond yes but I am fit or big boned or some equally silly answer, so what answer would the other 6 give?

I seriously think the entire obesity issue is way more complex than a simple one of diet and exercise. Perhaps this explains why some people do succeed at loosing weight and others struggle all their life with it.
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Re: Obesity-Alarm bells but no-one's listening

Postby Xplora » Sun Jun 01, 2014 10:42 am

Feel for you DT - being motivated but unable to increase the workload because of weak bones and joints really stinks. But you're right, the psychology of it is crucial.
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Re: Obesity-Alarm bells but no-one's listening

Postby casual_cyclist » Tue Jun 03, 2014 12:21 pm

bychosis wrote:
ColinOldnCranky wrote:
So there you have it – as a population, we are all getting fatter. Making matters worse, the fatter we all get, the less we seem to notice and the less likely we are to do anything about our bulging waistlines.


Anyone seen Wall-e the movie? :shock:

I have. It reminded me of the overly large people zipping about my local shopping centre in motorised vehicles. I thought wall-e was a chilling vision of things to come.
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Re: Obesity-Alarm bells but no-one's listening

Postby anttismo » Wed Jun 11, 2014 5:17 pm

I've been reading a few papers about obesity, basically trying to understand how big of a problem being overweight (defined in this context as BMI 25-30) is. The OP link seemed to go about 60% overweight or obese. But does it matter?

The following is an example of one such paper

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60318-4/fulltext

You always hear melodramatic stuff "increases the risk of yada" or "associated with this and that" and so on. It all always seemed to be blown out of proportion - like the whole "avoid processed foods, and added sugars because they are poison" kind of things. Sure, obesity is problem, and perhaps we "have an epidemic" , but it always strikes me as storm in tea cup kind of thing.

Anyway, it seem being overweight is really little more unhealthy than being normal weight, in terms of mortality in general. Once cigarette smokers are removed, then sure, being overweight is mildly worse. But the effects are really quite small, kind of like being slightly underweight. Increasing you BMI from 24 (in the ideal range) to 28 (overweight) seems to lead to 1 year shorter life expectancy, and going to 32 (obese) equates to a further 2 year reduction. To me these seem not so worry some.

So, in summary, seems largely trivial to be merely overweight rather than normal weight. And even mild obesity doesn't seem to matter much. How it looks to me anyway :)
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Re: Obesity-Alarm bells but no-one's listening

Postby dynamictiger » Wed Jun 11, 2014 5:39 pm

I can see your point.

I also must comment I am classified as morbidly obese with a BMI of 38 today. I am not going to be king of a mountain anytime soon, however BMI does need to be used with a large pinch of salt. I think even applied to populations it needs to be seen as indicative only and at best a poor indicator.

Looking at different countries and different population groups I cant help but observe trends. For example Samoan woman as a general rule are usually larger, Tongan men as a rule are usually huge in every dimension, Asian groups tend to be shorter and again generally slight compared to their European counterparts of a similar age.

Whilst I am not going to say I am tiny or svelte, I am going to say when I look at myself and think about these groups of people and then read something like the BMI slightly higher or lower indicates one thing or another I wonder how accurate this is. I know for me I will have no chance of getting my BMI below about 30 even if I really made an effort to eat nothing but water for 6 months. In 40 years I havent weighed in lower than BMI 35 even when I was able to claim KOM.

So whilst on one hand I can appreciate obesity may not be the major killer it is painted to be. I must also admit on the other hand to having a cautiously pessimistic approach to it as I see no harm in at least making an effort to loose some of the weight I carry. For me this is appropriate. On the other hand as I stated previously I would be reasonably certain many of the fatties in fatness for fitties I attend are in fact 78 kilogram people in a 130 kg body. At least I am a 140 kg person in a 115 kg body, and this would go a long way to explain the attitude to lifting weights etc.
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Re: Obesity-Alarm bells but no-one's listening

Postby biker jk » Wed Jun 11, 2014 6:04 pm

I found this article quite interesting in that it suggests the impact of obesity on mortality has been significantly understated. The authors find that 1 in 5 deaths can be attributed to obesity.

http://www.medscape.com/viewarticle/809516
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Re: Obesity-Alarm bells but no-one's listening

Postby march83 » Wed Jun 11, 2014 6:33 pm

@anttismo. you don't consider quality of life at all important?
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Re: Obesity-Alarm bells but no-one's listening

Postby ColinOldnCranky » Wed Jun 11, 2014 8:47 pm

march83 wrote:@anttismo. you don't consider quality of life at all important?

Yes. The incidence of diabetes is way up and, by all accounts, is a direct result of the greter weights of people these days. Indeed, we now even have a new grouping popularly termed type 1.5 because of the significant number of people who are movign from type two to their pancreas simply not making insulin. Until recent times they did not bother about such a group as it was pretty uncommon. Some were born with type 1. Others developed type 2 from diet and overweight. Never the twain shall meet.

If anyone thinks that living with diabetes is not an issue then , yes, I can see them also suggesting that being overweight or obese is not an issue. Me? I don't buy it. Diabetes is serious. The "epidemic" is serious.

Let's see - march 83 mentioned lifestyle. Lifestyle? What of it? Well, for a start, amputations, medication and diagnostic services, kidney dialysis, loss of vision, debilitating bouts of dizziness. And that partial list is only for what is attributable to diabetes. There is a raft of other problems not to do wioth diabetes. Stroke, failng joints, high blood pressure, etc. While the subject may still be living, they are highly likely to not be doing it very well.

I'm 62. I am constantly reminded by media and public policy statements that the health system will be overwhelmed by the demands of me and the rest of the baby boomers. As an aside I wonder if my peers will ever get to bother the health system. We'll have to first elbow our way past people a lot younger than us. Overweight people in increasing numbers.

Even if I do accept that it has minimal effect on mortality (this is bit left-field so I am yet to be convinced) I go with march83.
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Re: Obesity-Alarm bells but no-one's listening

Postby anttismo » Thu Jun 12, 2014 7:37 am

march83 wrote:@anttismo. you don't consider quality of life at all important?


Yes. Very. And not worrying about trivialities increases my quality of life :)

And I certainly don't recommend diabetes, if that was the question. Doesn't sound pleasant at all. In fact, nothing about living beyond 70 sounds that pleasant. Using my dad a guid given our similar genetics - a clean living health freak who is still pretty fit and healthy... excpet now in the dementia ward at a nursing home in his mid 70s - I'm expressly planning to not live beyond 70. Indeed, if I was for maximising my length of life, I wouldn't cycle as much as I do. Nor would I race motorcycles. I would avpoid a lot of the risks I chose. I will likely, even hopefully, be killed due to severe 2-wheeled accident related trauma....

Live now, live well, enjoy your life, smile as much as possible, then die :)
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Re: Obesity-Alarm bells but no-one's listening

Postby anttismo » Thu Jun 12, 2014 7:45 am

I don't doubt there is an obesity "epidemic" And it does seem like we are >50% of people overweight. I just don't see the overweight definition (BMI>25) being appropriate or even desirable. Just in my opinion it doesn't seem very important compared to other things like say, smoking, going out to night clubs, or cycling in the city :)
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Re: Obesity-Alarm bells but no-one's listening

Postby Nobody » Thu Jun 12, 2014 8:52 am

anttismo wrote:I just don't see the overweight definition (BMI>25) being appropriate or even desirable.
There are better ways to get a health indicator. Skin fold measurement, waist measurement, blood pressure, blood test. All are stronger pointers to future health problems than BMI as far as I know. However, if these were done on an average cross section of Australia, I suspect the results in regard to an indication of future health problems would be similar.
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Re: Obesity-Alarm bells but no-one's listening

Postby mikesbytes » Thu Jun 12, 2014 9:33 am

Interesting discussion and a lot of good points

Genetics: Correct me if I'm wrong, but didn't we have the same genetics in the 1950's but a far lower rate of obesity

Information: It's readily available to everyone, its entirely up to one to decide what they want about their body. If one lacks the skills to seek and implement the information, then there are professionals such as dietitians who can guide

Society influences: Unfortunately an industry has been built around poor food choices and its heavily marketed to us. Those who have not sought the right information are more likely to be influenced by it
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Re: Obesity-Alarm bells but no-one's listening

Postby Sweeper59 » Thu Jun 12, 2014 9:45 am

I have just returned from an 8 week tour of Europe, covering about 12 different countries. We generally only visited the main cities of each country, but we commented a number of times that there appeared to be far less obese people than in Australian cities. I was surprised at this, given that their winters are much harsher than ours, making exercise for 6 months of the year more difficult. On the other hand, the average European's reliance on motor vehicles is far less than Australians. Most European countries also far more accepting of cycling.
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Re: Obesity-Alarm bells but no-one's listening

Postby anttismo » Thu Jun 12, 2014 9:48 am

Here's another one, data from WA about a decade ago

http://www.nature.com/ijo/journal/v24/n1/full/0801093a.html

From the discussion: "In this Australian population we can say that our findings suggest an ideal weight/height2 or body mass index of 25 kg/m2 with a range of 22.5-27.5 kg/m2 is appropriate in men and women; and in women a weight/height measure of 45 kg/m with a range 40-50 kg/m, is appropriate as an index of leanness and fatness in the population."

Looking at some of the graphs, it does very much seem like around 25 is closer to ideal overall, and getting down toward 20 increases mortality in general - not too much different to be 30 (obese).


Another one looking at more recent UK trend

http://www.nature.com/ijo/journal/v38/n6/full/ijo2013161a.html

"Conclusion:
In England, recent slowing down of adult BMI trend increases can be explained by two sub-populations—a high BMI sub-population getting ‘fatter’ and a majority ‘resistant’ normal BMI sub-population. These findings support a targeted, rather than a population-wide, policy to tackle the determinants of obesity"

I guess my main point is not to say it is better to be more over weight, even though there is evidence that overall mortality, even removing smokers and smoking induced conditions, but it is better to be slightly over weight than toward the bottom of the targeted 20-25 range. The range is just not right, IMO. Further, there appears to be little need for concern at all at being overweight, but not obese.

Obviously obesity at higher levels is risky, and being morbidly obese is not very good at all.

My main annoyance is the original article - "63% of aussies are overweight" Sure, the are, but it doesn't matter very much. The percentage that is obese matters more. And the percentage that are morbidly obese matter even more still.

I like the conclusion of the recent paper above. Targeted strategy seems more sensible if it can be effective. For the obese it would be good to lose weight. For the merely overweight, rock on - you are doing ok :lol:
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Re: Obesity-Alarm bells but no-one's listening

Postby Xplora » Thu Jun 12, 2014 9:54 am

anttismo wrote: I just don't see the overweight definition (BMI>25) being appropriate or even desirable.


It's a good "ball park". It's worth bearing in mind that while tons of people are very healthy above this number, there are many more who are quite unhealthy above this number as well, and it's CERTAINLY useful for those healthy people to be keeping a much closer eye on their health than the 20 BMI weed. Things like cholesterol or skin pinch testing is going to be worthwhile if you weigh 110kgs despite being a healthy athlete because the difference between a healthy athlete and a dying mess is 6 months of injury or retirement from sport. I look at myself, who topped out at almost 80 after a strict regime of a large dominos pizza for breakfast or a KFC meal for breakfast, above my normal healthy weight of 72. 10% extra weight. Lost the lot within 6 months of riding a bike. My BMI is 20. I have to put on 12kgs to register as obese... I'm very very low risk for obesity :idea: My mates who are heavier set at 90kgs without too much fat aren't obese, they are quite healthy, but I'd suggest they need to be more careful because 2 beers doesn't make you fat, but 4 certainly will :idea:
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Re: Obesity-Alarm bells but no-one's listening

Postby barefoot » Thu Jun 12, 2014 10:50 am

anttismo wrote:Anyway, it seem being overweight is really little more unhealthy than being normal weight, in terms of mortality in general.


Interesting studies.

I wonder, though, whether mortality is the best measure of health WRT overweight and obesity.

It's quite possible that being overweight leads to an increase in chronic conditions that can be managed medically, at great expense and some discomfort, without causing a reduction in actual life expectancy.

Even things like joint failure. A colleague of mine (who Antti also knows ;-) ) is certainly overweight but probably not obese. He's in his 50s, and just had a knee replaced. Sure, he may have generically bad knees, he may have injured that knee in his youth... whatever. But if that knee had been supporting 10kg less of him throughout his adult life, would it have lasted longer?

Low-level heart disease is very much survivable these days. People go on blood thinners and blood pressure tablets and cholesterol pills and Dog knows what else, and chomp down a daily diet of medication from their 40s right through until they lose their marbles and die of skin cancer or some other non-obesity-related condition. Would they have needed so much medication if they had been lighter, fitter and healthier through their adult life?

But then again... does chewing pills for breakfast reduce your quality of life anyway, as long as it keeps you alive? I don't know.

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Re: Obesity-Alarm bells but no-one's listening

Postby anttismo » Thu Jun 12, 2014 11:01 am

barefoot wrote: Interesting studies.

I wonder, though, whether mortality is the best measure of health WRT overweight and obesity.

It's quite possible that being overweight leads to an increase in chronic conditions that can be managed medically, at great expense and some discomfort, without causing a reduction in actual life expectancy.

Even things like joint failure. A colleague of mine (who Antti also knows ;-) ) is certainly overweight but probably not obese. He's in his 50s, and just had a knee replaced. Sure, he may have generically bad knees, he may have injured that knee in his youth... whatever. But if that knee had been supporting 10kg less of him throughout his adult life, would it have lasted longer?

Low-level heart disease is very much survivable these days. People go on blood thinners and blood pressure tablets and cholesterol pills and Dog knows what else, and chomp down a daily diet of medication from their 40s right through until they lose their marbles and die of skin cancer or some other non-obesity-related condition. Would they have needed so much medication if they had been lighter, fitter and healthier through their adult life?

But then again... does chewing pills for breakfast reduce your quality of life anyway, as long as it keeps you alive? I don't know.

tim


Yep, I think mortality might not be the perfect measure. Indeed I reckon that was probably what march1983 meant by quality of life earlier. BMI vs mortality papers are easy to find and look at thought :)

And I guess mortality is implied often in many comments you hear - "I going to do this because I want to see my grand kids grow up" and so forth.

It is nice to prod and poke though, get people thinking. From what I can gather, modern highly processed foods should be avoided mostly because they are driving an obesity epidemic. And an obesity epidemic is bad because people are dying younger, or cost more medically. That's all probably true. But, just from my perspective and applicable mainly to me, modern processed foods are great to eat and have no real downside other than perhaps causing slight increase in appetite and weight, which in turn has no real downside other slightly increasing my chances of diabetes. Hardly the kind of stuff to fill me with terror :)
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Re: Obesity-Alarm bells but no-one's listening

Postby Gordonhooker » Thu Jun 12, 2014 11:19 am

biker jk wrote:I read recently that a Canberra hospital had to replace its toilets with heavy duty versions due to obese patients. The existing toilets were rated to 150kg while their replacements can cope with up to 500kg. :shock:


Yikes my eyes bug out when trying to get that image out of my mind as well :shock: :shock: :shock: :shock:
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Re: Obesity-Alarm bells but no-one's listening

Postby Sweeper59 » Thu Jun 12, 2014 11:55 am

Obesity is currently the biggest problem our health system is facing, and in my view, it's almost entirely a lifestyle problem. Yet it's interesting how society dances around the topic. We're not allowed to call anyone 'fat' for fear of offending them, and terms such as 'big-boned' and 'plus size' are becoming more acceptable. I saw a recent article about a Size 18 model, who said everyone should accept their body shape, no matter how big they are.
Why is it that Australia can embrace a 30 year 'anti-smoking' campaign, which has seen a big drop in the number of cigarette smokers by making smoking 'socially unacceptable', but appear to accept obesity, which is killing just as many people, and affecting the lives of 75% of Australians?
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Re: Obesity-Alarm bells but no-one's listening

Postby simonn » Thu Jun 12, 2014 12:12 pm

anttismo wrote:From what I can gather, modern highly processed foods should be avoided mostly because they are driving an obesity epidemic.


It's not so much about avoiding processed foods as knowing what you eat. "Avoid processed foods" is just three words which is easy to remember and easy to implement.

Gordonhooker wrote:Why is it that Australia can embrace a 30 year 'anti-smoking' campaign, which has seen a big drop in the number of cigarette smokers by making smoking 'socially unacceptable', but appear to accept obesity, which is killing just as many people, and affecting the lives of 75% of Australians?


Oddly, there is a negative correlation between smoking and obesity. Lets see where we are in around 20 years time, estimating that we have only really been worried about obesity for ~10 years. In the US childhood obesity rates are dropping.
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Re: Obesity-Alarm bells but no-one's listening

Postby lobstermash » Thu Jun 12, 2014 12:17 pm

Xplora wrote: My mates who are heavier set at 90kgs without too much fat aren't obese, they are quite healthy,


There's visceral and subcutaneous fat... They might not carry much subcutaneous fat, but the visceral fat is the nasty stuff. Additionally, I think you're right in that someone who is 'overweight' is at much greater risk of becoming obese than someone at or just below the 'magic' 25 on the BMI. Personally, my BMI was 18 in 2001, and it took more than a decade of relative inactivity and frivolous eating to hit 29. And just 12 months to get it back down below 25 through the pedals...
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Re: Obesity-Alarm bells but no-one's listening

Postby simonn » Thu Jun 12, 2014 1:03 pm

Xplora wrote: My BMI is 20. I have to put on 12kgs to register as obese...


How short are you? A 142cm short person needs to put on more than that, almost double in fact, to move from a BMI 20 to a BMI of 30 (according to chart below).

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I'm very very low risk for obesity :idea: My mates who are heavier set at 90kgs without too much fat aren't obese, they are quite healthy, but I'd suggest they need to be more careful because 2 beers doesn't make you fat, but 4 certainly will :idea:


I assume that you have all done fold tests, WHRs etc, because BMI is not the be and end all ;)
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Re: Obesity-Alarm bells but no-one's listening

Postby barefoot » Thu Jun 12, 2014 1:22 pm

Xplora wrote:
anttismo wrote: I just don't see the overweight definition (BMI>25) being appropriate or even desirable.


It's a good "ball park". It's worth bearing in mind that while tons of people are very healthy above this number, there are many more who are quite unhealthy above this number as well, and it's CERTAINLY useful for those healthy people to be keeping a much closer eye on their health than the 20 BMI weed
...
My mates who are heavier set at 90kgs without too much fat aren't obese, they are quite healthy, but I'd suggest they need to be more careful because 2 beers doesn't make you fat, but 4 certainly will :idea:


You also have to consider that BMI is a very blunt tool that doesn't take body shape into consideration.

I've read a few articles that claim waist:hip and waist:height as being far better individual indicators of obesity-linked health problems than BMI.

Of course, I'm biased toward such articles because they paint me in a good light. At 178cm and 84kg, my BMI is about 26 (overweight).

But I have about an 82cm waist, so my waist-to-height ratio is 0.46 or so, which is below average and well into the "healthy" range.
And I have a big @rse - somewhere upward of 105cm at the hip - so my waist-to-hip ratio is well under the "heatlhy" 0.9 figure.

Still, I could do with losing a few kilos to help me up hills faster :-/
And Durianrider says I should be about 60kg at my height, if I had an awesome ripped body like his, and he's always right :lol:

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Re: Obesity-Alarm bells but no-one's listening

Postby lobstermash » Thu Jun 12, 2014 2:14 pm

It's a blunt tool, but the 'healthy weight' range has around 12kg of variance to take into account different body shapes. You'd expect an ectomorph to be near the lower end of the bmi range and an endomorph to be near the top. Yes, it doesn't account for the exceptionally muscular and lean, but they'd be rare in a population
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Re: Obesity-Alarm bells but no-one's listening

Postby ColinOldnCranky » Thu Jun 12, 2014 2:39 pm

lobstermash wrote:It's a blunt tool, but the 'healthy weight' range has around 12kg of variance to take into account different body shapes. You'd expect an ectomorph to be near the lower end of the bmi range and an endomorph to be near the top. Yes, it doesn't account for the exceptionally muscular and lean, but they'd be rare in a population

Yes, it is a crude measure. But then so are most of the health related metrics. BP and pulse included.

It has always been a tool better though still imperfectly suited to a population demographic rather than the individual.

BMI pops up with relentless monotony on this forum. I venture that most people posting in BMI related threads here are aware of the alternative (and less flawed) metrics that have gained favour in recent times. Yet we continue to largely ignore them and focus on one that is descredited and which we would mostly agree is flawed. BMI is no longer worthy of the atention that we give it.
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