While Laura Cipullo and the Laura Cipullo Whole Nutrition Team work on some new and exciting projects, you may notice less posts on the Eating and Living Moderately Blog. We have created a “blog shelf” below to keep you entertained and educated. Get caught up on the latest nutrition education by clicking on each year below. We will send you nutrition updates, but we will not be inundating your mailboxes on a weekly basis. If you want weekly “love” and inspiration, subscribe to our Mom Dishes It Out blog for weekly posts and recipes. Mom Dishes It Out provides expert advice from mom Registered Dietitians and mom Speech Pathologists on the “how to” of health promotion!
The EALM Blog Shelf
Please feel free to peruse our posts organized by year below. Or take a look at the categories listed at the bottom of the page to find a post in the desired.
A Reflection on BMI: Part 2 BMI Report Cards By Laura Cipullo Whole Nutrition Services Team
Just to recap what we learned in Part I, BMI is a measurement based on an individual’s height and weight. It is used on a scale to reflect one’s status as underweight, normal and underweight. While using measurements is essential for statistical reasons and diagnostic tools, BMI is being utilized as a marker of health rather than focusing on behaviors and a cluster of measurements. We have said it before and will say it again; BMI is only one measurement and it’s not always reflective of a person’s state of health.
After collecting all of this information on BMI, does this change how we look at it for our growing children and adolescents?
Adolescent bodies, the time of development just after childhood, are growing at a rapid pace. Mentally and physically. Teens deal with an increased level of hormones in their bodies, which contribute to the many different growth spurts they will endure. They struggle with self-identity and the desire for independence. This combination often causes teens to be deeply self-conscious, which can inhibit decision-making. It could cause them to become defiant and often times unresponsive to parental guidance.
Puberty arrives at different times, stages and intervals for every child but usually happens around age 11-14. On average, teens experience a 20-25% growth increase during this time—35 pounds for girls and 45 pounds for boys. In an average one-year spurt, girls grow roughly 3.5 inches and boys about 4 inches. Using a measurement such as BMI, which is already so marginalized to determine the health status of a rapidly changing youth seems counterproductive.
Over the past few years, you may have heard of BMI Report Cards or, as they are more harshly referred to, “Fat Letters.” They are letters sent home from schools reporting on a child’s BMI and suggesting to seek out a physician if results are above normal. Needless to say, parents did not respond well to this. It caused a national outrage. In 2004, Arkansas was the first state to send BMI report cards home to parents and/or guardians. Children and adolescents with a BMI indicating they were “overweight” were suggested to consult a health care professional. Today, the program is implemented in over a quarter of United States school districts.
A cover story from the New York Post last week chronicled (with pictures!) this same concern. Click here to read the article in full and see the letter that a young girl was sent home with from the NY Department of Education. Unfortunately, this is happening with more regularity in New York City schools than the article chronicled. It isn’t just front cover news; a friend of ours recently received “obese” range marks for two of her three children who are nowhere near overweight. Now it becomes clear that we cannot possible classify these kids as overweight or underweight without taking into consideration other factors such as fat distribution, family history and the child’s behavior. This leads us to a very important question—if BMI calculates the relationship between height and weight, in a time when height and weight are rapidly changing at different paces and intervals, how can we justify using this as a determinant of adolescent health?
Knowing everything that we know about BMI, is this really something that will be beneficial for children and adolescents? Shouldn’t we be focusing on their habits through this time to pave the way for a lifelong positive relationship with health and food?
Perhaps even more important, we should be considering how these letters impact the children receiving them. We know that adolescence is the time that individuals are molded into adults. So what happens when a child is told they are fat? A recent article published by the LA Times discusses a study at UCLA that researched this question. Their data reflects “10-year-old girls who are told they are too fat by people that are close to them are more likely to be obese at 19 than girls who were never told they were too fat.” (LA Times, Deborah Netburn) The research goes on to emphasize the danger of “Weight Labeling” at this age. With our understanding of adolescent development, it’s easy to see why.
The major flaw with BMI calculations continues to be that it cannot tell you an individual’s habits. Those high in muscle weight are considered overweight, petite individuals are underweight and normal range individuals could be harboring unhealthy eating habits. BMI is limiting. It doesn’t ask the big questions; have you started menstruating? Are you feeling pressure to experiment with drugs, alcohol, cigarettes, or sex? How often do you think about food? Are you eating a balanced diet? These are the thoughts and habits that, overtime, determine the health of an individual.
Has your child received a BMI report card known as a Fitness Gram? What are your feelings concerning weight stigmas and children?
A Reflection on BMI Part 1 – In The Media By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team
We’ve been hearing a lot about BMI recently in news. Between The Biggest Loser controversy and a recent article recounting a Yale student’s struggle with her school’s perception of health, BMI seems to be the hottest new weight assessment. Mom Dishes it Out covered BMI in 2012 (the article can be accessed here) emphasizing the importance of good and healthy behaviors over the use of a flawed scale of measurement. Since then, we found that it continues to be used in the media as a fact determining obesity. But what does BMI really tell us about our bodies? Body Mass Index—or BMI—is a measurement of body fat based on an individual’s height and weight. To determine your own BMI, you can use this easy equation.
BMI = weight (kg)/ height (m)2
Determining BMI is not specific; it’s general. An individual’s BMI is just one part of the puzzle when health care professionals work towards improving an individuals habits and it should not be used as the sole determinate to suggest that an individual is either under or overweight. It is merely a clue as part of a larger nutrition and health assessment. In recent years, the parameters for BMI have changed, causing more people to fall into certain categories.
Consider this – muscle weighs more than fat. So are Tom Brady, Michael Phelps, and many of the female Olympic gymnasts overweight? Their BMI says yes, though we know this is not the case. Bodies come in all shapes, sizes, and masses and it is important to remember this.
The fueling argument behind The Biggest Loser contestant, Rachel Frederickson’s, weight controversy was her BMI of 18, a value considered just underweight and malnourished. Without considering her BMI, it’s easy to understand how and why a driven and competitive individual involved in a nationally televised weight-loss competition (who would win $250,000) would be so intent on dramatic weight loss. However, we don’t think her weight was healthy. But not because of her BMI, rather her report of exercising 6 hours a day while only consuming 1600 kcals daily in addition to losing 266 pounds in such a short period of time. This is not realistic to continue nor healthy for a lifestyle. If an Olympic athletic were in training, they may exercise for so many hours but they would also be likely consuming 4000 kcals/day. Since the final weigh-in, and after resuming her “normal lifestyle” with the tools she learned from the show, Rachel has a BMI of about 20.
What is more important to consider, is that she reports she is finding time to exercise everyday for about 60 minutes. She loves cooking and is enthusiastic about her meals. She has a renewed sense of her athleticism. She has invested in behavior modification and it is working for her. Instead of using her BMI as a tool to ask the larger questions, we used it’s against her stating that is was a fact that she was unhealthy and now that her BMI is in normal range it is a fact that she is healthy. When, in reality, none of us truly have access to that information. Particularly since none of us know the mental and physical impact that social scrutiny had on her—that’s certainly not information we can get from her BMI. We wonder, is she menstruating, is she thinking about food all of the time or some of the time? We don’t need Rachel to answer these questions, but rather, for us to understand that a mid-range BMI and decreased exercise still does not equate health. More questions need to be answered.
A similar scandal arose when Yale student, Frances Chan, reported in an article later picked up by the Huffington Post, that Yale was forcing her to gain weight, at risk of mandated medical leave from school, based on her BMI. Chan, 5’2” and 90 lbs has a BMI of 16.5. Says Chan;
The University blindly uses BMI as the primary means of diagnosis, it remains oblivious to students who truly need help but do not have low enough BMIs. Instead, it subjects students who have a personal and family history of low weight to treatment that harms our mental health.
While we are given access to Chan’s height and weight and, therefore, her BMI—she is not our patient. We do not have her medical history or understanding of her body’s development overtime. Most importantly, we are not made aware of Chan’s habits and behaviors. With all of that said, her BMI is quiet low. This is a red flag to health professionals suggesting they dig deeper into one’s medical status and mental health to determine if there is an issue, perhaps behavioral, that needs addressing. Chan suggests that Yale used her BMI as the sole determinant during her nutrition intervention. Whether or not an intervention was required remains unclear to us, but we would hope that more than one’s BMI will be used in future assessments and they would take into account her medical status, her mental health and her behavior/habits.
The above scenario is particularly true when visually assessing others. The point here is size is not the only measurement of health especially that of BMI. Some people qualify as healthy with a BMI of 20 yet their behaviors say otherwise by implementing dietary restriction, smoking, over exercising and even purging. While others, with a BMI of 26 could be healthy, exercising, not smoking, and eating normally yet be considered overweight. The same holds true for someone in the extreme margins of BMI. There are many nutrition clients that we have counseled with BMI’s greater than 29 who have made dietary and lifestyle behavioral changes yet their weight does not reflect the media’s representation of health. And so the same goes for someone who is naturally thin and healthy. For women, regular menstruation, adequate nutrition intake and lack of food thoughts/obsessions along with a normal blood pressure, EKG and more, may be a better indicator of true health. So don’t judge a book by its cover.
Stay tuned; there is more information to come about BMI and how it is being used in our culture and society.