The EALM Blog Shelf

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!

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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.







What Happens on the Bike…

Photo Credit: RambergMediaImages via Compfight cc
Photo Credit: RambergMediaImages via Compfight cc

What Happens on the Bike…
By Laura Cipullo, RD, CDE, CEDRD

About three years ago, my good friend Jaime invited me to go to spin class with her. She would come over every Sunday and literally stand above my bed and ask me if I was ready. I was a mom with two very young kids, a professional career, and a husband who worked all of the time. Was I ready? Of course not! But all I had to do was throw on leggings, a tank top and sunglasses to cover the mascara smudges around my eyes from the day before! The spin studio was rather dark inside so no one would see that I hadn’t used my make-up remover. Well, what happened on that bike was more than I ever hoped might happen! Thank you, Jaime, for dragging me out of bed! Thank you, Robert, for watching the kids! And thank you, Janet, for reminding me of my own possibilities.


Once I got to class that first morning, I never looked back. Now please realize…I’m not talking about spinning right now, but rather about having the time to dream again, to set goals again, and to just feel the remarkable joy of moving in my own body. I had been in a motorcycle accident in 1996; since that time, I’d never been able to ski, run, or even wear my stilettos without severe consequences and/or extreme pain. But cycling was easier on my leg…and it gave me back “my edge.” It provided me with the opportunity—as Janet, the spin instructor advised—to set an intention on the bike for when you were literally off the bike. She didn’t talk about calories (well, maybe sometimes); instead she spoke of envisioning something you wanted to achieve and riding for that purpose. I took her every word seriously. And while on that bike, I decided that I was going to pursue my dream of writing a book.


Week after week, I went to my church (“Soul Cycle”), as Janet would say—to envision my book and sometimes to ride for a friend or family member in need of positive energy. But I have to admit that it was in Janet’s class every Sunday morning that I reminded myself that I really could do this.


I soon learned that writing a book and getting it published by a big publishing house was, in short, a seemingly backward process. Instead of writing a book and then trying to get your name and book into the public eye, I was advised by all the top editors to start a personal blog (that project eventually became MomDishesItOut) and then to go straight to television. Many advised me to skip writing a book altogether, but a book was important to me—a stepping stone in my career, something I personally wanted to do, and something I really wanted to accomplish for my mom. So I decided to take the route of working in the media while trying to write the book too. But my time was limited, and after six months of media appearances, I received my first offer to write a book. This was not necessarily my dream book, but then again, I’d never specified which book I wanted to write while I spent all those Sundays spinning away! The book’s subject was, however, close to my heart because it was about diabetes. You see, all the men in my family have diabetes. Each had helped me in my career. Whether it was letting me come along on their appointments with dietitians or introducing me to their doctors, it was meaningful to me. So, this book could, and would, be my tribute to all of them.


In the fall of 2013, what happened on that bike actually became my reality. Rodale published my first book, The Diabetes Comfort Food Diet Cookbook, authored by me and the editors of Prevention Magazine. And then, just one month later, I self-published my second book, Healthy Habits: 8 Essential Nutrition Lessons Every Parent and Educator Needs. I dedicated my first book to my family members with diabetes and, of course, to my mother. My second book is not dedicated to anyone specifically; rather, it’s for every person with great hope that each will one day create a positive relationship with eating and a neutral relationship with food. It’s for my children, my clients, and all the parents out there who receive mixed messages on nutrition. This is the book that focuses on self-care and nutrient density, not weight loss and what you can’t have. It’s sort of like spinning. I spin to take care of myself and set goals rather than to lose weight or punish myself for eating a holiday dinner.

Photo Credit: rachel a. k. via Compfight cc
Photo Credit: rachel a. k. via Compfight cc

So find your vehicle—whether it’s a spin bike or a yoga mat or even a pew in your own spiritual temple. Set your intentions for 2015. And then let us know what happens! And again, thank you Jaime, Robert and Janet.

Life after Menopause…

Life after menopause…
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team


Menopause, the permanent end of menstruation and fertility, is defined as occurring 12 months after your last menstrual period. Women typically enter peri-menopause and then menopause in their 40s and 50s. The average age for menopause is 51.1 The transition into this phase in a woman’s life cycle and living optimally thereafter can be ameliorated through diet and physical activity. Embrace life after menopause by following these five tips for living life healthfully.


Photo Credit: brendan-c via Compfight cc
Photo Credit: brendan-c via Compfight cc
  1. Eat your estrogen through soy! Soybeans contain a hormone-like substance called phytoestrogen. It can mimic the effect of estrogen and have a vast impact on your overall health before, during, and after menopause. Fermented forms of soy are ideal. So choose miso, tempeh, natto, tofu and young soybeans in the pod known as edamame. Stick with eating soy in the real form rather than via supplements and bars.2
  2. Stand up straight. Now is the time to use light weights to counter osteoporosis. Osteoporosis, otherwise known as weak bones, is due to risk factors such as age, genetics, and dietary deficiencies in both calcium and Vitamin D. Women experience an increased rate of bone loss during menopause and for the ten years thereafter. Though osteoporosis is not reversible at this age, woman can manage, slow and or even stop it by strength training among other things. The act of weight training increases the activity of osteoblasts (bone building cells) and increases muscle strength which counters the effect of gravity. The effect of gravity on weak bones is observable as a “hunch back.” So stand strong—and be sure to incorporate light weights or resistant weight training twice a week.3
  3. Prevent weight gain in the waist area that is often associated with menopause. All you have to do is curb carb consumption at meals. With a decrease in estrogen, women are likely to see an increase in belly fat. While you cannot reverse aging, you can prevent a wide waist by limiting carbs at mealtime. When you eat carbohydrates and even protein, a hormone known as insulin increases to transport the carbohydrates (also known as sugar) into your blood cells. When insulin levels rise, research demonstrates there is likely an increase in belly fat deposition. Therefore, if you prevent insulin from spiking by minimizing the amount of carbohydrates you eat at a meal, not only will you be cutting calories, but you will also be preventing excess belly fat deposits. Women should use 45 grams of carbohydrate per meal and 15 grams of carbohydrate per snack as a guide.4
  4. Stay happy and heart healthy with essential fatty acids. Omega 3 fatty acids are associated with decreased depression, inflammation and triglyceride levels.5 And women are more likely to experience both depression and heart disease after menopause.6 The key to omega 3 fatty acid intake is first ensuring that you are eating the right form—the fish form such as wild salmon, trout, bass and canned chunk light tuna. These fish contain higher amounts of the omegas known as DHA—docosahexaenoic acid. DHA is the specific fatty acid studied whereas the vegetarian sources of omega 3 fatty acids (pumpkin seeds, walnuts and even algae) contain ALA—alpha-linoleic acid. Only ten percent of ALA gets converted to the beneficial form of DHA. So go fishing for dinner.5
  5. Decrease vaginal discomfort…including dryness and incontinence. Some tricks of the trade help to reduce the pain and improve your sex life. During and after menopause, there can be thinning and inflammation of the vaginal walls. The decrease in the hormone estrogen affects the moisture level causing vaginal dryness and “pelvic relaxation.” Incontinence is the inability to hold urine from your urethra due to pelvic relaxation.7 The positive news is that research from the Mayo Clinic suggests limiting alcohol, caffeine and or acidic foods to lessen irritation. Practicing yoga and kegel exercises and participating in vaginal physical therapy can reduce pain and even incontinence.8



1. “Menopause.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 24 Jan. 2013. Web. 26 May 2014. <>.

2. Hyman, Mark, MD. “How Soy Can Kill You and Save Your Life – Dr. Mark Hyman.” Dr. Mark Hyman., 25 Feb. 2013. Web. 24 May 2014. <>.

3. “General Facts on Osteoporosis.” National Osteoporosis Foundation (n.d.): n. pag. Web. 24 May 2014. <>.

4. Cipullo, Laura. The Diabetes Comfort Food Diet Cookbook. New York: Rodale, 2013. Print.

5. “Fish Oil: MedlinePlus Supplements.” MedlinePlus. U.S. National Library of Medicine, 04 Sept. 2013. Web. 26 May 2014. <>.

6. “Depression in Older Persons Fact Sheet.” NAMI. NAMI – The National Alliance on Mental Illness, Oct. 2009. Web. 24 May 2014. <>.

7. “Urinary Incontinence.” NAMS. The North American Menopause Society, n.d. Web. 23 May 2014. <>.

8. “Yoga, Kegel Exercises, Pelvic Floor Physical Therapy.” NAMS. The North American Menopause Society, n.d. Web. 23 May 2014. <>.

Boosting Positive Body Image

Take a moment this week to focus more on the positive, forget black and white thinking, and exercise your passion with this inspirational blog post!

Photo Credit: andresAzp via Compfight cc
Photo Credit: andresAzp via Compfight cc

More on the Positive – Instead of focusing on weight, scales or muscles, think about the positive characteristics you possess…humor, creativity, passion. Focusing your positive characteristics can help you build self-esteem and positive body image.

Forget Black and White Thinking – No food is “bad” or “good.” Food provides us with energy and nutrients but in varying amounts. By refraining from labeling foods, we can help prevent ourselves from internalizing those same labels. To learn more about how to foster a healthy habits with food, check out the Healthy Habits Program.

Exercise Your Passion – Do you enjoy swimming, hiking or basketball? Have you ever tried a relaxing yoga session or an upbeat spinning class? Trying a new activity with a friend or simply going hiking with your family can be a great way to socialize and fit in physical activity. Experiment with different activities and find what you enjoy the most. It’s important to exercise for health, wellness and enjoyment rather than just weight loss. For physical activity, think about overall wellbeing rather than pinpointing areas you find negative.

Additional Tips for Boosting Positive Body Image

  1. Surround yourself with positive people
  2. Accept that every shape and body size is beautiful
  3. Understand that the media portrays beauty in varying ways. The media and advertisements project images that are often not realistic.

Diabulimia: Learning More about your Teen and their Type-1 Diabetes Diagnosis

Diabulimia: Learning More about your Teen and their Type-1 Diabetes Diagnosis
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team


Diabulimia is an unofficial term, used by both the American Diabetes Association and the Juvenile Diabetes Research Foundation, to define a serious condition effecting, but not limited to, adolescent girls diagnosed with type 1 diabetes.

Photo Credit: via Compfight cc
Photo Credit: via Compfight cc

An adolescent diagnosed with diabulimia (known formally as ED-DMT1) is characterized by the intentional misuse and manipulation of insulin for the purposes of weight loss and control. By decreasing, or skipping the necessary dose of insulin, the individual’s body cannot absorb the carbohydrate, which affects weight and causes high blood sugar. This is very dangerous state as high blood sugar can cause Diabetic Ketoacidosis.


Did you know diabulimia’s prevalence is most widely recognized in adolescent girls? Studies conducted by the Academy of Nutrition and Dietetics: Pediatric Nutrition, report that an adolescent girl, with T1DM, is 2.4 times more likely to develop an eating disorder than her peers. While it is difficult to pinpoint the culprit behind diabulimia, the current assumption is the hyper focus on diet, control and weight. The strict diet associated with diabetes care and the pressures associated with women, eating, and body image could “exacerbate preexisting disordered eating tendencies.” (Childers)


If your tween or teen has diabetes, here are signs that may signify there is an element of disordered eating or an eating disorder:

  1. Frequent Diabetic Ketoacidosis
  2. Excessive Exercise
  3. Use of diet pills or laxatives to control weight
  4. Anxiety about or avoidance of being weighed
  5. Frequent and severe hypoglycemia
  6. Binging with alcohol
  7. Severe stress in family
  8. Frequent Insulin omission (Franz)

This is a relatively new branch to the field of nutrition, displayed by its mixture of symptoms and heath concerns.  It is important to remember the American Diabetes Association (ADA) continues to stress that there is no “one-size-fits-all” eating pattern for individuals with diabetes. When it comes to dietary recommendations, there is a strong emphasis on personal/cultural sensitivity and care. If your adolescent shows the above signs, it is highly recommended to seek a registered dietitian who specializes in both diabetes and eating disorders.


What do you think the prevalence of Diabulimia suggests about adolescent girls perception of health? How can we help to reframe this image?




  • Nancy, Childers, and Hansen-Petrik Melissa. “Diabulimia in Adolescent Females.” Pediatric Nutrition 37.3 (2014): 13-16. Print.
  • Franz, Marion J., and Kulkarni, Karmeen. Diabetes Education and Program Management. Chicago, IL: American Association of Diabetes Educators, 2001. 159. Print.

Is Your Trainer Trained?

Is Your Trainer Trained?

Do you ever wonder what the initials after your trainer’s name stand for? Or what initials should a trainer even have? EALM asked fitness trainer Tiffany Chag, CSCS to let us know what credentials a personal fitness trainer should have and what they mean. Here is her response!

Photo Credit: Robert S. Donovan via Compfight cc
Photo Credit: Robert S. Donovan via Compfight cc

Chag shared “It is most important that the trainer has an up-to-date personal training certification accredited by the National Commission of Certifying Agencies (NCCA).”  Just so you know, some require a four-year college degree while others take only 20 minutes to complete online.  She let us know there are many personal training certifications out there, but there are three widely recognized personal training governing bodies and their respective certifications.”


  1. National Strength and Conditioning Association (NSCA): offers both the Certified Strength and Conditioning Specialist (CSCS) certification and the Certified Personal Trainer (CPT) certification.  The CSCS is the most recognized and respected certification in the fitness profession, intended for trainers focused on maximizing athletic performance.  In order to sit for the four-hour exam, you must have a four-year college degree.  The CPT, also highly regarded, is intended for trainers working with the general population.
  2. American College of Sports Medicine—Certified Personal Trainer (ACSM-CPT):  Like the NSCA-CPT, this certification is intended for trainers working with the general population.  As stated on its website, the ACSM, “advances and integrates scientific research to provide educational and practical applications of exercise science and sports medicine.”
  3. National Academy of Sports Medicine—Certified Personal Trainer (NASM-CPT): This certification is also meant for trainers working with the general population and focuses more on corrective exercise through balance and functional movement.  They created the Optimum Performance Training (OPT) model to design personal training programs.


Tiffany made us aware of additional certifications trainers may earn. “Many trainers complete certifications for special populations such as triathlon training, pre- and post-natal, weight loss, and youth or seniors. Trainers can also obtain certifications focused on different modalities of exercise, such as: kettle bells, TRX (the black and yellow rope you see hanging around your gym), or spinning/cycling.  If you’re looking for something in particular, ask if a trainer has a specialty certification or if they’ve ever worked with someone in a similar situation.  Most trainers will gladly provide referrals, if you’re interested.”

Photo Credit: Justin Liew via Compfight cc
Photo Credit: Justin Liew via Compfight cc

Tiffany Chag’s Words of Wisdom for the World of Fitness:

“Ask questions!  I can count on one hand the number of times a prospective client has asked about my background—this always surprises me. The more you learn about the trainer, the more likely you are to find the right match to help you reach your health and fitness goals.

Working with a trainer should be challenging and should push you outside your comfort zone, but mostly…it should be fun.  In between catching your breath, ideally you’re able to eke out a smile!”

Thanks Tiffany!! You can check out more about Tiffany Chag, CSCS and her certifications at: ~ Facebook.

Laura Cipullo and EALM’s Words of Wisdom for the World of Fitness:

Look for the initials CSCS, CPT and or NASM-CPT. Ask questions and make sure you don’t push too hard to cause injury!! Also check out to see if your trainer has been trained to work with eating disorders.

Healthy and Happy: The Positive Role Team Sports Play on Adolescent Girls

Headline: Sign Your Girls Up For Team Sports this Fall!

Photo Credit: evoo73 via Compfight cc
Photo Credit: evoo73 via Compfight cc

Healthy and Happy: The Positive Role Team Sports Play on Adolescent Girls
By Lauren Cohen and Laura Cipullo Whole Nutrition Services


Do you remember what middle school was like for you? If you’re like me, you probably try not to remember. Being a teenager is difficult. Between the physical changes, social changes, and mental changes, overwhelming is probably an understatement—and that’s not even including schoolwork! And then there are the girls. The pressure and social anxiety to “fit it” is exacerbated by the feeling that you need to wear the right clothes or carry the right backpack or have the right friends. As many times as we try to profess that all girls feel it (yes, even that “it” girl!), it is an isolating and lonely sensation. While we can’t eliminate the discomfort that comes along with being a teenage girl—we can work to improve it.


New research suggests that team sports may be the answer to helping adolescent girls live happier, healthy lives. While research is continuing to expand our knowledge as to why this is the case, the results show a varied and wide impact. In an essay published by the World Health Organization, the benefits of participation in team sports are classified into five categories; physical, mental, social, intellectual/ educational development and reproductive health.


Physical Health

Physical health is improved in two ways. First, it can reduce the risk for diseases that often affect children and adolescents including diabetes and high blood pressure. Secondly, it can reduce the risk for chronic diseases that often develop later in life including cancer, diabetes, and coronary heart disease. Physical activity also continues to prevent childhood obesity, which has a close relationship with adolescent depressive disorders.


Mental Health

The National Institute of Mental Health reports that roughly 11% of adolescents develop depressive disorders by age 18—and girls are twice as likely to have a depressive episode then boys. While that is a scary statistic, it is important to remember that there are many ways to combat and understand depressive disorders. Team sports are one of them. It has a positive effect on a young girl’s physiological well-being and can reduce levels of anxiety and depression. There are new studies that suggest physical activity as a treatment option  – since it often acts as an anti-depressant and lowers stress levels.


An article published by the LA Times in April 2014 recently addressed a study suggesting that calling a girl “too fat” by people close to her are more likely to become obese by age 19. The link seems to be emotional—if girls feel bad about themselves, they turn to food for comfort.


Social/Intellectual/Educational Health

With lower levels of stress and increased physical health, studies show an upward trend in academic and intellectual success. There is also a higher rate of interest in graduation from high school and college with a lower rate of dropouts and higher GPAs—particularly in math and science. Socially, these team players experience a sense of belonging, a community, and teammates who share a common interest and goal.


Sexual Health

Limited research also suggests that inclusion in team sports gives young women a sense of pride, respect, and empowerment towards their bodies.


In many settings, adolescents may be encouraged to view their bodies as sexual and reproductive resources for men, rather than sources of strength for themselves. Early studies conducted in the US have found that adolescent girls who participate in sports tend to become sexually active later in life, have fewer partners, and, when sexually active, make greater use of contraception than non-sporting girls.

-Girls Participation in Physical Activities and Sports: Benefits, Patterns, Influences, and ways Forward; Bailey, Wellard, Dismore


With increased rates of adolescent pregnancy and poor sexual health & education, the hope that young women will display bodily empowerment and respect is certainly desirable and correlates with participation in team sports.


As we already know, physical activity already has such a wide range of positive impacts that reach from muscle toning to mind toning. When we add the element of team building and comradeship, it really might be the best mixture for adolescent girls. Even if practice is just once a week, sign up! The tools she gains and the resources she learns are the very skills that teach us to live a happy and healthy life.





Fueling for a Moonwalk

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This coming Saturday night (7/26), thousands of people will walk together for Walk the Walk America’s 2nd Annual NYC Moonwalk. Participants will walk  the streets of NYC in a fight against breast cancer. I was fortunate to have had the opportunity to speak to some of these participants last month. On June 26th, I spoke with Moonwalk participants about the importance of nutrition when completing a marathon. Please read on to see some of the items we discussed:


What to Eat Before a Marathon

2-3 Days Before:

•Mostly carbohydrates, moderate protein, and low fat
•Carbs provide the muscles with adequate glucose (sugar) for glycogen storage

3–4 Hours Prior:

•Eat simple, easy-to-digest carbohydrates (moderate protein & low fat)
•White bread, pasta, etc.
•Avoid high-fiber foods to limit intestinal residue

•Prevent the need for bowel movements
•Prevent bloating and gas

Photo Credit: flowercarole via Compfight cc
Photo Credit: flowercarole via Compfight cc


Pre-Competition Meal Ideas

•Cheerios with low-fat milk, fruit-flavored Greek yogurt, and banana
•Omelet with cheese and baked hash brown potatoes
•White English muffin with avocado, hummus, and applesauce
•Bagel with natural peanut butter and jam
•Turkey on white bread with a low-fat yogurt
•White pasta with pesto and shrimp
Photo Credit: shecodes via Compfight cc
Photo Credit: shecodes via Compfight cc


Before, During, and After

2 cups 2 hours before, and 2 cups during

•Recommended to drink 16 oz. of fluid at least 2 hours before event
•Remember to drink 2 cups for each hour of event
•If > 1 hr. replete electrolytes especially sodium and potassium
•Drink 16 oz./2 cups of electrolyte beverage for every pound of body weight lost during the event
Photo Credit: chuddlesworth via Compfight cc
Photo Credit: chuddlesworth via Compfight cc


Eating on the “Run/Walk”

•Eat 30–60 grams of carbs for every hour
•15 grams of carbs every 15 minutes
Eat 90 grams of carbs for events lasting > 3 hrs
ž•Get carbs from your sports beverage (typically 6–8 percent carbs)or gel packs



What to Eat After

•Eat between 30 minutes and 1 hr. after
•Reload glycogen muscle storage
•Replenish your body with carbohydrates
•Eat protein (about 3 oz.) to help to repair your muscles
•Antioxidants repair free radical damage
•Muscle recovery lasts 30 minutes to 4 hours post-exercise


For more information on the 2014 NYC Moonwalk or Walk the Walk America, please click here to be redirected to their website.

4 Tips To Feeding Your Inner Self With Self Care

This post is an excerpt from a previously published blog post on YourTango, to see the original post click here.
Photo Credit: NA.dir via Compfight cc
Photo Credit: NA.dir via Compfight cc

In a world of external focus where a scale determines your worth and your salary defines your success, you need to turn inward to find wellness and well-being. In order to survive and create balance, start connecting with your inner core — your true self. But how can you make this connection when everything around you points to the polar opposite of looking outward?

Here are my favorite ways to self-care that allow for connecting with yourself and feeling the best. The beautiful thing is that you don’t need to shell out money in order to utilize these methods. All of the following tips ultimately affect food intake, so pay close attention. They will help lead you on your journey to feeling and being well.

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1. De-Stress Your Nervous System

That’s right! Rid pain, inflammation and more with my favorite at home self-care set. It is the “melt method” and props. This method is not about melting away your love handles. It’s about ridding pain while also restoring balance to your nervous system ultimately affecting digestion, energy levels and more.

I was first introduced to this method by my master gyrotonic and pilates instructor, Michelle Spinner, at Kinected Studios in NYC. Michelle, as well as my rolfing practitioner, Marie Zahn, always told me, it starts in our feet. If your feet are “off,” your body will be “off.” It makes perfect sense, yet most people never think about their feet when contemplating well-being.

So start from the tips of your toes, and work your way up. Use the melt hand and foot treatment with the melt balls. These little balls may not exactly feel heavenly the first time you use them, but they work. I started using them last Fall, and by the time winter rolled around, I noticed remarkable change.

This was the first year that I was able to ski pain-free since 1996! I used the melt method every night after skiing. The best thing about this new tool? The balls are travel-friendly! You can easily transport the balls with you wherever you go. The melt balls enable you to be proactive with your own form of manual therapy!

Read more at YourTango:

A Reflection on BMI

A Reflection on BMI
Part 1 – In The Media
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team

Photo Credit: Barbara.K via Compfight cc
Photo Credit: Barbara.K via Compfight cc

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 

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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.

Photo Credit: -Paul H- via Compfight cc
Photo Credit: -Paul H- via Compfight cc

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.