Featuring fresh takes and real-time analysis from HuffPost's signature lineup of contributors
Hot on the Blog
Raffi Cavoukian
Yoni Freedhoff M.D.

Yoni Freedhoff M.D.

GET UPDATES FROM Yoni Freedhoff M.D.

Why the Body Mass Index Is Pretty Stupid

Posted: 06/ 7/11 12:46 PM ET

There is no right way to lose weight, but there are plenty of wrong ways, and what's right for one person is almost certainly wrong for another.

A few weeks ago I got into a gentle and congenial Twitter spat with Rebecca Scritchfield. Rebecca is a registered dietitian, and she's a great fan, and an expert practitioner, of intuitive eating -- using inner cues, not calories, to help guide dietary choices.

Me? I don't intuit my eating as well as Rebecca and so I food diarize every last ounce of food that goes into my mouth. Rest assured, I'm not pathological about it. I don't use my food diary to judge what I've eaten, instead I use it to help guide what I eat, and I teach my patients to do the same. To me, looking at the calories when I eat is akin to looking at price tags when I shop -- and just like price isn't the only consideration when shopping, neither are calories the only consideration when eating. We use food in our lives to both celebrate and comfort, and consequently caloric literacy definitely doesn't always lead to low-calorie choices.

Our gentle spat began when I retweeted one of Brian Wansink's tweets. In case you don't know Brian, he's a brilliant researcher based out of Cornell whose life's work (and his bestselling book) revolve around mindless eating. His latest research found that consuming crackers from 100 calorie packs vs. large bags, cut consumed calories by 25%.

In my Twitter discussion with Rebecca, I had noted that food diarizing protects against mindless eating by allowing for the use of calories in decision making.

Rebecca pointed out that you don't need to count calories to eat mindfully, and that there were other ways of journaling.

So who's right?

Should you intuitively eat, or should you count calories?

And looking at an even larger picture, should you do low-carb, slow-carb or low-fat? Should you include cheat days or no-cheat days? Should there be forbidden foods, or should everything go? These questions could go on and on.

The National Weight Control Registry, the world's largest prospective study of folks who have been successful with long-term weight management, keeps track of the means with which people lost prior to their registration. There's no doubt about it, those folks are good at weight management, with the average registrant having lost about 65 pounds, keeping it off for more than five years. What the Registry has taught us is that while there are some behaviours that are shared by a large majority of registrants (like eating breakfast and exercising), there is also tremendous variety in the registrants' weight management approaches.

Checking in with Amazon.com just now, I found 64,231 titles with the word, "diet" in them. And frankly, they probably all 'work.' Of course classic dieting, under-eating and over-exercising, while likely to lead you to a temporary result, is far less likely to get you into the Registry. Instead you need to actually like your life or you're very unlikely to keep living (or weighing) that way.

It's about living the healthiest life that you can enjoy, not the healthiest life that you can tolerate, because if your life is simply tolerable, you're not likely to keep living that way. To take an extreme example, while becoming a teetotaling, vegan, shut-in, marathon runner might well help you to manage your weight, is that a life you'd be willing, or even able, to live with forever?

Remember, too, that weight is a complex reflection of literally dozens of different variables. Some will indeed be within your control, while others won't. Therefore in regard to change, while I'm certain that there will be some things in your life that you can change to help manage your weight, I'm equally certain that there will be some things in your life, affecting your weight, that you either won't be able, or won't be willing, to change.

Consequently all of those numbers that come out of scales -- weight, body mass index, body-fat percentage -- none of them are particularly useful. I could use them to talk about your risk of developing weight-related medical conditions, but I don't bother, at least not in a counselling context as I don't find the fear approach to be helpful. You could use the numbers as calls to action -- to decide that you're going to do something. But what neither of us, and frankly no one should do, is use those numbers to set goals. The only goal that's fair to set is to live the healthiest life that you can enjoy.

Why?

Because there's simply no point in you trying to live a life you can't sustain. While you may not reach some table's definition of 'ideal,' is there anything other than weight in your life where you consider 'ideal' to be your goal? Why is it that every other area of your life you're rightfully proud and satisfied with your personal best? Why isn't your personal best good enough weight wise?

So what should you do? Whatever works for you. Whatever you can honestly see yourself doing for the rest of your life, and therefore the answer to the question as to whether Rebecca or I was right with our approach to dealing with mindless eating -- both of us and neither of us. The answer would all depend on the individual we were counselling.

If there were one right way, we'd all be doing it.

Dr. Yoni Freedhoff, MD is known as a "nutritional watchdog" for his advocacy efforts for improved public policies regarding nutrition and obesity. He is the founder and Medical Director of the Bariatric Medical Institute, dedicated to the (nonsurgical) treatment of overweight and obesity since 2004, and his personal website, Weighty Matters, is ranked among the world's top health blogs.

 

Follow Yoni Freedhoff M.D. on Twitter: www.twitter.com/yonifreedhoff

There is no right way to lose weight, but there are plenty of wrong ways, and what's right for one person is almost certainly wrong for another. A few weeks ago I got into a gentle and congenial Twit...
There is no right way to lose weight, but there are plenty of wrong ways, and what's right for one person is almost certainly wrong for another. A few weeks ago I got into a gentle and congenial Twit...
 
 
  • Comments
  • 22
  • Pending Comments
  • 0
  • View FAQ
Comments are closed for this entry
View All
Recency  | 
Popularity
photo
HUFFPOST SUPER USER
William Anderson LMHC
Licensed Psychotherapist, Weight Control Expert
07:40 AM on 06/09/2011
I was overweight starting at age 7 and got worse over the years listening to "experts" like your RD friend preaching intuitive eating and other diet nonsense. After 25 years of failing with the wrong approaches, I finally solved the problem when I lost 140 lbs. after discovering a unique method of behavior therapy. I've maintained my ideal body weight for over 25 years now. I'm an expert now in Behavioral Medicine, specializing in weight control, and I teach other clinicians. I'm also one of the study subjects of the NWCR, one of the people "who are really good at weight management" that you spoke of. Take it from me; you are much more in tune with the truth regarding sound and permanent weight control technique than Rebecca. It makes me angry that people insist teaching their false doctrine to unsuspecting sufferers who are then blamed because the nonsense does no good. They may think they know how to solve chronic obesity, but they don't. You are much closer to the solution. Keep up the good work.

William Anderson, LMHC
Author of 'The Anderson Method - Secrets of Permanent Weight Loss'
www.TheAndersonMethod.com
photo
ScritchfieldRD
Helping people detox from deprivation diets and ge
09:07 AM on 06/12/2011
Wow, William thanks for ripping me apart -- along with thousands of other qualified and successful experts in nutrition who use intuitive eating as a tool for healthy weight management as part of their behavior change nutrition therapy. What evidence do you have that intuitive eating is non-sense? Many of your peers in psychotherapy also embrace the approach that basically says eat when you are hungry and respect when you are physically full.

My friendly discussion with Yoni was around 100 calorie packs. Consuming 25% fewer calories from a 100 calorie pack is hardly helpful in weight control, especially considering the quality of "food" with what in in those 100 calorie packs. We then discussed various forms of journaling. You can count calories, you can journal your hunger/fullness/satisfaction (intuitive eating).

For the record, journaling in all forms is a tool. Working with the client we discuss the pros and cons of different types of journaling for them. Most people who pick up journaling will do it for a short time, but I don't have a single client who ended up journaling every day the rest of their life.
photo
HUFFPOST SUPER USER
William Anderson LMHC
Licensed Psychotherapist, Weight Control Expert
11:55 AM on 06/12/2011
Sorry about the ripping. My comments about the intuitive eating were made to express the reality that many of us have: intuitive eating is frustrating and worthless to us, and the insistence that it works is worse. We do not have the same experience as you. Some people see all colors, and some people are color blind. There was a time that full spectrum people thought color blind people were stupid or stubborn, until it was learned that color blind people do not have the same experience as others. I'm sure that intuitive eating is helpful for those that experience it as helpful. However, it is nonsense to many of us, and I have a multitude of patients who can attest to that. The insistence that it should work for everyone does not help. It is testimony that you do not understand our experience.

I am not a fan of journaling or snacking, 100 calories or otherwise. I am an advocate of planned eating, no snacking, and being aware of the calories consumed, keeping a written account until it is no longer needed.

Again, I sincerely apologize for being offensive. I needn't be that enthusiastic in being critical, a mistake. I think you might find my book enlightening, and I invite you to read it. It will give you good insights to the experience that I and many of my patients have had with obesity and its treatments.
05:00 AM on 06/09/2011
Yoni,

As always, eminently sensible and balanced.

But...

Just as the liberalism assumes autonomy (which is not always evinced in certain citizens due to duress, coercion, age etc.), so too your theory assumes that "what you can enjoy" is a choice.

Perhaps it's not.

Perhaps the hyper-palatable food industry CREATES preferences for us...in which case, what appears at first to articulate a perfectly benign maxim (i.e. 'eat what you enjoy') takes on a more sinister overtone under translation (e.g. 'eat what they MAKE you enjoy').

Of course, your broader point holds - there quite simply is no point in trying to live a life without joy. But, it still is worth noting that the presumption of free agency with regards to many consumer choices is often overly optimistic.

Cheers
photo
HUFFPOST BLOGGER
YoniFreedhoff
Obesity med. doc, blogger, author, speaker, dad.
05:31 AM on 06/09/2011
The food industry certainly doesn't make it any easier.

Experientially, dealing with hyperpalatable foods is something that well organized eating can help with. Meaning ensuring frequent, sufficiently robust meals and snacks throughout the day can help dramatically with the ability to control choices, even with hyperpalatable foods.

Best,
Yoni
09:48 PM on 06/09/2011
Hi Yoni,
Yep, for sure you can employ strategies that mitigate against the pull of addictive foods, and that's certainly better than inaction.

But,all of these mitigations are merely post hoc solutions' if (as David Kessler, Stephan Guyenet argue) our very conceptions of "enjoyable food" are being generated by consuming hyper-palatable foods.

So, while we ought to enjoy our food, we need to qualify that with the understanding that our enjoyment mechanisms are plastic - and at least in the last 30 years, have been significantly manipulated by the addictive pull of engineered hyper-palatable foods.

If we can directly address the disregulation of appetite via controlling exposure to hyper-palatable foods, the need to employ prescriptive dietary manoeuvres (e.g. regular small snacks, X amount of protein in each meal, eating X amount of minutes after rising in the morning etc.) may be entirely obviated.

The question is, what is driving the disregulation of appetite? Clearly, it's not that people are failing to follow certain prescriptive eating rules (seeing as healthy eaters across the world's cultures employ a wide variety of eating patterns)...to focus on symptomatic mitigation is to conflate treatment with etiology.

I very much appreciate and respect your work in treating obesity...I'm just trying to gently nudge you a little more towards considering the driver(s) of the problem, as I suspect that this might suggest solutions more powerful than ad hoc 'eating rules' (useful as they are).

Cheers
08:20 AM on 06/08/2011
I do appreciate the spirit of the article, but I have to say that being vegan is not difficult and it is not an extreme lifestyle. It is a choice based upon compassion and concern for the environment.

I would also point out, in good humor, that it is a little ironic that your business is called BMI and you have a BMI calculator on your site :)
photo
HUFFPOST BLOGGER
YoniFreedhoff
Obesity med. doc, blogger, author, speaker, dad.
09:04 AM on 06/08/2011
You're right!

We named our business when we opened our doors in 2004. At that time, our philosophy was a bit less refined than now.

That said, BMI is useful insofar as it can identify statistical risk.

Risks of course, are not guarantees, and there are indeed folks whose weights don't confer any medical comorbidity.

I believe our calculator points that fact out as well.

Thanks for the comment,
Yoni
This user has chosen to opt out of the Badges program
11:05 AM on 06/08/2011
It is an extreme lifestyle, so is living a completely Kosher lifestyle.
The fact that you manage just fine does not make normal in any sense of the word and you should be proud of your achievement.
Most of us don't have strong impulses towards religiosity or what you call "compassion" (which, to be frank, is an extreme definition of the word).
05:33 PM on 06/08/2011
Maxben: I agree that being vegan can be inconvenient occasionally, but most days I don't even think about it. I'm a pretty lazy guy, so if I can do it then it can't be too much of a challenge.
I also don't feel that I am anymore compassionate than the next person. I just see the cognitive dissonance of a society that values the humane treatment of animals and respect for the environment but still has a meat industry.
07:23 PM on 06/07/2011
I was liking the article until you had to basically belittle and make fun of a certain lifestyle ("To take an extreme example, while becoming a teetotaling, vegan, shut-in, marathon runner might well help you to manage your weight, is that a life you'd be willing, or even able, to live with forever?")
Pretty contradictory since you seem to endorse the "there's just not one right way".

Well guess what? I am a 36 years old woman who gets asked by my patients all the time if I'm the "med student" and I'm vegan (and have been for over 5 years) and a marathon runner. I love my life and there's no other way I would rather live it. It's very disappointing that you felt the need to belittle other people's choices.
photo
HUFFPOST BLOGGER
YoniFreedhoff
Obesity med. doc, blogger, author, speaker, dad.
07:57 PM on 06/07/2011
Actually Josee, I was holding up the teetotaling, vegan, shut-in, marathon runner as an example of an exceedingly healthy lifestyle that the majority of folks wouldn't be willing to live.

Kudos to you for living a lifestyle far healthier than most.

Best,
Yoni
photo
HUFFPOST SUPER USER
babybelle
EARTH without art is just EH
05:10 PM on 06/07/2011
I cured myself of mindless eating by ditching junk food and eating 3 meals a day
No snacks.
It works.
I weight less now than I did when I was 18 and I was 105 then.
photo
ScritchfieldRD
Helping people detox from deprivation diets and ge
09:22 AM on 06/12/2011
Good for you! I encourage my clients for 3 balanced meals a day as a minimum and snacks if you are hungry between meals or fueling a workout if you didn't have a meal 2 hours before exercise.
photo
Voltage
You can't spell Canada without "eh."
02:00 PM on 06/07/2011
I used to be a yo-you dieter, but the strings got caught in my teeth.
Nice article, Yoni.
01:34 PM on 06/07/2011
Excellent, excellent, excellent article Yoni! I will share this for sure. It is all about sustainability - it is so painful mentally and physically to yo-yo throughout your life. Dieting is like renting weight loss...much better to settle into habits you can own.
photo
HUFFPOST BLOGGER
YoniFreedhoff
Obesity med. doc, blogger, author, speaker, dad.
01:40 PM on 06/07/2011
Thanks!

If don't enjoy the life you're living when you're losing, you're just wasting your time.

Best,
Yoni
photo
ScritchfieldRD
Helping people detox from deprivation diets and ge
09:27 AM on 06/12/2011
We have all the scientific evidence that shows dieting does not work. There is an excellent book called "rethinking thin". A major issue that has not been brought up is the idea that our culture pushes us to seek thinness as a sign of health. We can be perfectly healthy and overweight, with healthy behaviors. I do trail runs with people who have an "obese" BMI and they are out there being physically active consistently. I have clients who are overweight, but they eat well and exercise often. We can't have an attachment to a specific scale weight.

I love this: own your habits :)
photo
HUFFPOST SUPER USER
Finnegans Wake
riverrun, past Eve and Adam's, from swerve of shor
05:01 PM on 06/14/2011
Liked your comment on Dr. Katz's blog, and was just checking your posts here. My experience was that when I was growing up, and all through my 20s, I was rail thin, too thin. At 6'2", 185#, I had a healthy BMI but it didn't look good on my frame. In my 30s, I added some weight and was 205# when I met my wife; by the BMI charts, I was overweight, but she says to this day that I was STILL a little thin. (I have a broad frame, and wear a 54 long sports jacket.)

With middle-aged creep, I did find that despite mostly good eating habits (perhaps due to too much wine!), I had put on a belly. So I decided to take up low-impact running (hadn't run in 25+ years!) and to watch my carb intake -- only during the week. On the weekends, all was fair. In 7 weeks I lost 17 pounds, and was up to 5 miles running and better energy. I'd still like to lose another 15 pounds or so, but I've hit the proverbial plateau. I feel great, but even if I lost that 15 pounds, I'd STILL be at the upper BMI limit of "overweight."

In short, I agree that BMI is an artificial contstruct of little value. Aside from a shrinking belly, there isn't much fat on me. Should I lose lean tissue and bone mass to have a "healthy" BMI?