Is BMI the Gold Standard?
Q: The articles I read on body mass index (BMI) focus on body weights per height for people who, I assume, do not work out or have unusually active metabolisms.
I work out at the gym at least five times a week, about ten hours. I am 51 years old and weigh approximately 183 pounds. I am 5 feet 9 inches tall and am fairly muscular. According to the BMI scale, I am overweight. Since muscle weighs more than fat or nonmuscular mass, how do active people use these indexes?
Is there another index to use if we can’t use the BMI, or does it matter?
Michael K. Kurtis
Suffern, New York
A: As you have surmised, the BMI values are not applicable to all people. If you are well-muscled, then the BMI is inappropriate.
A good measurement of body fatness is a test with skin-fold calipers or underwater weighing, both of which can be done at an area university’s exercise science department. These tests estimate the percentage of your total body weight that is fat. Meaningful normative data are available.
A second test that you can easily do at home is to measure your waist circumference. Using the widest part of your midsection and without holding your breath or sucking the tummy in, measure your girth.
The waist circumference should be no larger than 40 inches in a male regardless of body weight. Values above this number indicate excess visceral or abdominal obesity, which is well correlated with type 2 diabetes, hypertension, cardiovascular disease and dyslipidemia.
At 5 feet 9 inches and 183 pounds and being physically active and well-muscled, you sound just fine. However, a definitive test such as the underwater weighing may be helpful. It is the most accurate assessment of body fatness and shouldn’t be very expensive.
Kris Berg, EdD
Professor and Director of the Exercise Physiology Lab
University of Nebraska
My Daughter Has Diabetes and Wants to Pierce Her Nose. What Should I Do?
Q: My daughter, who is 15, has had diabetes for six years. She wears an insulin pump, and her A1C runs in the 8.4% to 8.6% range. She would like to get her nose pierced with a stud, and I am having a hard time with the concept—especially with her diabetes. I know that healing is slower, and with her A1C as high as it is, I’m afraid of infection.
Do you have any information I could bring to her attention?
Palm Beach Gardens, Florida
A: As the parent of a teenager myself, I can appreciate your reservations.
In my clinical experience, I have not seen teenagers with A1C levels in this range have a significantly increased problem with infections and healing. However, it occurred to me that this could be a good opportunity to encourage your daughter to improve her diabetes control.
Perhaps you would be more receptive to her idea of a nose piercing if your daughter could demonstrate the ability to maintain improved diabetes control. For example, you might feel more comfortable with the piercing if she could lower her A1C a full point to 7.4%.
As your daughter is utilizing an insulin pump, she likely has a diabetes educator and nutritionist available with whom she could work to improve her diabetes care. She should be able to significantly improve her diabetes control without excess or severe hypoglycemia if she is using an insulin pump.
If you are okay with the piercing from other perspectives, my suggestion would be that you and your daughter use this opportunity to develop a plan with your diabetes educator to help your daughter improve her diabetes control before she gets her nose pierced.
Denise Richards, MSN, FNP, CDE
Massachusetts General Hospital for Children
Diabetes and Endocrinology Division