Overweight people a URM in medical school?

[vatootova]

I have noticed that in my class of nearly 200 medical students, there isn't a single fat person. Maybe a small number are a bit pudgy (say getting towards a BMI over 25), but none are even close to obese (BMI>30). Considering that almost 2/3 of Americans are overweight with a BMI>25, and around 30% are obese with a BMI>30 (http://www.nature.com/oby/journal/v16/n10/full/oby2008351a.html), why is this population so underrepresented in medical school? My school for example has obese people underrepresented by around 30%... this is no coincidence. I don't think that we can generalize that all fat people are lazy a) because its a stereotype (although true in some cases) and b) there are lots of fat successful people, including doctors (but they most likely got fat after/during medical school). Is the same trend present at your school? Either it is due to the adcoms (consciously or unconsciously), the overweight people themselves, or some other confounder. Just curious of other peoples thoughts.

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[mmmcdowe]

I noted this during my interviews to. Thing is, weren't many fat applicants either.

 

[IHeartNerds]

In my class of 154, two or three people push a BMI of 25-26. Nobody comes close to what the majority of our patients look like. The reason is a mystery...

 

[lilnoelle]

Hmmm.... well, I can say for sure that not ALL schools are like that, because we have quite a few overweight individuals in my class.
Remember that for the most part, individuals in med school are young, and the majority of the overweight/obese individuals are a generation ahead of us. You also need to consider the fact that we are a health conscious group and also a well educated group.
I think my class is pretty representative of society in our age group, especially considering our level of education and level of health conciousness.
We have a few obese individuals, our share of overweight individuals (I was one of them until I lost 20 pounds about a year ago), and plenty of slim/fit individuals who are in the gym on a regular basis.

 

[devilpup]

I have noticed that in my class of nearly 200 medical students, there isn't a single fat person. .

hmmm... just give it sometime. Take a good look around shortly after taking Step I, the shunkiness will become much more evident.

 

[hardy]

I think you guys are underestimating your classmates' BMIs. My BMI is around 26 (overweight ) but I don't think anybody would ever give me that. I'm willing to bet that those people you think are around 25-26 are pushing 30 or more.

 

[ClockworkDoc]

Yep, med students tend to be in better shape, smoke less, and eat healthier than the general public. They are also have a 2-3x high likelihood of suicidal ideation.

You win some, you lose some.

 

[WellWornLad]

I think you guys are underestimating your classmates' BMIs. My BMI is around 26 (overweight ) but I don't think anybody would ever give me that. I'm willing to bet that those people you think are around 25-26 are pushing 30 or more.

Agreed. If you do any weightlifting, you're probably "overweight" according to the BMI. I'm 190 and 6', with a waist circumference of 32", and technically I'm overweight (~26).

When I was interviewing one of my 4th year tour guides was maybe 5'8" and at least 300 pounds. Probably closer to 400, but definitely over 300. Seemed like a nice enough guy, gave a good tour at least. I can't imagine what kind of crap he had to put up with during rotations. Definitely an anomaly, though.

 

[DocVirk]

I think you guys are underestimating your classmates' BMIs. My BMI is around 26 (overweight ) but I don't think anybody would ever give me that. I'm willing to bet that those people you think are around 25-26 are pushing 30 or more.

I totally agree with this. We had a professor once tell us, "If you think someone is normal size, they're probably overweight, and if you think someone is overweight they're probably obese." My BMI is like 25-26 and no one would ever guess that. My wife's is 20 (perfectly normal) and every person she meets comments that she's too skinny.

That being said, I agree with the OP. I think it probably has a lot to do with socio-economic status and education. Medical students are typically at the high end of both, and that weighs heavily in their favor for not being obese.

 

[GeraldMonroe]

They are also have a 2-3x high likelihood of suicidal ideation.

When does this start? From day 1 of med school, or during stressful clinical rotations when they might witness a patient die?

 

[Droopy Snoopy]

When does this start? From day 1 of med school, or during stressful clinical rotations when they might witness a patient die?

I don't know, but I'd like to see some evidence to support that statement.

 

[scube]

When does this start? From day 1 of med school, or during stressful clinical rotations when they might witness a patient die?

It really depends on who you compare them too. general public age control, i would believe it. age control and SES control maybe. I bet if there was a study the risk wouldn't start day one but a few months in. Stress has an uncanny way of uncovering psychosis/depression.

 

[scube]

I don't know, but I'd like to see some evidence to support that statement.

I would like to see this information as well.

 

[brucecanbeatyou]

Under Represented means that there are not enough represented. That is not the case with fat people in medical school. Any fat person in medical school is an over represented minority.

 

[masterofmonkeys]

The whole concept of URM is silly. Of course, i'm a member of an ORM so it makes sense I'd say that.

i concur with what someone else said about understimation of peoples' BMI.

Also, the BMI is a stupid piece of worthless crap. I realize its not practicable to DEXA scan everyone to determine body composition, but there are decent alternatives, such as a simple abdominal circumference measurement, or if you want to actually spend two minutes, a 7-site skinfold.

But ultimately, who the hell gives a damn.

It's true that not all fat people are lazy, and that many of them do try quite hard to lose weight. But often the strategies they use are counterproductive or just plain inefficient.

Granted, with our lack of focus on the science of nutrition and exercise, it's no surprise that we (the medical profession) haven't done much to develop efficient diet and exercise interventions.

The real question should be, why don't medical schools place a focus on the science of exercise and nutrition?

 

[bleeker10]

I think in 5-10 years you will see more and more students in med school who are obese. I remember in junior high and high school there weren't many obese kids but it seems like a significant number of kids in the 5-15 age range are very obese. Just look at all the commercials telling kids to go out and play for an hour a day. They never had those when I was a kid, but I was always outside playing anyways and so were my friends.

 

[WellWornLad]

I don't know, but I'd like to see some evidence to support that statement.

[FONT=verdana,arial,helvetica,sans-serif][SIZE=-1][FONT=arial, verdana, helvetica, sans-serif]Burnout and Suicidal Ideation among U.S. Medical Students (2008)
.[/SIZE].

http://www.annals.org/cgi/content/abstract/149/5/334

According to this paper, suicidal ideation among medical students (within the past 12 months) is about 1.6x that of the general population (11.2% vs 6.9%).

They reference other (generally smaller) studies with suicide ideation rates of 3-20%, however.

When does this start? From day 1 of med school, or during stressful clinical rotations when they might witness a patient die?

In one study at a single "midwestern" medical school (http://www.ncbi.nlm.nih.gov/pubmed/3172426), the rate of suicidal ideation was consistently between 15-20% for students from post-first year until graduation, while depression peaked at the end of second year.

See what happens when you don't go to the beach?

 

[turkeyjerky]

Like others have said, you need to account for the relative youth and SES of the medical student population, as well as warped perceptions about appearance and BMI. Off the top of my head, I'd say that 60% of my class is of normal weight, 30% are overweight, and 10% are obese.

Anybody know of any studies that have tracked changes in student BMI's over the 4 years of med school? That'd be kind of interesting to see.

 

[bones11]

Granted, with our lack of focus on the science of nutrition and exercise, it's no surprise that we (the medical profession) haven't done much to develop efficient diet and exercise interventions.

The real question should be, why don't medical schools place a focus on the science of exercise and nutrition?

First of all, I should say that I am passionate about nutrition and excercise education, and would like to see physicians take a stronger hand in emphasizing this (although I think we're already doing a much better job, my school at least emphasizes it pretty well).

But I get annoyed (not with you per se) with the chorus of people criticizing western medicine for not doing enough on nutrition/prevention etc. Look at the leading causes of death in 1900, and it's obvious the only reason people can whine is that the physicians and scientists of the last hundred years triumphed so thoroughly over what used to kill everybody.

The leading cause of death in this country today is poor decision making. Education is great and all, but at the end of the day if people want to eat/lounge/smoke themselves to death, that's what they're going to do.

 

[RySerr21]

The leading cause of death in this country today is poor decision making. Education is great and all, but at the end of the day if people want to eat/lounge/smoke themselves to death, that's what they're going to do.

this is true, but for the most part people have no idea wtf they are doing to their body's. Thats a pretty big problem. Part of the problem is the wealth of **** information that is out there on the tv ads, computers, bogus books about new weight loss techniques, etc.

 

[Tiger26]

Agreed. If you do any weightlifting, you're probably "overweight" according to the BMI. I'm 190 and 6', with a waist circumference of 32", and technically I'm overweight (~26).

When I was interviewing one of my 4th year tour guides was maybe 5'8" and at least 300 pounds. Probably closer to 400, but definitely over 300. Seemed like a nice enough guy, gave a good tour at least. I can't imagine what kind of crap he had to put up with during rotations. Definitely an anomaly, though.

agreed--my bmi is about 30, but i'm 6' 210lbs with a 32" waist and who can rattle off 25 pull-ups without breaking a sweat--in my opinion bmi works for most in the bell curve, but really fails to consider any outliers

 

[rabidpanda13]

.

 

[Nanon]

this is true, but for the most part people have no idea wtf they are doing to their body's. Thats a pretty big problem. Part of the problem is the wealth of **** information that is out there on the tv ads, computers, bogus books about new weight loss techniques, etc.

Agreed. Having worked in harm reduction most of my career, and watched it work, I really believe that most people are:

a) overwhelmed by the amount of information they get on how to take better care of themselves,
b) overwhelmed by the perception that they would have to change everything all at once to have any effect on their health,
c) overwhelmed by guilt and shame when they fail, which they will, over and over again.

In my experience, when you give people concrete, short-term and/or easy goals, they are more likely to succeed.

 

[masterofmonkeys]

But I get annoyed (not with you per se) with the chorus of people criticizing western medicine for not doing enough on nutrition/prevention etc. Look at the leading causes of death in 1900, and it's obvious the only reason people can whine is that the physicians and scientists of the last hundred years triumphed so thoroughly over what used to kill everybody.

Lol I'd never thought of it that way. Hilarious, but true point.[/quote]

The leading cause of death in this country today is poor decision making. Education is great and all, but at the end of the day if people want to eat/lounge/smoke themselves to death, that's what they're going to do.

You'll brook no argument from me there. Indeed one of my big problems with the thrust of obesity research is that we're wasting millions of dollars looking at the genetics and endocrine aspects of obesity while ignoring that this is a fundamentally a problem of what we do to our bodies not what's happening inside of them.

Agreed. Having worked in harm reduction most of my career, and watched it work, I really believe that most people are:

a) overwhelmed by the amount of information they get on how to take better care of themselves,
b) overwhelmed by the perception that they would have to change everything all at once to have any effect on their health,
c) overwhelmed by guilt and shame when they fail, which they will, over and over again.

In my experience, when you give people concrete, short-term and/or easy goals, they are more likely to succeed.

More great points. I'll take it one step further. When you bust your butt and don't see great results, its hard to keep trying.

I think one of the biggest things we can gain from being educated in exercise science and nutrition is a better understanding of how to promote time and effort efficient ways of exercise. Fundamentally losing weight isn't hard. Exercise more. Eat less.

But if you exercise too much, or eat too little, you can shoot your efforts in the butt. It's called homeostasis. If your body goes into stress-starvation mode, it's not going to want to lose weight.

And all exercise isn't created equal. We all know that a combination of resistance and aerobic workout is best. But what form of aerobic exercise? How do you program your resistance training? How do you achieve the most in the smallest amount of time? Hint: it's not steady-state cardio and a machine circuit.

I read a recent study in Archives of Internal Medicine that looked at aerobic and resistance exercise in older adults. Methodologically it was a great study, and I really appreciated the fact that they directly measured vo2 max and insulin resistance. But the chosen interventions themselves were crap. It was a bit like randomizing people to 2.5mg simvastatin versus 100mg of n-3 fatty acids. Umm? who cares?

The aerobic intervention was steady-state treadmill jogging. The resistance training was an odd selection of exercises that didn't do a great job of targeting the most amount of muscle possible (leg curls lol). And the regimen was one set of each to failure.

Exercise scientists have known for about 20 years now that steady-state aerobic exercise isn't time or energy efficient. Interval training gets better results with less time. And its very easily done on stairclimbers (my preferred cardio method for non-swimmers), ellipticals (next), and bikes (if they can't tolerate other forms of exercise as well). And there can be negative consequences to steady-state cardio if done too much. Elevations in cortisol, an actual increased propensity for fat deposition, and an increase in appetite drive.

And as for the weight-lifting routine? That's classic High Intensity Training, of which the bodybuilder Mike Mentzer was probably the foremost proponent. A training philosophy that increases muscle SIZE, but not necessarily strength or BMR (which comes from increasing the myofibrillar component of muscle tissue...not the sarcoplasmic component as HIT does).

The fact that physicians understand exercise so little that these things can pass the review process is fairly shameful IMO. More dismaying to me, is that I put a fair amount of stock in that old saying that a fool thinks he knows everything and a wise man knows he knows nothing, or as the Tao says, you must empty the bowl to be able to fill it. I feel a palpable attitude amongst most physicians that their ignorance in the matters of exercise and nutrition just isn't that important. After all, you just have to eat less, and workout more. You don't see too many docs around that are similarly dismissive of the intricacies of HTN or DM2 pharmacotherapy.


If you coudl tell your patients 'hey if you do 15-20 minutes of intervals, you can burn as many or more calories as an hour just jogging' don't you think they'd be more likely to exercise? And if you could give them a simple 4-5 exercise 3-4 sets of 6-8 reps weightlifting plan that manages to hit almost every major muscle group and can be done inside of 30 minutes while yielding relatively rapid results don't you think they'd be more likely to engage in it?

I see a lot of overweight and obese people working VERY hard at my gym. But they're working out stupidly and not getting results. I also see a lot of overweight and obese people who DON't exercise looking at them and say 'why bother spending 5-10hrs a week in the gym if i'm only going to lose a pound or two a month? At that rate I'll be 70 before I've gotten rid of this belly/love handles/thunder thighs/badonkadonk.

Like Uncle Scrooge of Ducktales fame says 'work smarter, not harder'. We should be doing everythign in our power to develop optimal methods of exercise and nutrition. Which we currently don't.

 

[ChubbyChaser]

Yep, med students tend to be in better shape, smoke less, and eat healthier than the general public. quote]
Do they Drink more though?

 

[BoneNibbler]

Yep, med students tend to be in better shape, smoke less, and eat healthier than the general public. quote]
Do they Drink more though?[/quote]


I do not think they drink more.....because with a test every 4 weeks or so they cant be hung over every weekend like the normal populus.

BTW , your avatar made me have emesis a bit in my mouth

How do you guys deal with disgusting fat people as patients?

 

[Mr hawkings]

Yep, med students tend to be in better shape, smoke less, and eat healthier than the general public. quote]
Do they Drink more though?[/quote]


I do not think they drink more.....because with a test every 4 weeks or so they cant be hung over every weekend like the normal populus.

BTW , your avatar made me have emesis a bit in my mouth

How do you guys deal with disgusting fat people as patients?

JEEZ

 

[mjl1717]

Yep, med students tend to be in better shape, smoke less, and eat healthier than the general public. They are also have a 2-3x high likelihood of suicidal ideation.

You win some, you lose some.

Geez, I would not think that this info would come across as a complete shock, especially to the medical community!

Not that i would commit suicide but in med school I had an idea why someone would commit suicide.

 

[AmoryBlaine]

The whole concept of URM is silly. Of course, i'm a member of an ORM so it makes sense I'd say that.

i concur with what someone else said about understimation of peoples' BMI.

Also, the BMI is a stupid piece of worthless crap. I realize its not practicable to DEXA scan everyone to determine body composition, but there are decent alternatives, such as a simple abdominal circumference measurement, or if you want to actually spend two minutes, a 7-site skinfold.

But ultimately, who the hell gives a damn.

It's true that not all fat people are lazy, and that many of them do try quite hard to lose weight. But often the strategies they use are counterproductive or just plain inefficient.

Granted, with our lack of focus on the science of nutrition and exercise, it's no surprise that we (the medical profession) haven't done much to develop efficient diet and exercise interventions.

The real question should be, why don't medical schools place a focus on the science of exercise and nutrition?

There's no evidence for this. The BMI performs well as an estimate for all but the most muscular people.

If you go into primary care BMI will work just fine for 99% of your patients. We disparage it party because we have so severely adjusted our collective mindset for overweight that we think "that person CAN'T be overweight."

 

[nogolfinsnow]

hmmm... just give it sometime. Take a good look around shortly after taking Step I, the shunkiness will become much more evident.

Totally agree here. Several classmates of mine who were probably around normal or pushing a 25 BMI on day one have clearly put on weight. If you don't come to school w/ some sort of exercise regimen you'll have a tough time developing one once you're there. So while our class definitely doesn't mirror the population in general (maybe only a couple with BMI 30+) there are many who could stand for some more exercise and less cafeteria food.

 

[dilated]

We have one or two girls pushing obese, but no really fat guys in my class.

Three of the four male PA students in the hospital with me on a previous rotation were obese, one morbidly so (his white coat had clearly been let out in the back to accommodate his .. er .. girth). I was joking with a friend that they got rejected from medical school because of the no chubs policy, but there might be a bit of truth in it. I think there's a screening process at the interviews where they (consciously or not) assess whether people will look suitably "doctorly", even if objectively qualified.

 

[masterofmonkeys]

There's no evidence for this. The BMI performs well as an estimate for all but the most muscular people.

If you go into primary care BMI will work just fine for 99% of your patients. We disparage it party because we have so severely adjusted our collective mindset for overweight that we think "that person CAN'T be overweight."

Oh there's plenty of evidence for BMI being crap. I think it discounts the importance of adequate lean body mass and lulls people with 'normal' BMIs into a sense of indifference. Let's start with what the BMI is. It's a measure of weight and height. That's it. Now do heavier people tend to be fatter? Sure. But is this a causal relationship? Hardly.

Now, does it tend to work across the population? Fairly well. Again because heavier people tend to be fatter.

Does it work at an individual level? Not as well as at a population level.

How bad is it exactly?

http://www.sciencedaily.com/releases/2008/03/080327172025.htm

Over half of the population said to be 'normal BMI' had unhealthy levels of bodyfat. OVER HALF. That's not 99%. In fact, BMI was found to better correlate to lean body mass than bf% in men in this study (which is a result that has been found before).

What we are concerned with is bodyfat. Does BMI measure bodyfat in any meaningful way? No. Does it proxy bodyfat very well? I'd call a false negative rate of over 50% to be pretty bad.

Clinically, this just isn't good. To my knowledge there have been no studies done on the proportion of 'overweight' and 'obese' people as categorized by BMI with normal levels of body fat. It won't be as high as 50%, but in the overweight population I figure it's a substantial minority--especially in men. Anecdotally I can tell you it's hilarious that I, with a 32" waist and a BMI around 29 get counselled about my bodyweight on a regular basis, but people with 'normal range' BMIs who ACTUALLY DO HAVE significant abdominal and subcutaneous fat do not.

Scientifically, it may be even worse. When so much of the 'normal' BMI population has unhealthy levels of bodyfat, we may be significantly underestimating the threat of adiposity to our health.

And it also hurts us in that the BMI cannot give us a proxy of lean body mass as differentiated from body fat (BMI is positively correlated with both). Given that studies looking specifically at lean body mass have found risk reductions in everything from MSK, to cardiovascular, to cancer, to dementia, I'd say that's pretty harmful.

Many studies have found that the 'overweight' group might actually have lower risks of certain major medical problems than the 'normal weight' group. Could it be that some body fat is protective? Or could it be that the overweight group may differ from the normal weight group more in lean body mass than in body fat percentage? Who the heck knows? Using the BMI certainly can't shed any light on this. In the study I cited above, they even found that the BMI was an indeterminate measurement in this group.

At a clinical level, the BMI is no better than the eyeball, if even that. I can certainly eyeball 'normal weight obesity' with a fair amount of ease. The BMI can't.

At a scientific level, its woefully inadequate. It can pretty much tell us that being fat is bad, but can't tell us how bad. It also can't tell us how good lean body mass is.

There's more than one consequence of poor dietary habits and lack of exercise. Adiposity is certainly one of them. Loss of skeletal muscle is another though.

 

[BoneNibbler]

In my med school class we have a couple of chubs (all women) the one obese guy failed last year and has to repeat. But there is one obese girl (BMI 40) who is in our class and fat. But the funny thing is when in a group discussion in lecture with the professor she says " I do not understand how people can be so fat, i mean just stop eating"....everyone went quiet...

 

[Jolie South]

I understand the limitations of BMI, but really what other easy, cheap method do we have to use as a proxy measure for body mass? I think most of us can eyeball a body builder and an obese person with a BMI of 30 and see a difference and understand that we don't need to be worried about the athlete.

It seems like it's probably more useful for tracking progress in weight loss in those folks that have an unhealthy 30 BMI, at least that's how it was presented in our lectures.

 

[GeraldMonroe]

Is there a correlation between fat mass/BMI and mental energy/thinking speed? I ask because the MCAT seems like a test of thinking speed as much as it is a test of knowledge, and med school workloads are so heavy that I would imagine someone with more energy might do better.

For instance, among a group of med students I know, the fat one was the guy getting the Cs and failing exams. Probably just anechdotal, but...

 

[mercaptovizadeh]

Is there a correlation between fat mass/BMI and mental energy/thinking speed? I ask because the MCAT seems like a test of thinking speed as much as it is a test of knowledge, and med school workloads are so heavy that I would imagine someone with more energy might do better.

For instance, among a group of med students I know, the fat one was the guy getting the Cs and failing exams. Probably just anechdotal, but...

Man, it's scary how people think. Didn't it occur to you that people who are disciplined enough to have a regular exercise regimen and watch what they eat are also more likely to be organized in their study habits and thus do better?

 

[Van Chowder]

Man, it's scary how people think. Didn't it occur to you that people who are disciplined enough to have a regular exercise regimen and watch what they eat are also more likely to be organized in their study habits and thus do better?

Agreed.. In other words, self discipline, is self discipline, regardless of where it is applied..

 

[masterofmonkeys]

I understand the limitations of BMI, but really what other easy, cheap method do we have to use as a proxy measure for body mass? I think most of us can eyeball a body builder and an obese person with a BMI of 30 and see a difference and understand that we don't need to be worried about the athlete.

No I mean that the eyeball is probably more accurate than the BMI across all weight classes, not just the 'obese'.

So the BMI is easy, cheap, and fast. But it has a false negative rate in the 'normal range' population of darn near 50%, completely fails to tell us anything about body fat content in 'overweight' category, but works for the 'obese' category, simply because of statistical likelihood. In addition, in men, the positive correlation between BMI and lean body mass is greater than the correlation between BMI and fat. LBM is a good thing, btw.

It's easy, cheap, and fast but basically useless. You're right, we should keep using it.

It seems like it's probably more useful for tracking progress in weight loss in those folks that have an unhealthy 30 BMI, at least that's how it was presented in our lectures.

Why would you need to look at their BMI if you're tracking their weight loss progress? How dramatically are we expecting their height to change? more importantly, how do we know they aren't losing LBM as well (an unfortunate consequence of starvation diets and cardio addiction)?

Here are some more sensible alternatives:

Some combination of height/weight/abdominal girth is also stupid fast to do. It's not perfect but I guarantee you it's better than the BMI. Less than a minute. Free.

Waist/hip ratio controlling for weight (in women) would be another great stupid fast one that actually tells you something. Less than a minute. Free.

Biolectrical impedance is also pretty good, except in the very heavy (where it underestimates bf%). But then again, these people are heavy enough that the monitor still would show an 'unhealthy' level of bodyfat. 15 seconds. One-time cost of purchasing a tanita monitor for your practice...not exactly bank-breaking.

7-site skinfold. Depending on who you talk to, a little better than Bioelectrical impedance. But can underestimate central adiposity. A couple minutes plus training. Typical rates for someone who walks off the street into the gym to get it checked range from 5-15 dollars.

DEXA. Gold standard. Somewhat costly and impractical. Meh.

Optical scanning. Similar to DEXA. Also somewhat costly and impractical.

That's three fast, cheap and easy methods right there that actually measure variables directly and causally related to bf% and lean body mass, with very good sensitivity and specificity for fat mass and health risks. And a couple more that are more sensitive if we need them.

 

[Nanon]

I have issues with most of the free, easy measurements, but this one in particular bugs me:

Waist/hip ratio controlling for weight (in women) would be another great stupid fast one that actually tells you something. Less than a minute. Free.

It completely discounts diversity in body shape - adipose tissue distribution not withstanding. For instance, my hip/waist ratio is about .80, no matter what I weigh, even at my bmi extremes of 28 and 19. I look like a boy, but there's really nothing I can do about that.

I lost 50 lbs. after my last pregnancy, and I did it by restricting my calories to 1500 - 1800 a day, 6 days a week, and increasing my overall activity by about 1.5 hours a day. I never joined a gym, I just did a lot more housework. (Easy to do with an infant, btw). I made it as simple and cheap and low-stakes as I could, and it worked. Just saying.

 

[mjl1717]

Man, it's scary how people think. Didn't it occur to you that people who are disciplined enough to have a regular exercise regimen and watch what they eat are also more likely to be organized in their study habits and thus do better?

Yes Im a little amazed too.. The guys are actually making "REVELATIONS" out of this..

 

[Jolie South]

No I mean that the eyeball is probably more accurate than the BMI across all weight classes, not just the 'obese'.

So the BMI is easy, cheap, and fast. But it has a false negative rate in the 'normal range' population of darn near 50%, completely fails to tell us anything about body fat content in 'overweight' category, but works for the 'obese' category, simply because of statistical likelihood. In addition, in men, the positive correlation between BMI and lean body mass is greater than the correlation between BMI and fat. LBM is a good thing, btw.

It's easy, cheap, and fast but basically useless. You're right, we should keep using it.



Why would you need to look at their BMI if you're tracking their weight loss progress? How dramatically are we expecting their height to change? more importantly, how do we know they aren't losing LBM as well (an unfortunate consequence of starvation diets and cardio addiction)?

Here are some more sensible alternatives:

Some combination of height/weight/abdominal girth is also stupid fast to do. It's not perfect but I guarantee you it's better than the BMI. Less than a minute. Free.

Waist/hip ratio controlling for weight (in women) would be another great stupid fast one that actually tells you something. Less than a minute. Free.

Biolectrical impedance is also pretty good, except in the very heavy (where it underestimates bf%). But then again, these people are heavy enough that the monitor still would show an 'unhealthy' level of bodyfat. 15 seconds. One-time cost of purchasing a tanita monitor for your practice...not exactly bank-breaking.

7-site skinfold. Depending on who you talk to, a little better than Bioelectrical impedance. But can underestimate central adiposity. A couple minutes plus training. Typical rates for someone who walks off the street into the gym to get it checked range from 5-15 dollars.

DEXA. Gold standard. Somewhat costly and impractical. Meh.

Optical scanning. Similar to DEXA. Also somewhat costly and impractical.

That's three fast, cheap and easy methods right there that actually measure variables directly and causally related to bf% and lean body mass, with very good sensitivity and specificity for fat mass and health risks. And a couple more that are more sensitive if we need them.

No need to get argumentative. I must admit that I never really did any research on that outside of class. Optical scans/caliper type measurements were presented as the alternatives.

If there is all this evidence against BMI measurements, then why are we still using them when there are cheap, easy alternatives? Why is BMI so entrenched? It doesn't seem like its shortcomings are new discoveries.

 

[engineeredout]

Man I can't believe I used to have a BMI of 31.4 (5'11", 225lbs, 38" waist), and believe me that wasn't due to my bodybuilding physique. I dropped 50lbs, mostly through running, and now I float the line between normal/overweight (24-25).

Losing weight wasn't easy until it started working. At the beginning nothing was happening and I really had to force myself to keep going. All of a sudden however it was like my metabolism finally turned on, and the weight started melting off.

Kept it off for 2.5 years thus far, and working out has become a routine in my life. I go to the gym 4-5 days per week and lift weights in addition to running now. When I don't go I feel off and guilty as hell. Last time I had a cold I had to break from working out, but despite knowing there was nothing I could do and that trying to work out while sick would not be helpful at all, I still felt guilty.

Only hope I can keep it up in med school.

 

[nogolfinsnow]

Man I can't believe I used to have a BMI of 31.4 (5'11", 225lbs, 38" waist), and believe me that wasn't due to my bodybuilding physique. I dropped 50lbs, mostly through running, and now I float the line between normal/overweight (24-25).

Losing weight wasn't easy until it started working. At the beginning nothing was happening and I really had to force myself to keep going. All of a sudden however it was like my metabolism finally turned on, and the weight started melting off.

Kept it off for 2.5 years thus far, and working out has become a routine in my life. I go to the gym 4-5 days per week and lift weights in addition to running now. When I don't go I feel off and guilty as hell. Last time I had a cold I had to break from working out, but despite knowing there was nothing I could do and that trying to work out while sick would not be helpful at all, I still felt guilty.

Only hope I can keep it up in med school.

Good for you. And you definitely can keep it up in medical school. Just make it a priority and build it into your schedule. If you're good with time management, then getting to the gym 4-5x/week in years 1 and 2 is extremely doable and is an awesome way to de-stress. My classmates who don't work out always look like they're about to explode from stress.

I can't speak to year 3 yet but I suspect it's still doable with some alterations in workout lengths.

 

[Droopy Snoopy]

No need to get argumentative. I must admit that I never really did any research on that outside of class. Optical scans/caliper type measurements were presented as the alternatives.

If there is all this evidence against BMI measurements, then why are we still using them when there are cheap, easy alternatives? Why is BMI so entrenched? It doesn't seem like its shortcomings are new discoveries.

Just FYI this guy has been around the boards awhile and, while making good contributions in the way of EBM, has a tendency to go from passive-aggressive to downright childish very quickly.

I look at it as yeah BMI isn't perfect but neither are the alternatives. There's no freakin' way practicing physicians have the time or manpower to do anything other than look first at the number the tech has jotted down on the chart and then at the patient. Less than a minute nothing, it takes less than a second. The reason BMI is commonplace is because it's objective, practical, chartable, trackable over time. And in the world of the PCP there's really no reason to delve any further because it's simply another rough indicator, one of many useful tools in evaluating a person's overall health.

Which is also what EBM should be for clinical decision-making.

 

[Mr hawkings]

Just FYI this guy has been around the boards awhile and, while making good contributions in the way of EBM, has a tendency to go from passive-aggressive to downright childish very quickly.

I look at it as yeah BMI isn't perfect but neither are the alternatives. There's no freakin' way practicing physicians have the time or manpower to do anything other than look first at the number the tech has jotted down on the chart and then at the patient. Less than a minute nothing, it takes less than a second. The reason BMI is commonplace is because it's objective, practical, chartable, trackable over time. And in the world of the PCP there's really no reason to delve any further because it's simply another rough indicator, one of many useful tools in evaluating a person's overall health.

Which is also what EBM should be for clinical decision-making.

Agreed

I think this is the point where the physician could make a subjective assesment as to how seriously to take the BMI/other measurement.
I remmember a few years ago when i saw a physician for minor chest pain, my BMI was around 27-28. later when i got a copy of my records, i saw that the doctor made a note in the chart that " the patient appears muscular and in good physical condition".
I think this probably played a role in determining wether or not to order tests beyond the standard EKG. I'm sure if my appearance had been different, i would probably have had to do a some unnecesary tests.

Now that i am considerably more flabby, the same chest pain (at the same BMI) would probably warrant a closer look.

 

[deleted202457]

We have one or two girls pushing obese, but no really fat guys in my class.

Three of the four male PA students in the hospital with me on a previous rotation were obese, one morbidly so (his white coat had clearly been let out in the back to accommodate his .. er .. girth). I was joking with a friend that they got rejected from medical school because of the no chubs policy, but there might be a bit of truth in it. I think there's a screening process at the interviews where they (consciously or not) assess whether people will look suitably "doctorly", even if objectively qualified.

I've always heard of the no Chubs policy. And it makes sense. Not just because no one will listen to a fat dr that says to lose weight or watch their cholesterol, but also because individuals that are in shape are better adept in dealing with the stresses of med school and residency because their bodies can adapt to heavy stress easier than their heavier counterparts. Just my thoughts

 

[brucecanbeatyou]

I've always heard of the no Chubs policy. And it makes sense. Not just because no one will listen to a fat dr that says to lose weight or watch their cholesterol, but also because individuals that are in shape are better adept in dealing with the stresses of med school and residency because their bodies can adapt to heavy stress easier than their heavier counterparts. Just my thoughts

If I were on an admissions committee, I would ask fat candidates, "which aspect of your own health to you value most?"

 

[brucecanbeatyou]

Man I can't believe I used to have a BMI of 31.4 (5'11", 225lbs, 38" waist), and believe me that wasn't due to my bodybuilding physique. I dropped 50lbs, mostly through running, and now I float the line between normal/overweight (24-25).

Losing weight wasn't easy until it started working. At the beginning nothing was happening and I really had to force myself to keep going. All of a sudden however it was like my metabolism finally turned on, and the weight started melting off.

Kept it off for 2.5 years thus far, and working out has become a routine in my life. I go to the gym 4-5 days per week and lift weights in addition to running now. When I don't go I feel off and guilty as hell. Last time I had a cold I had to break from working out, but despite knowing there was nothing I could do and that trying to work out while sick would not be helpful at all, I still felt guilty.

Only hope I can keep it up in med school.

 

[nu2004]

Re: BMI

Let's please note that NO single value is a "gold standard" for evaluating health. BMI works pretty well despite being an imperfect measurement, and we can certainly hope that our peers in medicine will not be developing management plans based on that measure alone -- even dietitians are far more advanced than that. What we should all be AGREEING on is that BMI is only a small part of an individual's overall picture of health.

PS - great long post masterofmonkeys

 

[45408]

agreed--my bmi is about 30, but i'm 6' 210lbs with a 32" waist and who can rattle off 25 pull-ups without breaking a sweat--in my opinion bmi works for most in the bell curve, but really fails to consider any outliers

that must be under your pannus, good sir!