While no one is fond of stepping on a scale, the annual weigh-in is one of the simplest ways health care providers can evaluate risk of chronic disease that can be easily tracked over time. Without any blood drawn, BMI may tell a lot about a person’s potential health risks. Body Mass Index (BMI) measures a person’s height to weight ratio and the higher it is, the more likely a person may develop health problems including diabetes, hypertension, heart disease, arthritis or other medical issues. 1
A normal BMI is between 18.5 and just under 25. A low BMI (below 18.5) is considered underweight and may be suggestive of malnutrition, while a BMI between 25 and 29.9 indicates that a person is overweight. An individual is considered obese once that number climbs to 30 or higher. BMI does not measure body composition, so theoretically, a very muscular person with a BMI over 30 would be placed in the obese category. However, most adults are not elite athletes. As of 2016, nearly 39% of US adults were considered obese and 31% of the US population is considered overweight. 2 It is no wonder there is a rise in diabetes in this country.
Weight gain is a complicated problem. Risk factors for overweight and obesity include age, heredity, race, ethnicity and sex, which unfortunately, are not controllable. According to the CDC in 2016, 47% of Hispanics and 46.8% of non-Hispanic blacks had the highest age-adjusted prevalence of obesity with non-Hispanic whites at 37.9% and non-Hispanic Asians at 12.7%. Education also seems to be a factor. College educated men and women have lower rates of obesity than those with less education. Income may also impact weight, though variations are seen amongst lower and higher incomes compared to middle class. Lower and higher incomes tend to experience less obesity than middle class in non-Hispanic black men. 2
Certain medications such as steroids, anti-anxiety, anti-psychotic or anti-depressants may be responsible for weight gain. Diabetic medications including insulin and sulfonylureas have also been associated with unwanted pounds. 3 Medical conditions such as arthritis or MS, which impact movement may also lead to weight gain. And finally, the abundance of highly processed, high calorie food cannot be ignored in having an effect on the rising numbers on the scale. Thankfully, lifestyle changes can prevent and control weight gain, which seems to be inevitable for most adults over time.
It’s been said that you “cannot outrun a bad diet” and most nutrition experts advise people trying to lose weight to adopt a lower calorie diet for weight control. But it’s not always that simple. People often “stuff” their emotions down with high calorie comfort food like dessert, chips or fast food. They eat due to boredom, anxiety, stress, fatigue and sadness. Or, like many chronic dieters, they fall into a pattern of eating too little, then overeating later. 4
So, where to start when a person arrives with a higher BMI than desired? For starters, look at their whole lifestyle, not just diet. Are they eating enough, or starving then binge eating later? Are they active or sedentary? How do they handle stress? Do they obtain adequate sleep? Are they snacking too often? These are all factors that may impact their weight. Reassure your patient that they don’t need to get down to a “normal” BMI. A drop in BMI of 2-3 points can still improve the person’s health risks. This is equivalent to a 10% weight loss in an overweight or obese individual. 5 Setting realistic goals may help your client reach an acceptable weight. Normal weight loss is only .5-1 lb per week.
Clients may be tempted to try the latest fad diet such as Keto, Paleo or celery juice for weight loss. While these diets may show results in the short term, stick to science and remind them that sustainable changes will not only help them lose weight, but keep it off long term.
- The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis,” Gariepy, G., Nitka, D., and Schmitz, N., International J of Obesity 21;2010 34: 407-419
Submitted by Lisa Andrews, MEd, RD, LD