The Tea about why the scale isn't your friend
I’ll be spilling the tea on body weight and why the scale isn’t your friend.
As a practicing physician, one of the first things we do when we bring a patient into the clinic is check their weight. This is typically a patient’s least favorite part about coming into the office for an appointment. And I get it, no one wants that reminder of the number on the scale going up or never seeming to be going down. It’s frustrating!! And for some, seeing that number on the scale may even trigger feelings of trauma if that individual has experienced lifelong challenges with their weight.
So why do we do it? The short answer is that it's what we’ve always done.
The longer answer is regarding the need for a weight measurement to calculate one’s Body Mass Index or BMI and to determine a person's perceived risks for the development of certain health conditions based upon their BMI. I’ll reserve my thoughts about BMI for a little later in this discussion.
And don’t get me wrong, measuring weight to monitor proper developmental growth in children, measuring weight to monitor proper growth of a baby in the uterus of a pregnant individual, measuring weight in an individual who suffers from heart disease to make sure they aren't retaining too much fluid in their body which can lead to complications of this condition, measuring weight to monitor the nutritional status of someone who may be unintentionally losing weight due to a health condition; and other health conditions related reasons are all excellent reasons to have your weight measured at every doctor’s appointment.
But just know that unless you are a child, a pregnant individual or you have certain health conditions that may cause significant weight fluctuations that need to be monitored closely; checking your weight at every single doctor’s appointment may not be absolutely necessary.
But, I’ll tell you a secret, our healthcare system here in America is set up in a way that dictates to your doctor’s office certain parameters that must be collected, so this sometimes leads to additional, not always necessarily work for the medical clinic. Now this is certainly another topic for another day. So I will table the American healthcare system discussion right here.
Now you may be asking if I don’t know how much I weigh, how will I know if my current size is healthy or not?
That’s a wonderful question and something you should be thinking about.
Body Mass Index or BMI is a calculation based upon a person’s weight in kilograms divided by the square of height in meters. It is used as a screening tool to help categorize weight and determine one’s risk factors for disease.
The categories of BMI are defined as an individual’s weight categorized as Underweight if their BMI is below 18.5; an individual’s weight categorized as Normal Weight if their BMI is in the range of 18.5 – 24.9; an individual’s weight categorized as Overweight if their BMI is in the range of 25.0 – 29.9; and an individual’s weight categorized as Obese Weight if their BMI is 30.0 or greater.
However, BMI is not a perfect tool for determining healthy versus unhealthy.
There are some common pitfalls of BMI including 1) BMI doesn’t take into account muscle mass. For example, a bodybuilder or an athlete may be very muscular with little body fat. However, their BMI may deem their weight category to be overweight or obese weight based on the weight of their muscles. 2) BMI doesn’t account for bone density. Older adults with decreased bone density may have more body fat than younger adults of the same BMI who have a higher bone density. So the BMI measurement alone wouldn’t be accurate in terms of assessing the health of this individual.; and 3) BMI doesn’t account for fat distribution. Studies have shown that waist circumference can be a determinant of health versus increased risk for disease. However, BMI doesn’t take this fact into account.
So let me give you the tea on other ways to measure body size and to determine if someone is at a healthy size!
I want to tell you about how one client of mine recently overcame the numbers on the scale. One of the offerings at Essence of Health Wellness Clinic and Coaching is Body Composition Analysis. Our cohort of participants in this program has been learning about how to objectively determine their health status and health risks beyond seeing their weight on the scale. Body composition analysis allows us to measure the percent body fat, lean muscle, the fat surrounding our organs, and much more. This particular client has been doing fabulous and following the personalized health plan they received in our program. However, they were concerned that they hadn't seen any change in their actual weight. Their exact words were "My clothes fit more loosely but the scale isn't moving."
This is my point; while we use the scale as a unit of measure; it is not our friend. This client had a repeat Body Composition Analysis scan and it revealed a much more accurate picture of the actual progress this client had made. In just 4 short weeks, they've already lowered their percent body fat, lowered the amount of unhealthy fat surrounding their organs, also called visceral fat, and gained more muscle mass. Think about how much better this client felt about themselves. How they were able to develop a healthier mindset at that moment by just knowing that their hard work in changing their lifestyle in order to prevent and reverse chronic disease is actually showing them objective results and not just some arbitrary number on the scale.
Body Composition is an important tool in tracking your weight for those wanting to lose weight, gain weight, and for those wanting to maintain their weight.
When working with my weight management patients, they can become frustrated with the number on the scale. However, body composition shows us that just because you aren't losing pounds doesn’t mean you aren’t losing fat.
And, more often than not, changes are occurring in water weight, or potentially gaining muscle and losing fat at the same time. This is where body composition testing comes in; to give us this more objective, necessary data.
The scale can tell you how much you weigh; but body composition analysis tells you where that weight is coming from whether it be fat, muscles, water, or bone.
Body Composition can be measured in a number of ways including Skinfold Testing, Bioelectrical Impedance Analysis (BIA) Testing, Hydrostatic/Underwater weighing, Air Displacement Testing (BodPod), and via DEXA Scanning.
Let’s sip a little more tea here as we discuss a bit more about what these methods entail to determine if someone is a healthy size.
Skinfold Testing is one of the oldest and most basic ways to measure the amount of body fat you have. Think of the old-school Calipers your physical education teacher may have shown you when you were in school. With this method, calipers are used to pinch the body in specific areas to measure the skinfold thickness. These measurements are then combined with a person's age and gender and input into a specific formula to provide a percent body fat estimate.
Skinfold tests are limited because it only measures subcutaneous fat which is the fat just below the surface of the skin and do not do a full body assessment. Not everyone stores fat in their body the exact same way so skinfold tests may miss some important factors if being used to assess the actual health of an individual. It is also subject to human error depending on who is performing the test and how and where they are holding the calipers.
Bioelectrical Impedance Analysis or BIA is another method to determine one’s body composition. The InBody Testing in our office is an advanced form of BIA Testing. It uses a low electric current that travels through the body to estimate fat-free mass. You don’t feel the current as the testing is performed and it is not harmful to you.
Here’s more about how it works. And I’ll warn you that I’m gonna nerd out here for just a moment. Since electricity can only travel through water, and each bodily tissue contains varying amounts of water, the flow of the electric current is impacted by the conductivity of each tissue type. So for example, muscle holds more water than fat, so the flow of the current becomes less interrupted (low impedance) when a person has more lean mass and more interrupted (high impedance) when they have more body fat. These currents are then calculated to give the components of your body composition.
Because of the way Bioelectrical Impedance Analysis functions, hydration status can significantly impact the accuracy of the results. This also includes whether or not you’ve eaten or done any exercise before the test. So just know that inaccuracies are possible if the proper instructions for testing aren’t followed before one has this particular analysis performed.
Another way to measure Body Composition is through Hydrostatic or underwater weighing. This is a form of densitometry that uses your body weight on land and in water, along with water displacement to estimate your body composition.
Muscle is more dense than fat. Underwater, muscle sinks, and fat floats, so a person with more muscle mass will weigh more underwater than a person with a higher percentage of body fat.
This form of testing takes into account this principle to measure your body composition.
Air displacement works similar to water displacement except in an air controlled chamber resembling an egg-shaped pod. BodPod is a form of Air Displacement Testing that uses a mechanical diaphragm to create small volume changes in a confined and controlled space and then measures the pressure responses. It measures how much air you displace and uses formulas to determine how much lean mass and fat mass your body contains.
And last but certainly not least is the DEXA Scan. The DEXA Scan is actually considered to be the gold standard of body composition analysis as it has been shown to be up to 99% accurate at measuring one’s body composition!
It works by sending dual low-power X-ray beams that can accurately and precisely differentiate between bone mineral, lean mass, and fat mass. It’s also used for bone density screening when testing for Osteoporosis.
I gave you all of this information to show you that your weight on the scale is just one small factor of health, and using weight or BMI alone does not give you an accurate picture of health.
The formula for calculating BMI that we discussed earlier in this talk, was the creation of a Belgian mathematician and astronomer, named Lambert Adolphe Jacques Quetelet (quay-tell-ay) and developed in the 1800s. [Now get this tea], Quetelet, was not studying obesity or health when this calculation was developed. He was analyzing crime and death rates in order to link crime to human traits and social conditions. While doing this work, he noted a relationship between an individual’s weight and height and developed a theory of the makeup of “the average man.” The development of this theory of height weight compared to the average man concept was to look at a population to help determine patterns of death.
Fast forward to the 1970s, an American physiologist, Ancel Keys, rebranded BMI when it moved from printed height weight tables to based upon Quetelet’s calculation and in this rebranding it was touted as a good way to measure obesity.
Here’s the problem. When Quetelet was doing his research, it didn’t take into account today’s population of individuals and their lifestyles, and it didn’t take into account people of color as we know the early research was based on European populations and even the research done in the 1970s was with primarily white men as the subjects in the studies.
My goals for this podcast are to not only educate the masses on health, wellness, and plant based nutrition; but to also improve health literacy and highlight the pitfalls of our health system when it comes to people of color who suffer the most from disparities in healthcare, access to quality healthcare, and bias within the healthcare system.
I’ll spill some tea here from the United States Department of Health and Human Services.
African American women have the highest rates of obesity or being overweight compared to other groups in the United States. About 4 out of 5 African American women are overweight or obese.
In 2018, African American women were 50 percent more likely to be obese than non-Hispanic white women.
From 2013-2016, non-Hispanic black females were 2.3 times more likely to be overweight as compared to non-Hispanic white females.
Yes, America we have a weight problem. But get this, looking at BMI as the end all to be all of health and risks for disease can actually create more risks for an individual.
Some procedures and medications aren’t available to some individuals unless their BMI is a certain number. It doesn’t matter the health of the individual, just the number.
BMI creates stigma. Sometimes those with lower BMI or those with normal BMI may not be assessed for certain health conditions due to the thought that they should be low risk for those conditions based upon BMI. This leaves those normal and low BMI folks at risk for potential lingering health conditions due to them not being seen as a priority based upon this number.
I have often heard friends and family members tell me “Well the doctor didn’t listen to any of my concerns they only wanted to talk about my weight or BMI.”
Yes, weight is important. Yes, excess weight can increase one’s risk for chronic preventable disease. But let’s address obesity for what it is and not just through an arbitrary lens as BMI.
Obesity is a chronic disease. The World Health Organization (WHO) first recognized obesity as a disease in 1948 and defined it as abnormal or excessive fat accumulation that presents a risk to health.
Years ago obesity was thought of as a disorder by someone who has a lack of willpower. What we now know is that there are a multitude of factors that contribute to obesity.
Obesity is actually a disease caused by a complex inter webbing of genetics, environmental factors, socioeconomic factors, and many other factors. Recent studies suggest that genetics may contribute to 40-70% of cases of obesity. What you’ll learn here on the Essence of Health Tea Time Podcast is that not all calories are health promoting. Nutrition certainly plays a role not only in getting you to a certain number on the scale but more importantly in preventing and reversing chronic disease. Also, certain hormones can be attributed to cases of obesity in some individuals. Lifestyle including poor quality sleep and stress definitely plays a part in the development of obesity.
Let’s think back to the chronic stress that has been recognized in recent studies amongst populations of people of color in America and you’ll understand even more about the health disparities that exist as shown in the statistics I shared with you.
Environmental factors have also been linked to obesity; which also helps to draw more conclusions regarding some of the health disparities we see amongst populations.
I’m highlighting these things not to give anyone a pass, if you will, to go and make poor health and lifestyle choices. But the purpose of this discussion is to allow you to see more broadly that we are all more than the number on the scale.
The scale is not your friend but healthy living should always be the goal.
Now, let’s transition over to our Ask The Expert segment.
In today’s Ask The Expert segment; our question was submitted by Crystal. Her question is “What foods are natural energy boosting foods?”
Thanks for submitting this question Crystal!
Here’s some highly energized tea for you on this topic!
Health promoting foods in general will be energizing to you. Think of it this way; when we consume high-fat, highly processed foods, we tend to feel sluggish after we eat. Just think of the typical Thanksgiving meal. A traditional, Standard American type of Thanksgiving meal, especially here in the South where I’m from, will likely include turkey and/or ham, roasted beef, potatoes drenched in butter, a green vegetable cooked in a pot of ham or turkey, some type of salad drenched in mayonnaise, and a decadent dessert. Most people eat this type of meal and then are in need of a nap immediately afterward. That’s because the fat, sugar, oils, and disease-promoting properties of the food items in this meal aren’t nourishing the body in a way to trigger health and energy.
Yes, your belly will be filled with this meal. But you’ll also feel pretty sluggish.
Instead, focus on health promoting foods like whole unprocessed grains, fruits, and vegetables. These particular foods will contain vitamins and minerals to energize you. Think about berries that are naturally high in antioxidants to promote healthy cell development.
Think about a variety of colors of peppers, carrots, sweet potatoes, and oranges with good amounts of beta carotene, B vitamins, and vitamin C to promote a strong immune system and healthy cells.
Think about steel cut oatmeal, barley, farro, and brown rice which are great sources of carbohydrates that release energy into the cells naturally, thereby giving your muscles more of a boost to power you through your day.
Energy boosting foods are health promoting foods!
The Essence of Health is in You!