Why do YOU routinely use the Tape Measure or InBody, Dr Mike?
This week’s blog/column comes from two questions recently asked:
This week’s blog/column comes from two questions recently asked (feel free to send them to questions@longevityplaybook.com:
I don’t know whether I should post this at this time of year, but the questions came in this last week, so the subject is probably getting people’s attention now:
Q1: You, Dr Mike, say that I’m obese even though my BMI is 25.1—just barely into the overweight range for my height (5’5”) and age (45). That’s because you did two tests of my body fat that you said could be dangerous –a tape test at my belly button and when I questioned that, you did an Inbody fat percentage. You said that Inbody confirmed my visceral fat percentage at 35%--that you said put me at risk for obesity-related complications. Does this make sense—I like the BMI result better?
Kitty T., a patient from Pensacola, FL—name age and city changed for PHI protection.
Q2: I come from three generations of people with obesity, and I am headed that way (age 22). Is there anything I can do to avoid all the health problems that come from being severely overweight?
Jessica D., Denver, CO
A: BMI (body mass index) has long been used as a way to determine the health risks associated with weight. But it turns out to have blind spots, a very muscular person may weigh more than an untoned person the same height, age and sex, and that fit person would also have a greater BMI—possibly one that was rated unhealthy, simply because muscle weighs more than fat. —for example, Michael Jordan in his prime (waist 31.5 and height 6 feet 6 or so) had a BMI in the fat range. That’s the biggest problem with BMI, next to results calculated for a pregnant woman.
Body fat percentage—especially omental or visceral fat—you know the kind in your middle that gives men a beer belly shape and women an apple shape, that fat below your belly button-- is very dangerous as it secretes substances that cause inflammation in you, and is thus a much more reliable indicator of overall health. [1] Research presented at the Endocrine Society annual meeting this year (2023) found that 74% of the people studied were able to be classified as obese based on their percent of body fat, while BMI only ID’d 36% as obese.
That is why, Kitty, I measure with a tape measure around you at your belly button with you sucking in (you will anyway). This waist measurement should be half or less than that of your height—so for 65 inches tall, your waist should be less than 32.5 inches around. Other studies reveal that a waist measurement greater than 37 or women or greater than 39 inches for men is associated with considerable risk of aging.
To validate, we used an estimate of body fat by impedance measurements—the InBody device does that as fat conducts current at a different rate than muscle or bone. InBody devices use a method called Bioelectrical Impedance Analysis (BIA) to measure body composition. It divides your weight into different components, such as muscle mass and fat mass, to assess your health and help guide interventions. Even more accurate is DEXA scan (see below).
Kitty, you have a[2] “good” (but not great) level of body fat if at age 40 to 49 it’s 29.9% to 23.8% and at age 60 to 60 it’s 23.35 to 27.9%. In the US the average female has at 41% body fat and the average male has 28%[3].
The best way to determine your body fat percentage is by getting a DEXA scan (also used for bone density)—it’s an x-ray and produces more risk and cost than the tape measure at the belly button .
Now while there are pills such as Semaglutide and Tirzepatide (Ozempic/Wagoovy and Mounjaro) as well as procedures cold exposure and sauna that as long as you stay with them help people loose belly fat and weight in randomized controlled trials, another method we use first with every patient is food and exercise tracking. In 2015, JLo shared her food diary with People magazine.
A typical day looked like this: Breakfast: A smoothie with a nutritional powder and berries, yogurt, lemon juice, and 1/4T of honey. Lunch: Kale salad with queso, pumpkin seeds, lemon juice and 3T of olive oil. Snack: An apple. Dinner: Skinless grilled chicken breast with 1/2 cup sautéed Brussels sprouts and 1/2 cup baked yam. Dessert! A Chocolate chip cookie. Total calories: 1392. “I don’t deprive myself,” she declared. One of her tricks? “I always have healthy snacks like fruit and vegetables with me.”
Keeping track of what you eat and drink and your steps and other exercise converted to step equivalents day-to-day is a powerful boost to any effort to shed excess pounds or maintain a healthy weight. And you don’t have to be perfect! According to a new study[4] done in conjunction with researchers from the Universities of Connecticut, Florida and Pennsylvania and Weight Watchers if you track around 30% of your days over six months you will lose about 3% of your body weight. Keep a written record of 40% of your meals and you’ll lose around 5%. And if you log 70% of your daily food intake, you’re on track to lose 10% of your body weight.
And doing it with steps seems to add even more in my patient’s personal experiences. That’s a clear demonstration of how logging your food intake reinforces your commitment to achieving and maintaining a healthy weight. So try tracking—it is a lot cheaper and without side effects — and if need be (you have a mental craving for food at all times) then you can add the medications and be inches ahead—remember do resistance exercises as the second choice after walking.
[1] https://www.medpagetoday.com/meetingcoverage/endo/105066?xid=nl_mpt_DHE_2023-06-16&eun=g446856d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%202023-06-16&utm_term=NL_Daily_DHE_dual-gmail-definition
[2] https://www.medicalnewstoday.com/articles/body-fat-percentage-chart#women
[3] https://pubmed.ncbi.nlm.nih.gov/20978478/#:~:text=Average%20American%20men%20and%20women,particularly%20in%20lower%20BMI%20categories.
[4] https://www.sciencedaily.com/releases/2023/06/230608120944.htm\
and
https://onlinelibrary.wiley.com/doi/10.1002/oby.23795