There has been much noise in the media recently as the Government considers providing bariatric surgery (gastric by-pass and gastric band operations) to people with Type 2 Diabetes. Let’s look at some of the facts and figures, shall we? First, definitions. Body Mass Index is defined as weight divided by height squared, or kg / m2. Originally devised by a Belgian mathematician almost 200 years ago  as a social study into average body build, it has come to be adopted as the medical industry norm. The scale has changed over time, the current settings being as follows: Below 18.5             possibly underweight 18.5 – 24.9             healthy 25.0 – 29.9            overweight 30.0 – 34.9           obese 35.0 – 39.9           very obese 40.0 and over     morbidly obese While I feel there should be a better way of measuring obesity (see my separate post on BMI), there is no escaping the fact that far too many people today are seriously overweight and this is impacting their health in many ways. The National Institute of Health and Care Excellence tells us that –

  • 25% of adults in England are obese (ie have a BMI of 30 or more) – that’s 1 in every 4 adults.
  • A BMI of 30 – 35 (obese) cuts life expectancy by up to four years.
  • A BMI of 40 or more (morbidly obese) cuts life expectancy by up to ten years.
  • Obesity costs the NHS some £5.1 billion every year.

The people at NICE say that very low-calorie diets (less than 800 calories a day) can be used in the short term to prepare people for surgery or to meet criteria for fertility treatment, but admits that while diets are increasingly popular, they do not keep weight off in the long term.  NICE guidance states that “regaining weight is likely” but that this is not down to the failure of either the client or the clinician. We have reached the stage where around 8,000 people a year are currently receiving bariatric surgery on the NHS – let’s have a look at a few other facts & figures about that too. One person in 200 who has a gastric band fitted will die as a result of the operation. If you think that’s bad, the figure for death following gastric by-pass is just one person in 100. Such operations can result in dramatic weight reduction – often up to 1/3 or even 1/2 of body weight prior to surgery – and this can create another problem in the (not very attractive) shape of folds of excess flabby skin that often needs further surgery to remove it. I work a lot with people who are would be defined as overweight or various stages of obese. Rather than berating them for eating too much or not doing enough exercise, I work from the inside out, focusing instead on the underlying emotional reasons why they are holding onto excess weight. This can be traced back to any number of reasons – abuse or bullying as a child; rejection or pain in a relationship; a past life when the client starved to death; or even a spirit “passenger” with a sweet tooth. If, having resolved these issues, the client still feels that he or she needs “belt and braces” reassurance, then I will “fit” a hypnotic gastric band. The procedure is totally non-invasive, and does not carry any of the risks of actual surgery. And of course it means that, having dealt with the real root causes, the client can move on with his or her life, whereas with conventional surgery, if those underlying reasons have not been dealt with, the operation “won’t work”; the client will find ways around. It is also far less expensive. The NHS puts the cost of bariatric surgery at anywhere between £3,000 and £5,000. A private hospital close to me is currently charging £6,145 for a gastric band operation. I charge £395.00 – yes, that is just under £400. Just think how much that could save the NHS! My number is 07597 020 512 – feel free to call me if you would like to know more.

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Your Body Mass Index is the number that defines whether you are normal, fat, obese or morbidly obese. With the latest news that the Government is looking at bariatric surgery (gastric by-pass or gastric band operations) for those suffering from Type 2 diabetes, the BMI is being quoted as the measuring stick – almost a magic wand – to ascertain who qualifies for such surgery and who doesn’t.

But let’s take a closer look at the BMI. Where did it originate from, and why? You may think it’s a modern development, by medical professionals keen to monitor the health of the general public. Think again. What is now called the BMI was actually invented in 1832 by a Belgian called Lambert Adolphe Jacques Quetelet. A mathematician by profession, he specialised in statistics and was among the first to try to apply statistics to social science. As part of his study into the concept of “the average man”, as defined by variables that follow a standard mathematical distribution curve, he came up with  a simple measure for classifying peoples’ weight relative to an ideal weight for their height. A person’s Body Mass Index – following Quetelet’s formula – is defined as their body weight divided by his / her height squared. Nowadays this has been translated to a measurement of Kilograms per metre squared (or, for the more technical among you, kg/m2).

The formula devised by Adolphe Quetelet was never meant to be used in the way it is now by the medical profession for defining obesity: it was purely a method of defining standard proportions of the average human build. In fact, Quetelet himself specifically warned against using his Index for individual diagnoses because of the many variables.

However, in the early 20th century, as the insurance industry came into its own, underwriters looked for a method of classifying people for health insurance and life assurance policies – and found the BMI, which is still also called the Quetelet Index. Et voilà – a social science formula became increasingly used as a medical industry measure. In 1972 a physiology professor and obesity researcher called Ancel Keys published “Indices of Relative Weight and Obesity”, the result of a study of some 7,400 men in five countries. Having compared various height-weight formulae, Keys decided that Quetelet’s kg/m2 to be the most accurate and so Quetelet’s Index became the Body Mass Index.

Because it was a simple formula, it allowed researchers – especially those in the insurance and obesity industries – to go back through back data and define what they perceived to be past levels of obesity. There are many obvious reasons why the BMI as currently based on Quetelet’s formula should not be the magic measuring stick for defining obesity.

For instance, it doesn’t take into account relative proportions of fat, muscle and bone in a person’s body. Bone is denser (and therefore heavier) than muscle, and about twice as dense as fat. People who go to the gym and work out a lot build strong, dense bones, lean muscle and have low fat – and yet they are frequently classified as overweight or obese! This shows that someone who is health conscious and very fit can score just as high on the BMI scale as someone who is genuinely obese because of wrong eating, lack of exercise or serious health issues.

There is no such thing as “an average man” any more than there is “an average family” with 2.4 children. Gender, age, ethnicity and body frame size can all influence the BMI figure – and yet these are rarely taken into account.

Over the years the classifications have changed too – the figure at which someone is now labelled “obese” seems to get progressively lower. There are many websites offering “find your BMI” charts. You can see for yourself how just that one more gram pushes you from overweight to obese; how just a couple of centimetres makes a big difference.

I am a good example of how it doesn’t work. I fall easily into the Obese bucket on the BMI and yet recent blood tests at my local health centre gave me a completely clean bill of health: liver and kidney both working perfectly; cholesterol and blood sugars fine, and blood pressure absolutely fine, thank you very much. I’m not saying that I’m totally saintly – I should eat smaller portions – but I am a big lady, with big bones and broad shoulders (and broad hips to match, dammit!). I had a sister who was 6 ft 3 ins and in my prime I was 5 ft 9 ins (I’m down to 5 ft 7 1/2 ins now, I’m told!). Totally different to someone of the same height but thin as a beanpole – and different again to someone from a different ethnic group, or 20 years younger . . .

There is no denying that obesity is a growing problem in the UK. But if the best measurement we can come up with is a 200-year-old formula devised by a mathematician for social science studies, then (in my humble opinion) we need to address that too.

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