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Body Mass Index – Don’t pay any attention to it

The Body Mass Index, or BMI,  is used to ascertain whether someone is overweight, obese or at the correct weight for their height.  It’s used by health professionals across this country as a guide for their patient’s health.  It’s wrong.

The reason for this blog is a conversation I had with a good friend of mine.  He also happens to own a gym and is a very talented and knowledgeable trainer/fitness coach.  We were discussing it in relation to his clients and my patients and how people are often times misled by the numbers they see when they use the BMI scale.

BMI was designed to be used as an easy tool for clinicians to assess their patients in terms of body weight relative to height. Before the BMI scale was invented it was hard to assess someone’s weight and say that it was appropriate because height is also an important factor in weight.  BMI combined those two.

How to calculate BMI:

The formula is simple.  You need your weight in pounds and your height in inches.  Take your weight and multiply it by 703.  Take your height and multiply it by itself (height squared).  Now divide the first number by the second number and you have your BMI.  Here is an example.  We’ll use my numbers.  I am 201 pounds and 71 inches tall.

201 lbs x 703 = 141,303
71 in. x 71 in. = 5,041
141,303/5,041 = 28.03

So my BMI is just over 28.  This puts me in the overweight category, actually moving close to obesity.  Wait…what?

If you look below you can see the classification system used for BMI.

You will see that anything above 30 is considered obese.  Technically anything above 29.9 is obese.  If we use this scale, I am only 13-14 pounds short of being considered obese.  People who know me will tell you that I do not look obese.  They will also tell you that I do not even look overweight.  So what’s the catch?

That is the problem with using BMI to assess health.  It doesn’t take into account many factors.

The problem for some people, like athletes, it does not take into account muscle mass.  A person that is heavily muscled will always be overweight according to the BMI.  As a matter of fact, I have been considered “overweight” since college despite always being is relatively good shape.  If we look at professional level athletes, most of them would be considered obese!

I understand that not everyone is an elite athlete.  What about the elderly?  BMI is not ideal for them either.  Many times an elderly person will fit nicely into the BMI by being considered “ideal weight” for their height.  This can be significantly misleading.  Why?  In the elderly muscle mass begins to drop.  It happens to all of us.  However, with this drop in muscle mass comes a drop in weight.  As weight is lost a person is likely to fall into the “ideal weight” category even though they should be concerned about muscle mass loss.  This loss in muscle mass causes a loss in strength and stability increasing the risk of falls and increasing the risk of osteoporosis.  Another problem with muscle loss is the change in your body composition.  As muscle mass is lost one’s body fat percentage increases.  Body fat percentage is a great indicator of health.  The lower it is (within reason) the healthier you are, generally speaking.

So does it work for anyone?  Yes, there are some people that it works for.  If a person is sedentary and eats a poor diet it may accurately depict your current weight status (ideal, overweight or obese).  There are, however, better ways to assess health.

Then how do I know if my weight is appropriate?

The best way to assess your weight status is to perform body composition.  This gives us a percentage number based on body fat.  For example, if you weigh 200 lbs and 50lbs of that is from fat, your body fat is 25%.  Below is the ideal body fat percentages for men and women.

The gold standard for measuring it is the caliper test or skin fold test.  A pinch of skin is precisely measured by calipers at several standardized points on the body to determine the subcutaneous fat layer thickness. These measurements are converted to an estimated body fat percentage by an equation.  It is most reliable when taken over time and it must be done by the same person to be accurate.  Techniques can vary from person to person and may change the results.

The other way to measure it by bioelectrical impedance.  You are hooked up to electrodes that are spaced far apart on your body; usually on each hand or on a hand and a foot.  An electrical signal is passed between the electrodes and the resistance to the current flow is measured.  This is a painless process.  Fat and muscle have different resistance rates so the machine can estimate the body fat percentage based on that.  It is affected by hydration levels so be sure to be hydrated when you take a test like this.  This is a very accurate method and does not depend on a person’s technique as the skin fold test does.

The best way to get your body fat to the desired level is a healthy diet and exercise.  You want to increase muscle mass and decrease fat.  This is done by weight training and short duration, intense circuit type workouts.  All of this can easily be done at any local gym.

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Great Ways To Boost Your Metabolism And Lose Weight

Below is an article I found on the USA Today website.  I was surprised when I read it because I usually do not agree with much that mainstream media says about health.  In this article they found some forward thinking, cutting edge people who had some great ideas!  Check it out.  (My comments are in bold within the article.)

USA Today Article

By Maura Kelly, Fitness magazine
Last winter I put on a few extra pounds. No biggie — I do it every year. The weight usually comes off in the spring once I stop chowing down on pasta and bread and shift my outdoor running program into high gear. But this year the scale refused to budge. At all.

“Maybe your metabolism is slowing,” a friend suggested. She had a point; I was in my 30s, after all, which is when scientists say the ebb usually starts. Yikes! How could I rev it back up and drop the flab? Here’s what I learned to turn up the burn — and how you can do it too.

The M factor

Metabolism sounds mysterious and complicated, but it’s actually pretty simple: It’s the amount of energy (aka calories) our bodies need daily. About 70% of those calories are used for basic functions, such as breathing and blood circulation, says Rochelle Goldsmith, director of the Exercise Physiology Lab at Columbia University Medical Center. An additional 20% is fuel for physical activity, including working out, fidgeting, walking and even holding our bodies upright while standing. The remaining 10% helps us digest what we eat (it’s true; eating burns calories!). The trouble begins when you consume more calories than your body needs to do these things: That’s when you pack on the pounds.

Dr. Court’s Comment: While it is true that consuming a significant amount more calories than you burn will cause weight gain, it isn’t the whole story.  Managing hormones like cortisol and insulin are hugely important.  I have many patients that go on ultra low calorie diets and don’t lose a single pound until they actually gain control on their hormones.  Remember, eating food is a hormonal process and you need to treat it that way!  The best way to control those hormones is to eat every 2-3 hours and keep hormone stimulating foods like simple carbohydrates out of the diet.

You can partly thank your parents for the speed of your metabolism. Genes contribute to the levels of appetite-control hormones we have floating around in our bodies, Goldsmith explains. “Some people are genetically programmed to be active; they’re naturally restless and use more energy,” she says. Those are the lucky high-metabolism types.

Gender also plays a role. “The average man’s metabolism is about 10 (percent) to 15% higher than a woman’s,” Goldsmith notes. That’s mainly because men have more muscle mass than women do, which means they burn more calories. “Muscle does the work to help you move, while fat just sits there,” says John Porcari, a Fitness advisory board member and director of the clinical exercise physiology program at the University of Wisconsin-La Crosse. Not only that, but women’s bodies are designed to hold on to body fat in case of pregnancy. Talk about unfair.

The good news is, you can make your metabolism faster, experts say, despite genetics and gender. These are the 10 simple secrets to boosting it big-time.

1. Exercise more often.

Working out is the No. 1 way to keep your furnace cranking. The more lean muscle you have, the more calories you burn all day. That’s because muscle uses energy even when you’re resting. Exercise enough and you can help prevent the natural metabolic slowdown that can begin as early as your late 20s, according to Goldsmith.

Your amp-it-up game plan: five workouts a week. “Do three days of aerobic activity and two days of weight lifting,” advises Shawn Talbott, an exercise physiologist, a nutritional biochemist and the executive producer of Killer at Large, a documentary about the U.S. obesity epidemic.

Dr Court’s Comments: Exercise more? Yes.  Long aerobic sessions?  No.  If you work out 3-4 times per week and each session has weight training and cardio in it that will do the trick.  The cardio should be interval training (discussed later) and should be full body exercise.  It should also be intense but short.  The intensity allows it to be short and have the same effect as a much longer cardiovascular workout.  By short I mean 4-12 minutes depending on your fitness level.

2. Kick up your cardio.

Aerobic intervals will help you maximize your burn, doubling the number of calories you torch during a workout, studies show. Intervals also keep your metabolic rate higher than a steady-pace routine does for as long as an hour after you stop exercising, according to Michele Olson, a Fitness advisory board member and professor of exercise science at Auburn University at Montgomery in Alabama. That means you could blast as many as 65 additional calories after your sweat session. The ideal metabolism-boosting interval routine is to “go hard for a couple of minutes, then take it down to an easier pace for a minute or two, and keep alternating like that throughout your workout,” Talbott says.

Just pick your cardio carefully. Aim for exercises that require your body to work its hardest by using a lot of muscle groups, Talbott says. That means running is better than cycling. Or try a cardio circuit. “Do a variety of activities — like running stadium stairs, jumping rope and squat thrusts — for two minutes each, aiming for a total of 10 minutes,” Olson says. “That will really rock your metabolism.”

3. Put some muscle behind it.

Too many women steer clear of weight machines, fearing that they’ll bulk up. Or they work only their legs and skip their arms. Don’t make this mistake. A head-to-toe strength routine will turbocharge your calorie-blasting quotient. Add five pounds of muscle to your body and you can zap as many as 600 calories an hour during your workout, Olson says. Be sure to choose a weight-lifting routine that targets your core, legs, arms, chest and shoulders; challenging numerous muscles will help your body function like a calorie-burning machine, Goldsmith says.

Dr. Court’s Comments: Yes, yes, yes.  You must train your muscles.  It is the single best way to increase metabolism.  Yes, if you train for a marathon you will lose weight because that much aerobic activity takes a ton of energy, but the minute you stop training you will start to put weight back on because you did nothing to increase your lean muscle mass.  I can’t say it enough – you must train your muscles.

4. Don’t skip meals.

We know you’re superbusy, but make sure you grab lunch. “Simply chewing, digesting and absorbing food kicks your metabolism into gear,” says Jim White, a national spokesperson for the American Dietetic Association.

“The more frequently you eat, the more often it revs up.” Conversely, missing a meal, or going too long between meals, brings your metabolism to a crawl. “Your body switches into starvation mode and your system slows down to conserve energy,” White explains. Keep your engine humming by having three healthy meals of 300 to 400 calories and two snacks of 200 to 300 calories every day, he advises.

Dr. Court’s Comments: This goes back to controlling the hormones associated with your metabolism.  If you eat more frequently you will have better control of those important hormones.  If your activity level is high the caloric suggestions above are too low so be sure to find out exactly how much you need from a trained professional.

5. Fill up on smart foods.

Start by serving yourself protein at every sitting, says Dr. Darwin Deen, medical professor in the department of community health and social medicine at City College of New York and a co-author of Nutrition for Life. Not only does your body need it to help build lean muscle mass, but protein also takes more calories to digest. To get your fix, have low-fat yogurt at breakfast, chicken in your salad at lunch and salmon for dinner. Between meals, snack on protein-rich walnuts. They contain omega-3 fatty acids, which help promote weight loss by increasing your feelings of fullness, according to a recent study in the journal Appetite.

While you’re at it, eat more foods that slowly release the sugar you need for sustained energy, like high-fiber fruits and veggies and whole-grain breads and pastas. Munch a food high in fiber three hours before your workout and you’ll also burn extra fat, a study at the University of Nottingham in England found.

Sipping java can also help. “Caffeine stimulates the production of adrenaline, which speeds up the metabolism,” White says. Research shows that caffeine can significantly accelerate your burn. Just limit yourself to no more than two cups a day; too much caffeine can overtax your system, resulting, ironically, in fatigue.

Dr. Court’s Comments: I agree with most of the above except for the low fat and bread/pasta recommendation.  Keep your diet focused on high quality fats, proteins and lower on the carbohydrate side.  That will be the best way to control your hormones.

6. Eat breakfast.

It will switch your metabolism from idle to high speed. That’s because your level of cortisol, a hormone that helps you use calories to build muscle, is highest just before you get up in the morning. When you eat an a.m. meal, your body is primed to turn those calories into muscle pronto — the only time during the day this happens. Take advantage of the natural torching process by having a healthy breakfast of scrambled eggs, low-fat turkey bacon and a piece of whole-grain toast.

Dr. Court’s Comments: Again this is important to regulate hormone levels so you can efficiently store your food for energy.  Don’t focus on the low fat/grain stuff.  Focus on my suggestions from above.

7. Get off your butt.

Sitting too much — at the computer at work, at home in front of the TV — slows your metabolism, even if you’re exercising regularly. An easy fix is to stretch, stroll and fidget throughout the day. That’s what scientists call NEAT, or non-exercise activity thermogenesis, and it can boost your burn and help you drop weight, says Dr. James Levine, professor of medicine at the Mayo Clinic in Rochester, Minn., and author of Move a Little, Lose a Lot.

The proof: In a study of lean volunteers who were fed extra calories, those who paced frequently, for example, maintained their weight, while the people who did no additional walking got chubbier. If you take advantage of every opportunity to walk and climb stairs, it can make a big difference. “A woman who needs to lose weight would have to burn about 190 to 200 extra calories a day to lose 10% of her body weight, which you can do by increasing your overall activity level,” Goldsmith says. “Try striding around your house or office when you’re on the phone, standing up at your desk whenever you can and walking to your co-worker’s cube instead of e-mailing her.”

8. Go to bed earlier.

Deprive yourself of sleep and your body starts to respond as if it were under siege. “When you get two hours less shut-eye than you normally do, your system becomes stressed and produces about 50% more cortisol,” Talbott says. “That in turn triggers your appetite.”

At the same time, lack of zzz’s throws the body’s hunger hormones leptin and ghrelin out of whack, making you more likely to overeat. Skimp on pillow time for too long and you could be facing a serious weight problem, says Michael Breus, author of Good Night: The Sleep Doctor’s 4-Week Program to Better Sleep and Better Health. In a 16-year study of sleep-deprived women published in the American Journal of Epidemiology, researchers found that those who slept seven to eight hours a night had the lowest risk for major weight gain, while women who got six hours a night were 12% more likely to pile on a significant number of pounds, and those who logged five hours or less were 32% more likely to gain weight.

Dr. Court’s Comments: Hormones, hormones, hormones.  I’ve stressed it enough in my comments above, but I’m glad they touched on it here.

9. Schedule a nighttime workout.

Do a 20- to 30-minute moderate-intensity cardio routine before you hit the hay to keep your metabolism humming all night, Porcari says. The average woman’s metabolic rate naturally decreases by about 15% while she sleeps, but an end-of-day sweat session will make the drop closer to 5%, he explains. So take the dog for an evening walk or go for a bike ride with your family after dinner. And don’t worry that the activity will keep you awake: As long as you exercise at least two and a half hours before lights out, you should be able to drift off with no problem, Breus says.

10. Check your meds.

Some of the most dramatic metabolic dips occur when women start taking birth control pills and widely prescribed antidepressants known as serotonin reuptake inhibitors, or SSRIs. “These drugs commonly slow the metabolism because they affect the functioning of the thyroid gland, which regulates how our bodies use energy,” says Dr. Kent Holtorf, a thyroidologist and the founder of the National Academy of Hypothyroidism. Depo-Provera, a contraceptive that’s injected every three months, seems to cause the most weight gain. “It’s high in the hormone progestin, which stimulates insulin secretion, leading to increased appetite and a lowered metabolism,” Holtorf explains. “It also signals the body to store fat.” (Oral contraceptives, which contain less progestin, aren’t as problematic.) If you’ve recently started taking any new medication and the scale is inching upward, ask your doc if there’s an alternative treatment that is less likely to cause weight gain.

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