My patient was disappointed. She had worked hard for a year. She felt better. And her health-related fitness results had improved. But her weight remained the same. In her mind she was unsuccessful. But I saw it differently. I knew she was focusing on the wrong number.
How did our society get to this point? We are so weight-centric. The numbers on a scale can send even the most level-headed person into an irrational panic. But did you know that your weight is not necessarily the most accurate predictor of good health?
The body mass index, or BMI, is one of the most standard measurements for weight management – and one that I do not agree with. The only reason I use this system with my patients is to guide them away from it.
The BMI ratio was created between 1830 and 1850. It divides your weight in kilograms by the square of your height in metres. A score of 18.5 to 24.9 is normal, 25 to 30 is overweight and 30-plus is obese. Every day at the clinic, patients are surprised to learn that they are classified as overweight. But they are focusing on the wrong number. And it's no wonder! The antiquated BMI system causes unnecessary confusion and distress among patients.
Now hold on, BMI fanatics – don't write an angry comment yet. Let me support my point. There is solid research behind this. When it comes to body measurements, there's a ratio that is a much better predictor of long-term health. It's not body-fat percentage either. Instead, it has something to do with your waist circumference.
A review study published in 2011 examined the use of the waist-to-height ratio as a screening tool for cardiometabolic risk factors. They studied results from 300,000 adults and reported that the waist-to-height ratio was a much stronger predictor for diabetes, hypertension and cardiovascular disease.
And you have probably already heard that abdominal fat is more detrimental to your health than other types of fat. So technically, that should mean that if you reduce your waist circumference, your overall health should improve.
Great, but what is the target? Health Canada advises that the low-risk range is less than 94 centimetres for men and 80 cm for women. But it makes little sense that a 6-foot-4 man has the same target as a 5-foot-6 man. In this example, the shorter man would be a higher risk. The solution?
Divide the waist measurement by the height measurement to get your waist-to-height ratio. Now I know what you're wondering: What should you aim for? The 2011 paper recommended a ratio of 50 per cent or below. So take your height and divide by two. That is the maximum for your waist, measured right above your hip bones. Where the love handles are located. Easy enough?
(For example, a six-foot or 72-inch-tall man with a 34-inch waist would have a waist-to-height ratio of 34/72, or 47 per cent, just below the 50-per-cent cut-off.)
Upon learning this method, my patient's frown quickly turned to a smile. She had lost two inches at her waist. Her hard work had melted fat and created lean tissue. She had made great progress but the scale had blinded her. Now you can all go throw out your scales and dust off your measuring tapes. Turn weight management into waist management.
Gilles Beaudin is a registered clinical exercise physiologist at Cleveland Clinic Canada.