You've probably heard me rant about it before, but it’s worth emphasizing again: BMI is NOT the be-all and end-all statistic measuring our health. Widely adopted in medicine and by insurance companies, it's often used to justify various treatments and decisions. But the truth is, BMI measurements can be downright misleading, especially for those who have undergone significant weight loss.
In this episode, I'm going to illustrate just how flawed BMI can be, using a case study of two patients who have both shed a considerable amount of weight. Through these real-life examples and data, we’ll see why solely relying on BMI might not give you an accurate picture of your health. Instead, we'll explore how understanding body composition can provide invaluable insights that BMI alone cannot, empowering you to make better-informed decisions about your health journey.
If you have lost a significant amount of weight and are feeling confused or frustrated by your BMI, this episode is for you!
Oops! We need to make a small correction from this episode:
“We’re going to think about obesity as being over a body fat percentage of 31%.”
00:50 - Dr. Rentea explains why relying solely on BMI can be misleading, especially for those who have lost a lot of weight, as it doesn't account for factors like loose skin.
03:45 - We hear a real life scenario from Dr. Rentea’s clinic, comparing two patients who have lost significant weight, which highlights the limitations of BMI as a sole measure of health.
06:55 - Dr. Rentea explains the issues that can arise when body fat drops too low.
07:49 - We find out why getting a body composition analysis helps you understand your metabolic health and differentiate between vanity goals and health goals.
Quotes
“If you're only looking at that BMI, you do not understand the health of the person.” - Matthea Rentea MD
“You can actually be incredibly healthy and still not be in a ‘mid-range/normal’ BMI.” - Matthea Rentea MD
“You need to work with someone that actually understands what to look at, what's important, and what's not.” - Matthea Rentea MD
“The reason we use the InBody is because we'll start to see that there's this tipping point where their body doesn't want to release any more fat.” - Matthea Rentea MD
“The data is only as good as you understanding what to do with it.” - Matthea Rentea MD
You've probably heard me rant about it before, but it’s worth emphasizing again: BMI is NOT the be-all and end-all statistic measuring our health. Widely adopted in medicine and by insurance companies, it's often used to justify various treatments and decisions. But the truth is, BMI measurements can be downright misleading, especially for those who have undergone significant weight loss.
In this episode, I'm going to illustrate just how flawed BMI can be, using a case study of two patients who have both shed a considerable amount of weight. Through these real-life examples and data, we’ll see why solely relying on BMI might not give you an accurate picture of your health. Instead, we'll explore how understanding body composition can provide invaluable insights that BMI alone cannot, empowering you to make better-informed decisions about your health journey.
If you have lost a significant amount of weight and are feeling confused or frustrated by your BMI, this episode is for you!
Oops! We need to make a small correction from this episode:
“We’re going to think about obesity as being over a body fat percentage of 31%.”
00:50 - Dr. Rentea explains why relying solely on BMI can be misleading, especially for those who have lost a lot of weight, as it doesn't account for factors like loose skin.
03:45 - We hear a real life scenario from Dr. Rentea’s clinic, comparing two patients who have lost significant weight, which highlights the limitations of BMI as a sole measure of health.
06:55 - Dr. Rentea explains the issues that can arise when body fat drops too low.
07:49 - We find out why getting a body composition analysis helps you understand your metabolic health and differentiate between vanity goals and health goals.
Quotes
“If you're only looking at that BMI, you do not understand the health of the person.” - Matthea Rentea MD
“You can actually be incredibly healthy and still not be in a ‘mid-range/normal’ BMI.” - Matthea Rentea MD
“You need to work with someone that actually understands what to look at, what's important, and what's not.” - Matthea Rentea MD
“The reason we use the InBody is because we'll start to see that there's this tipping point where their body doesn't want to release any more fat.” - Matthea Rentea MD
“The data is only as good as you understanding what to do with it.” - Matthea Rentea MD
Welcome back to another episode of the podcast. I have been preparing a few podcasts for all of you that are topics where I feel like if you can understand this, it's going to change your life. I'm not underselling this today. There's no underselling involved this. In fact, we need to way shoot this from the rafters. So I talked to all of you a lot about how I don't care about this BMI chart, which is a height for weight. a number that we come up with. And it's all over medicine. It's rampant because it got adopted by the insurance companies and then now they use it as justifications for things and stuff like that. And we also have it steeped in our definitions of overweight and obesity. And it's this horrible thing because you can actually be incredibly healthy and still not be in a quote unquote mid range normal BMI. And today is going to highlight that. I want to give one example today. I want to give the biggest thank you in the world to the person that is letting me use this data. I have explicitly asked for their consent because I do not like to violate privacy. or just your security when you work with me knowing that I do not talk about your information with anyone. Even when it's anonymized, you would recognize this scenario. Okay, so that is the reason that I asked this person. I am still in general going to anonymize certain aspects of their data, but there's one thing that they will know exactly who they are when I talk about this. So I want to talk through a very specific scenario today, and I'm gonna address. This is more niche. I want to address all of my folks, everyone that's listening here, patients, coaching clients, you name it, people at large, if you have lost a tremendous amount of body weight. So this can apply to you, frankly, if you're over 10%, but really it's going to massively apply to you if you've lost more than 25 to 30 percent of your body weight. You have a unique challenge with evaluating data that you don't know exists. So let's talk about this. You have lost a tremendous amount of weight and you don't know, am I done or not losing weight? And what ends up happening with these patients that I see, or coaching clients is that they still think they have more weight to lose because they lift up their arm and they see skin under their arm and they think they're still fat in there and then they're looking at their lower abdominal area and they're thinking I still have a lot of weight to lose. But here's the thing that you are not realizing when you are only looking at the total scale number, which is what we're doing when we do height for weight to get a BMI. We're looking at your height and then the total scale number. So whatever that number is popping out. And when we do that, we are not accounting for the fact that you have a massive amount of loose skin, that if you had it surgically removed, your BMI somehow magically would go down into a range that would be completely lower. So I want to give an example today to illustrate this, and this is going to be a shorter episode. Well, maybe not. We'll see by the time. I always say that, that it ends up being over 10 to 20 minutes. But here's the example. So I'm going to give this person's data, but then I'm also going to give someone else's data just anonymously because this happens all the time. So people that come into my clinic, I have the Rentier Metabolic Clinic. It's for residents of Indiana and Illinois. It's a telehealth metabolic health clinic. And when people come to me, they come at all different stages. So yes, there's some people that have never been on a medication or, you know, they want help. They want to work through these things. They like the comprehensive approach that we take. Great. I also have people that come to me that have actually already achieved maintenance, but they never got much education on the way down. So they don't even know, okay, am I doing all the right things to be able to keep this weight off? What do I look for? They want to work with someone that understands how to help them in the maintenance journey. Okay, so I had someone come in the other day and this person, I'm going to just tell you because it matters as far as when we're talking about data, both people that I'm going to talk about today are female. I do have both men and women that I work with, but just for today, these are both women cases. So this person came in, their, their BMI was 21, body fat percentage 25. I'm just going to give you some references today so you can kind of. Orientate yourself as far as what we're talking about because no one talks in body fat percentages. So just that you know, we're going to think about obesity as being under a body fat percentage of 31%. Again, these are all kind of like roughly subject to change and depending on where you're looking it up. So this person, again, hear me when I say this, BMI 21, body fat percentage 25. Okay, then there's another person on the flip side. They've both lost significant weight, by the way. This other person that I want to talk about, this person has lost well over 100 pounds, think in the vicinity of like 130 pounds, and they have an incredibly higher amount of muscle compared to this other person. So both of these, by the way, both of these people are using in my clinic what I recommend, which is the in body scale so we can really get an accurate body composition, meaning We know what's happening with skeletal muscle and we know what's happening with fat. And so this other person, although they've both lost tremendous amounts of weight and you know, all these things are going on, this other person has a much higher skeletal muscle mass. I'm talking literally 20 plus pounds more. Okay. And. Although their BMI, this other person, they've lost 130 pounds, their BMI is going to read 28, their actual body fat percentage is 15. 8%. Again, to give you reference, because I normally am not thinking about the percentages all day long, for a female in athletic range, so incredibly lean, will be anywhere from 14 to 21%. And so what's interesting is, You might think to yourself, if you only were looking at body mass index, which by the way, this is about 99 percent of doctors, if they're not trained in this area and they're not getting in bodies or some other body composition, there's SACA, there's in body, there's DEXA scan, there's many different ways to get, to get a body composition numbers. But if you're not looking at that, think about this person that they're going to go to their doctor Like in a traditional world, and they're gonna, their doctors are gonna see the 28 BMI, and they're gonna say, oh, yeah, you still have some more room to go, because they're gonna say, well, we want you to get 25 or lower on the body mass index. And what I can tell from looking at these numbers for this person is that, they don't need to lose any more fat. In fact, it's the opposite. We very much so need to not lose any more weight. And maybe if they're wanting to, this could be a plastic surgical procedure at that point. But this is not that they need to keep losing weight. They have very little fat to begin with on their body at this point. And sometimes if you go too low, especially based on what the goals of this person might be, maybe you're trying to work for fertility. Maybe you want to have a kid. Maybe, all the different things that might be going on. A lot of people will actually become what's called amenorrheic. Like they'll stop having their periods if the body fat goes too low. We actually don't want the body fat to be too low. There's a time when if it's too high, it might cause metabolic problems, but if it goes too low, this is, that's a very much so a problem, right? And so I want you to realize that the reason that it matters so much when I keep talking about you getting a body composition done, it's that if you can understand, work with someone, a physician that understands what your skeletal muscle is doing and what the fat mass is doing. So if we understand those two, number one, you're going to know the point at which you're metabolically optimized. Then you will understand point number two, when it just becomes, when I say a vanity thing, where it's no longer about metabolic health, but it just becomes sort of where you're most comfortable and what you're reaching for. And number three, you will understand when it's absolutely a stop point and it will have zero to do with that BMI. Like I can't stress enough. that if you're only looking at that BMI, you do not understand the health of the person. This person could have 100 percent normal labs at this point when maybe before a lot was going on that 100 plus pounds up. So they could have 100 percent normal labs. They could be like this person have literally the highest amount of natural skeletal muscle mass. I say natural because, you know, you need to make sure that this person isn't using anabolic steroids or something, right? But, literally has been working out, has been having nutrition on point, has been doing all that. Of course, genetically blessed as well, right? Because other people can be doing all that and not have all the muscle. But fat, but, but, but listen to this, have all that muscle and their body has been willing and able to release that fat for them, yet the BMI is still gonna tell them you're not enough, you need to keep going. This is why You need to work with someone that actually understands what to look at, what's important, and what's not. And along those lines too, if we're going to be using in body in some type of meaningful capacity, I've talked about this on other episodes, by the way, we'll make sure to link this. I always say this so that my copywriter knows we need to link it. I literally did an entire https: otter. ai What to look out for in my mini course. Again, we'll link to that as well. How to optimally lose body fat and maintain muscle on a GLP 1. I have a special bonus in there where I talk about how to interpret this in body. And of course, you first and foremost should always be working with your physician. But again, a lot of doctors are not trained in this. This is not an area of what they do. And so I just wanted to bring this example up today where if we were just looking at BMI, you would think oh, BMI 21, oh, that person's more healthy, they have lower body fat wouldn't you intuitively think that? That's what we've been sort of dog and pony programmed to think up to this point, but that's not the metabolic reality of what's going on. The person that is at a BMI of 28 in this scenario, is a whole lot more in a better place than the 21. And I just bring this up because you cannot go based on the BMI. You need other metrics. So if you're able to get a local in body done, things like that, a physician to go over with you so you can understand it, because it's the data is only as good as understanding what to do with it, right? So if you're able to do that, it can literally be life changing. I can't tell you. how impactful it's been for me to work with this person and how grateful I am that they're allowing me to share their data because literally I think that they thought they had to keep going. Like they didn't understand how great everything was looking, how amazing the muscle mass is, like where the body fat percentage is at, all the things. And then you can then decide next steps if you want to or not, if you want to look into a skin removal procedure or, you know, what you want to do, if you want to do that. But you're not going to sit there and fool yourself to think that there's 20 30 more pounds that are going to come off that literally there's At that point you're gonna be decimating your muscle and this is always the point that I talk about with patients It's like if you keep going at this point the reason we use the in body is because we'll start to see that there's this tipping point where their body doesn't want to release any more fat. Forget this example for a second, but let's just talk in general. And there comes this tipping point where it is very tough for them to maintain the muscle or not lose But or or keep it at a 10 percent muscle loss and not lose more Because the body basically is preferentially like we don't want to get rid of this fat anymore They, they, they get to this point. And so, these are very nuanced conversations. I typically have these when the body mass index gets under 30. And for me, it's always like, okay, now we're just in a zone where we need to have a different mindset and we need to do different things. This is why I love to work with people long term, because the challenges are going to be very different to you. Just mark this as being a truth. The challenges are going to be very different. Month one on the med, month six and beyond. Once you've been on the highest dose for six months, once you've reached maintenance, there are different challenges at different points. And if you work with someone like me that's Obesity Medicine Board Certified that understands this, where we're doing this all day long, that's in these numbers, that understands this. I mean, I can't stress enough to understand this in body. I had to do a lot of additional training, like literally seeking out a mentor, doing additional stuff, because I'm not just looking at the normal ranges on the, on the printouts of these reports, because again, the data is only as good as you understanding what to do with it. But I wanted to give this example today, number one, just to highlight that BMI. We talk about it, but I think this example highlights that a lot more, and then it will dictate your next steps as far as understanding, okay, got it, Oh, that actually wasn't me thinking there's a bunch of fat all over my body. This is actually loose skin getting all that perspective on all the different levels. You need to talk to a physician to go over these things so that you can understand it. So I hope that this episode was helpful today. I questioned putting it out because I wondered if it was just too in the weeds. But honestly, I think it's going to be life changing for some of you where this does apply to you. I feel like this is kind of behind closed doors. I'm talking with everybody about these things, but it needs to be said out there more because actually a lot of you are starting to encounter this. And if you're not, that's totally fine. Again, this is why it's a nuanced thing. But to those of you where it applies to you, if you know someone where they're in this scenario, where they've lost a significant amount of body weight, please pass this episode on to them, because they need to hear this. And I can't package it up small enough to put it on social. A topic like this will not work in a soundbite on social. This is why I have a podcast. All right. I hope you enjoyed this today. Send me a message. If you thought it was helpful, tag me in something on social. I'm a tear and TMD everywhere and all the social platforms. I love to hear from you because then I get to hear what episodes you really want. All right. We will talk soon. Have a great rest of the week.