momentary lapse, with chocolate

Yesterday was incredibly stressful in the office. I mean, totally horrible. I had blocked out my calendar so I could clear some stuff off of my desk but that never happened. Try as I might, I didn't actually finish one task that I had started. Physically, the stress was making me feel horrible. Walking wasn't helping, fresh air didn't do any good. Nothing was working for me. Well, nothing until I remembered I had some chocolate in my desk. Good chocolate at that, the kind of Europe. I don't normally have anything like that in my desk but it had been given to me the other day as part of a thank you goodie bag I'd received from a colleague (it also had lovely teas and a pretty mug). I really shouldn't have but I opened the chocolate and it actually helped me. I felt calmer and was able to get a few things sorted out before I left. I still didn't actually finish anything I started but at least I felt better. I didn't even beat myself up over the chocolate. Something was happening in me yesterday that could only be treated chemically, with chocolate. Weird huh??

Today is less stressful but still no more productive. I did have another fabulous workout this morning and my eating has been great all day so, so far, so good. I plan to take the weekend in stride too, no sense freaking myself out about it. I'm just planning to take things as they come and remain as on plan as I can!

food for thought

Fit or fat? BMI comes under fire

The body mass index is widely used to decide who is overweight and in danger of health problems

At 5 feet 4 inches tall and weighing 146 pounds, you think you're an average-sized woman.

And as guys go, at 5 feet 11 inches tall and 185 pounds, you think your husband is in pretty good shape, too.

Well, we hate to burst your bubble but according to the standard international benchmark for weight — the BMI or body mass index — you're both overweight and at a higher risk of a host of health problems.

Don't believe it? Neither do a growing chorus of experts who say the BMI does more harm than good because it focuses on weight and height and not physical activity as a factor in good health.

In fact, the "epidemic of obesity" linked to the BMI measurement that is supposedly wreaking havoc on the health and well-being of North Americans of all ages, is nothing but a bunch of bogus "mumbo jumbo," says Paul Campos, author of The Obesity Myth and a law professor at the University of Colorado.

"(The body mass index) is an artifact of an eating-disordered culture with a fear (of) fatness," he told a University of Toronto forum on the Politics of Obesity. "It is not based on rigorous science ... (and it is) part of a culture that worships emaciation."

The BMI was adopted in the 1970s, ostensibly to more accurately reflect a range of desirable weights and to get away from the life insurance tables that used height, weight and body frame to set healthy weights.

It is based on a mathematical formula using weight and height to derive a specific number. People with BMIs from 19 to 24.9 are considered to be at healthy weights, those with numbers from 25 to 29.9 are ranked as overweight and those who hit 30 and up are labelled obese.

However, factors such as physical activity, smoking, lifestyle and genetics affect health much more than weight, Campos says. He says there is no real correlation between overweight body mass and health risk if fitness and socio-economic levels are considered.

For Mary, a 44-year-old worker in the health care field who did not want her real name used, the BMI is very confusing. The mother of three gets up at 7 a.m. each day and is on the go until she hits the pillow about 11. She walks a lot to stay in shape and eats healthy foods. She had a thyroid condition now under control and in general thinks she is fit and healthy. But her doctor says she must lose weight because of her BMI.

"I'd like to be maybe one or two dress sizes smaller," she says. "The Barbie or model type image in the media is what we think we should be. But for many women they can't get there."

Campos says most of the studies used to calculate the relationship between BMI and health risks show people rated as overweight have lower death rates than those who are underweight or obese. And he says a fit obese person can be healthier than a normal-weight couch potato.

Study after study show the keys to health are following an active lifestyle and not smoking, he says.

Dr. Peter Katzmarzyk, a spokesperson for the Heart and Stroke Foundation of Canada, agrees that, across the board, fitness levels and smoking are the most important factors in determining health.

The BMI is based on statistical population averages and should be used as a general indicator of health risk and, as such, is a useful tool, Katzmarzyk says.

However, the index is being used by doctors, dietitians and some educators to set weight goals for individuals, a practice that is dead wrong, says Margaret MacNeill, an expert in health and physical education.

The BMI rates the vast majority of Canadians as overweight, says MacNeill, director of the Centre for Girls' and Women's Health and Physical Activity Research at the University of Toronto.

"But this just means they are at a potential risk for a health problem in the future. They are not currently unhealthy. The BMI is a number (on a scale), not a fact. I don't think it is a good tool," she says.

It "tyrannizes" people, especially women, who are conditioned to strive for unrealistic and unhealthy weights, she says.

The BMI cannot factor in the vast variations in body makeup, Campos says. Some people have more muscle or more bone density, making the index misleading, he says. Katzmarzyk says weight around the abdomen indicates a much higher health risk than weight evenly distributed across the body.

To get an idea of what a BMI means, consider that actor Bruce Willis at 6 feet and 211 pounds has a BMI of 29. Tom Cruise, at 5 feet 7 inches and 201 pounds, has a BMI of 31. Sylvester Stallone, who is 5 feet 9 inches and weighs 228 pounds, has a BMI of 34 and California governor Arnold Schwarzenegger, at 6 feet 2 inches and 257 pounds, has a BMI of 33.

No one debates that being obese is bad for your health, Campos and Katzmarzyk say. The number of people with excess weight has been increasing and society must reverse this unhealthy trend, they say.

But the answer is not to target specific people who need to lose weight, MacNeill and Campos say. That's partly because studies also show that many people lose weight but most gain it back — a process that is unhealthier than being overweight in the first place, Campos says.

Heath problems caused by overweight will be fixed only by changes in society, Campos, MacNeill and Katzmarzyk say. We must all become more active and eat healthier food, they say.

Two studies published in the Journal Of The American Medical Association last week show how complex the issue can be. One studied heart health and weight and physical activity; the other looked at the role both play in adult-onset diabetes.

The findings were contradictory. The heart study found higher physical activity correlated with better heart health, and weight was not a big factor. The diabetes study found overweight correlated with increased rates of adult-onset diabetes and that increased physical activity had much less impact.

That could be because the studies did not measure subjects' fitness — for example, by putting them on a treadmill and checking their heart rates — but relied on self-reports.

Weight and height are easy to measure; physical activity is hard to assess, MacNeill says. Peter Donnelly, a professor at the faculty of physical education and health at U of T, agrees that self-reported levels of physical activity are usually off the mark. Such surveys often ignore the full range of a subject's activity.

For example, the heart health study had women with heart problems report their level of physical activity and those who reported being more active had less heart trouble.

However, Katzmarzyk says the women who reported more physical activity did so because they had better heart health. The women who reported being less active may have more serious heart conditions. Subjects in the diabetes study also reported their own activity levels.

Most people do not understand what the BMI means, experts say, or how to apply it to their own health.

The media have oversimplified how it works, MacNeill says, and there is a real need to educate the public.

So think of it this way. Suppose researchers measured the speed of cars travelling on a highway and correlated speed with the number of accidents.

They'd likely find that, statistically, driving too fast or too slowly correlates with more accidents. But they could not say driving at a specific speed caused any specific accident.

In the real world, road conditions, the type of car, its state of repair, the age and experience of the driver along with a host of other things would be a factor in causing an accident.

The debate over "fit versus fat" is raging in the medical and scientific community, according to an editorial in the Journal Of The American Medical Association last week published along with the two recent studies.

"Indisputable evidence links obesity to health problems," the editorial says.

But it goes on to say that obese people with at least moderate activity levels "have lower rates of heart disease and overall mortality than their normal-weight but unfit peers." They also have about half the death rate of unfit people with normal weights, it said.

The conclusion? Physicians, researchers, and policymakers need to spend less time debating the role of fitness and obesity in health and more time getting people active.

So get active and get off the scale.