Are you really fat?

May 30th, 2014

During the annual physical exam, I typically ask my patients to categorize themselves as:  Underweight, Normal Weight, Overweight, or Obese.  Then I calculate their Body Mass Index (BMI) with an online calculator.  Usually, I get a look of shock or dismay when I tell people that they are overweight when they think they are normal weight.  Next, I recalculate their BMI with their guess as to what they think their weight should be.  Often, this is also above the normal weight for height.  Eventually, we come to a weight that when entered into the calculator is normal.  Then I usually hear another sigh, and a pause, followed by the statement “If I weighed that much, I would look sick and unhealthy!”

The BMI has not changed over the years, however our perception of what is “normal weight” has changed because many of us as a whole have gotten larger.  Imagine you are average height and you take a picture next to an NBA basketball team.  You would certainly feel short.  In this same way, if you are around people who are obese or overweight, you may not perceive yourself to be any different, or may even think of yourself as being thin.  The next time you are “people-watching” look at each family.  Obese parents will often have obese children.  Another good example is the sizes of clothes.  Over time, clothing manufacturers have had to increase the size of clothes to the point where a “Medium” today would be what was considered “Large” or “Extra Large” a few decades ago.  So when you think you have been a “Medium” for the past 20 years, you have actually been fooled.  Anyone who has travelled outside of the US and tried to buy clothes in Europe or South America will understand this.  In women’s clothing, they have had to make dresses in size “00” just to make sizes change with the times.  In New York City, there are subway car seats where very few people can fit in them comfortably today.  This is because the subway seats were designed in the 70’s when most people were smaller than they are today.

Portions of food are another way to see the change in caloric intake over time.  I recently purchased an antique dinner plate.  It was 9 inches in diameter.  These days, the average dinner plate start at 13 inches or more.  Portion sizes of all foods have increased and we are eating way too many calories.  It is not surprising that our waistlines are increasing as a result!

The BMI is as standard for good health.  Being in the overweight or obese categories increase risk of heart disease, diabetes, high blood pressure, and even depression!  Know your BMI and your goal weight.  Work on it!