The Truly Massive BMI Fiasco

If you’ve been following the evolution of our current obesity epidemic, likely you have heard the term “Body Mass Index” or BMI. It’s a height/weight formula used to diagnose and manage obesity. The formula is BMI = kg/m ² where kg is your weight in kilograms and m ² is your height in meters, squared. Thus, BMI is essentially a size measure. The experts at WHO have classified a BMI as outlined below.

 
Science, Science—Who stole the Science
As a family physician with an interest in metabolic problems and obesity, I find the history of BMI to be rather fascinating, if not somewhat disturbing. To understand why, let’s review the historical background of this popular measurement. BMI was first described in the early 1800’s by Adolphe Quetelet, a Belgian astronomer, sociologist, and mathematician. He never intended to use BMI for medical purposes, but rather to define the dimensions of the ideal human form. Things stumbled along for many years until Ancel Keys proposed using BMI to define obesity. He published his landmark article “Indices of Relative Weight and Obesity” in the Journal of Chronic Diseases in 1972. Keyes spent decades working in the bowels of research labs at the University of Minnesota. I am very familiar with his work, as I graduated from the University of Minnesota Medical School and spent years buried in research labs under the tutelage of Franz Halberg, who singlehandedly started the field of chronobiology. Keys and Halberg are likely the best-known University of Minnesota scientists.

Keys was obsessed with obesity, but he tended to criticize rather than just study the topic. Like most people who view obesity as a choice, he viewed it as a moral issue caused by too many calories and not enough activity. BMI became the international standard for measuring obesity in the 1980s and in June 1998, the National Institutes of Health approved the current BMI standards. There’s only one problem with this tortuous saga—it completely left out science.

Since my days working with Franz Halberg, I have considered myself to be a scientist. At the beginning of our current obesity epidemic, I decided that I needed to study the problem and I learned that obesity is defined as “excess body fat”. Obese individuals have too much fat in their body relative to other tissues like organs, muscle, connective tissue, etc., making obesity a body composition issue. There are many technologies to measure body composition. Most methods are expensive and only appropriate for research. Decades ago, I discovered two devices that I could purchase for my medical practice: an FDA approved scale that uses bioelectrical impedance, and a Futrex 5000 machine that uses near infrared light technology. I purchased both instruments and started to measure the body composition of every patient at every visit. I eventually took over 10,000 such measurements.

Unfortunately for the health of mankind, BMI became firmly entrenched in the medical and scientific communities. There’s a major problem with this approach. Although BMI and percent body fat tend to correlate in populations, you are not a population, and I don’t treat populations—I treat individual patients. What does BMI tell you about the amount of fat in your body? Zippo, zilch, nada, nothing! BMI is strictly a size measure, and I can estimate your size by simply looking at you! Using BMI in medicine has absolutely no basis in science and is firmly entrenched in anti-science. We know that there are dozens of likely variables that can contribute to obesity, including diet, activity level, genetic factors, associated medical conditions, emotional status, sleep, social support, race, and many other factors. In the world of science, there are two basic ways to study a problem:

1. Observations made in the real world, looking for correlations.
2. Controlled studies.

Regardless of which method you are using, when you decide to look at a given variable—say diet, next you must examine how dietary changes affect fat storage in groups or individuals. If you are using BMI to determine fat storage—good luck! You will have virtually no chance of determining anything about fat content because you refuse to measure it. You just flushed science down the toilet! I propose that anyone who endorses using BMI for anything related to medicine or science be referred to as a “fathead”, because if they have a brain, they obviously aren’t using it.

Connecting All the Dots
There’s another major adverse consequence of using BMI. It led the medical and scientific communities to miss the most common disease in developed societies. For decades I had an interest in neuroscience and I joined Stephen Stahl’s Neuroscience Education Institute. Because of this exposure, I became very familiar with the various symptoms that can accompany brain disorders. I was also measuring the body composition of every patient at every visit. Soon I noticed a correlation between certain brain dysfunction symptoms and changes in body composition. This change in symptoms always seemed to precede changes in body composition by several weeks. When the symptoms got worse, soon percent body fat would start to rise regardless of other factors like diet or exercise. If the symptoms got better, several weeks later percent body fat would start to automatically drop.

It became obvious that when it comes to fat storage, the brain calls the shots! That makes sense from an evolutionary standpoint. I eventually identified 22 symptoms that fit this pattern. It appeared to me that this condition fit the pattern of a disease that I term Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. I began to look for ways to suppress these symptoms, and eventually I found two approaches. These symptoms seem to reflect low levels of monoamine neurotransmitters like dopamine, norepinephrine, and serotonin. From my neuroscience studies I knew of two approaches that might work:

1. Use precursor amino acids that the brain uses to make monoamines.
2. Use drugs that magnify the effects of the monoamines.

The Fen-Phen Revolution
In 1983 a University of Rochester professor named Michael Weintraub proposed that the combination of the drugs phentermine and fenfluramine could be used as a combination to treat obesity. He ran a four-year study using the combination on 121 obese subjects and the results were published in 1992. I stumbled across his article in the early 1990’s and started using Fen-Phen in my medical practice. Because I was measuring the body composition on all my patients, I immediately realized the power of this combination to reduce excessive body fat while at the same time improving bothersome brain dysfunction symptoms.

Later I decided to add precursors like L-tyrosine and 5-htp and I formulated a product called CARB-22 that combines monoamine precursors along with some co-factors. When I added this product to Fen-Phen, I could easily taper most patients off the medications, and they would continue to lose body fat. How did I know? Because unlike the fatheads, I was measuring the body composition of every patient at every visit. As they say, follow the science! When Fen-Phen was gone, I switched to phentermine combined with low dose serotonin enhancing drugs like Prozac or Luvox, and my patients continued to lose excessive body fat as long as the continued CARB-22. This approach is still the most effective way to manage obesity, but virtually nobody knows about it because the fatheads continue to be obsessed with unscientific BMI. By doing so, they are stuck in the world of calories in/calories out, a real dead end. So much for the “age of science”.

Diagnose and Treat Your Own Obesity
If you seem to be storing excessive body fat, consider purchasing a relatively inexpensive scale that uses bioelectrical impedance to also measure body composition. They are available for less than $200. If you can’t afford a scale, measure your waist/hip ratio, a reflection of the more metabolically active abdominal fat. Whatever you do, don’t follow the fatheads, and waste your time measuring your BMI!

If you do seem to have some excessive body fat, I favor moving towards a low-carb, Paleo, Zone, or Ketogenic style diet and ramping up your level of exercise. Finding someone to prescribe Fen-Phen style medications will likely be a challenge, but many people do just fine by adding a precursor supplement like CARB-22 along with appropriate life-style changes. This type of supplement is also available under the brand name Appe-Curb. I don’t recommend taking the newer miracle weight loss drugs like Wegovy because these medications can’t be taken forever, they can have serious side effects, and when you stop taking them most of the weight is rapidly regained.

In summary, follow the science, and forget about Ancel Keys and the trail of obesity expert fatheads who have been leading us into our current massive, world-wide obesity epidemic. Although we have a worldwide obesity epidemic, you don’t have to be part of it. Take a deep breath and just do it, because when you follow the science, obesity is an eminently reversible and treatable condition, and as a bonus you will also experience markedly enhanced brain function. I call that a wonderful twofer!

Note: I would like to thank my friend and high school classmate Andy Steinfeldt for editing this post.