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Full terms at mintmobile.com. What's

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the podcast about, Sachi? We're

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on a quest to find out where in the

1:32

world women are prospering, from their physical health to

1:35

their emotional fulfillment, all so that we can imagine

1:37

what a perfect place for women would look like.

1:40

Yeah, it's fair to say we're not

1:42

big fans of a lot of the

1:44

content marketed to us as wellness, so

1:46

you won't catch us mushrooms stacking or

1:48

rainwater fasting. But we are

1:50

here to explore the lived experiences

1:52

of some incredible women around the

1:55

world. In each episode, we'll dig

1:57

into an important topic that affects all of

1:59

our lives. And we'll meet two women

2:01

who explain how things are going in two

2:03

very different countries that seem to be getting

2:05

something right. At the end, Sophia

2:07

and I will decide whether one of

2:09

these countries, or both, or neither, deserves

2:11

a spot in our female fantasy land.

2:14

Let's be a woman from the

2:16

BBC World Service. Listen now wherever

2:18

you get your BBC podcasts. Richard,

2:25

I'm in my bathroom. Are you in

2:27

your bathroom? I'm in my bathroom, Anna,

2:29

yeah. Okay, I need your numbers. Okay,

2:32

well I'm one metre ninety tall, or

2:34

six foot two. Okay, and

2:37

have you got your scales? I've got my

2:39

scales here, and it

2:41

tells me that I am

2:43

ninety four kilos. Okay, so

2:46

your one point nine

2:50

metres squared divided

2:53

by ninety four kilos gives

2:55

you twenty six. Congratulations,

2:58

twenty six. BMI of twenty

3:00

six, okay. Let's do yours now. Okay,

3:04

so standing on, that's

3:07

some kilos, two

3:10

point six two, and

3:12

then I divide that and it

3:14

gives me thirty, which was very

3:16

brave of me. Well done. Welcome

3:22

to Crowd Science from the BBC World Service.

3:24

I'm Marnie Chesterton. That was me

3:27

in my bathroom, my producer Richard

3:29

in his, armed with calculators, scales

3:31

and tape measures, because we were

3:33

calculating a common measure of our

3:36

body's health, the Body Mass Index,

3:38

or BMI. And the reason?

3:41

It's because of listener Mike in Germany. Hi,

3:43

my name is Mike Muller and my

3:45

question for Crowd Science is, what

3:47

does the BMI tell me about my

3:49

health and is it still a useful

3:51

measurement tool today? I'm

3:54

interested in this question because my

3:56

BMI has always been too high

3:58

and tells me therefore. that

4:00

I'm overweight but I

4:02

don't think that I really am. I've always

4:04

been quite muscly and I'm

4:06

not the tallest so therefore

4:09

I think that gives me a bit of

4:11

a distorted BMI. So I

4:13

wonder if you just come all in different

4:15

shapes and sizes. My background is

4:17

that I have worked with dogs for many many

4:19

years and we can't

4:22

be all greyhounds so I would

4:24

describe myself probably more the shape

4:26

and size of a Labrador crossed

4:28

with a stuffy. My

4:31

neighbours they are like greyhounds they can eat what

4:33

they want and they are really tall and slim.

4:36

For me I have just a different size and

4:38

shape so the BMI would never give me an

4:41

accurate reading I feel. The

4:43

Body Mass Index or BMI gives you

4:45

a number. The World Health Organization says

4:47

that 20 to 25 is normal 25 to 30 is overweight

4:49

30 to 35 is obese

4:56

and over 35 morbidly obese.

4:59

Their latest global figures put adult

5:01

obesity at one person in eight

5:03

double what it was in

5:06

1990 they say. Mike,

5:08

producer Riches and I have BMI's

5:11

of between 26 and

5:13

30. Mike has a

5:15

strong feeling that his is not a

5:17

fair reflection of his general health. Is

5:20

he right and if so why on

5:22

earth did the BMI rise to

5:24

its current status as universal health

5:26

marker? Time for a bit of history. The

5:31

inventor of the BMI was a 19th century

5:34

Belgian astronomer called Adolf Kettelay

5:36

who was interested in the

5:38

nature of the average man

5:40

or some say ideal man.

5:43

Even then he was thinking in terms

5:45

of populations rather than individual health care

5:48

entered the US health insurance companies

5:50

who noticed that those at the

5:52

extremes of the BMI the very

5:54

fat and very thin had a

5:56

higher risk of dying. The modern

5:58

term Body Mass index was coined

6:01

in 1972 by

6:03

Harvard physiologist Ansel Keys, who

6:05

said the BMI proves

6:07

to be, if not fully satisfactory,

6:09

at least as good as any

6:12

other relative weight index as an

6:14

indicator of obesity. Notes

6:16

the qualifier not fully

6:19

satisfactory. But from the 80s

6:21

onward the BMI has been used

6:23

by the World Health Organization for

6:25

recording obesity statistics. But

6:27

what does it tell us? That's a

6:30

question for Dr. Naveed Satter, professor

6:32

of cardiometabolic medicine at the University

6:34

of Glasgow and chair of the

6:36

UK's obesity mission. It's

6:39

a very good screening tool. It allows us

6:41

to work out in a really quick fashion

6:43

whether we need to delve into

6:45

aspects related to excess weight and

6:48

also whether I need to do additional blood

6:50

tests to tell me is the weight that

6:52

the individual is living with leading to some

6:54

complications of her tissues or organs that

6:56

then needs me to look for diagnosing

6:58

further conditions linked to excess weight. Why

7:01

is having a lot of fat bad for

7:03

you? So if you have

7:06

excess fat beyond the body's needs

7:08

it will seep into various organs,

7:10

into the blood, into the liver,

7:12

pancreas, muscles around the

7:14

kidneys and around the heart. And

7:18

excess fat effectively alters the few

7:20

that the body sees. It applies

7:22

pressure on the pumps and

7:24

pipes within your body. It

7:27

also disrupts some of the filters of your body,

7:29

i.e. your kidneys and your liver, so

7:31

that their function actually is impaired. But

7:35

one of the many criticisms of

7:37

the body mass index is that

7:39

it's inaccurate. Some incredibly fit athletes

7:41

like boxer Mike Tyson or tennis

7:43

legend Serena Williams or even

7:46

people like our listener Mike have

7:48

high BMIs which suggest they're overweight

7:50

and unhealthy when actually they just

7:52

have a lot of muscle. Given

7:55

this flaw, does Naveed see a point

7:57

to measuring the BMI? Yes

7:59

it is. I mean, I think again,

8:01

it will allow us as many nations to

8:03

look at the track of excess adiposity over

8:05

time. That's what we've measured. Many

8:08

people are able to measure change, you know, if

8:10

they under make a change, the best and most

8:12

accurate way to measure that change, at

8:14

least in the short term, is the weight,

8:17

which is measured on scales, which is a key part

8:19

of BMI. And as I

8:21

said, it's part of a screening tool, but

8:23

you're completely correct. BMI on its own is

8:25

not enough. We are gradually understanding

8:28

that where you put your fat and

8:30

what the consequences of fat are in

8:32

terms of your body and how doctors

8:34

capture that and how we explain that

8:36

to our patients, as well as think

8:38

about other aspects, what conditions they have

8:40

and what their activities of daily living

8:42

are. Putting all that into a package

8:44

will better help us assess whether that

8:46

individual's weight is leading to problems that

8:48

we can help them with. Naveed

8:51

says that excess fat puts our

8:53

bodies under stress, like an overloaded

8:56

car. And he admits he

8:58

still finds the BMI useful, sort of

9:00

as a starter test to see whether

9:02

more measures of a person's health are

9:04

needed. But if the

9:06

BMI is telling fit, muscly types

9:09

they're overweight, I wonder

9:11

what other tools are

9:14

on offer. Sometimes

9:16

here on CrowdScience we turn human

9:18

guinea pig and so with a

9:20

certain amount of reluctance, I

9:23

went to the University of Westminster in central

9:25

London to have a go on something called

9:27

a BodPod, an expensive

9:30

body composition measuring device.

9:33

There, to talk me through

9:35

the process, we're head of Life

9:37

Sciences Professor Brendan Noble and nutritional

9:39

expert technician Leah Siegel. Today

9:42

we're going to be doing a BodPod

9:44

measurement. So it is

9:47

a measure of your body composition

9:49

using air displacement and

9:51

the first few things that

9:53

we'll do, we'll take your height and weight and

9:56

you'll put on a very tight

9:58

outfit just so there's no added volume

10:00

with your clothes and we'll

10:02

also put a lovely little swim cap on

10:05

for you and then you'll go into the

10:07

pod and you'll have your body composition measured.

10:09

Great! What's

10:12

the point of this? So

10:15

looking at body composition people do it

10:17

for a lot of different reasons, maybe

10:20

from a health perspective, maybe from a

10:22

performance perspective if they take part in

10:24

sport or athletics. Okay so

10:26

Brendan is this better than doing a

10:28

BMI? Yes it's always certainly going

10:30

to be better than

10:33

doing a BMI. BMI is very useful across

10:36

the population but BMI is based

10:38

on height and weight and

10:41

muscle is very much heavier than

10:43

fat and so if you've

10:46

got a lot of muscle this

10:48

is going to skew things. I should tell the

10:50

radio audience because this is radio I did not

10:52

have a great deal of muscle, I wouldn't say

10:54

I'm stacked so

10:57

more of a curvy yeah.

11:00

We'll see what the bud pod says. If

11:07

you've seen any sci-fi

11:09

film you know people are

11:13

kind of frozen for long

11:16

distance space travel and they put

11:18

them in these kind of pods with a

11:20

little sort of viewing window out

11:24

the front. It's bulking that's what it looks like. Well

11:30

open up the bud pod and you can see inside.

11:33

The first measure it'll be very quick. I

11:51

was sitting in this pod in my

11:53

underwear with my hair bundled under a

11:56

swimming cap trying very hard not to

11:58

move. Wouldn't want my results. results to

12:00

be inaccurate. Okay, so you'll be

12:02

hit up in the Bod Pod now. What do you

12:05

think? Um, that was weird though. You can

12:08

exit the pod if you would like. Yeah,

12:10

I'll get it. As

12:12

I got dressed, the Bod Pod algorithm

12:14

did its calculations. I had to

12:17

tell it my ethnicity because if I

12:19

were a black Caribbean woman, for example,

12:21

my bones would be stronger and heavier.

12:24

Yet another subtle difference that the

12:26

BMI doesn't factor in. Right,

12:28

so this is a printout of your test

12:30

results. It has a few

12:33

different bits of information here. So

12:35

one of them is the body fat percentage that

12:37

you can see there. You also

12:39

have your FFM percentage. So FFM is

12:42

your fat free mass. That is everything

12:44

in your body that is not fat.

12:46

So that's your muscle, your bones, your

12:48

organs. Is it really worth me

12:50

having all this information? Unless I want to

12:52

compete in the Olympics this summer, and frankly,

12:54

I've left training a little late for that.

12:57

After all, the information from the Bod Pod,

13:00

how much of me is fat tissue, is

13:02

not massively different to what I've learnt

13:05

from my BMI. I

13:07

could also have used a tape measure around

13:09

my waist, or pinched an inch of belly

13:11

fat with some calipers. At

13:14

the office, I've also used

13:16

a bioelectric impedance machine. You

13:19

grip it with both hands, and it

13:21

sends a small and safe electrical current

13:23

through your body, measuring resistance. The

13:26

higher the resistance, the higher the body

13:28

fat. They all give

13:30

me the information I knew all along. I'm overweight.

13:34

Borderline obese. But

13:36

that's just me. BMI is

13:38

a globally used measure. And

13:41

as I just mentioned, Bod Pod

13:43

takes ethnicity into account in a

13:45

way that weight divided by your

13:47

height squared just doesn't. Is

13:49

that a problem? Well, let's

13:51

ask some people from one of

13:53

the world's most obese countries, according

13:55

to BMI statistics, Tonga, in

13:58

the South Pacific. What

14:00

do Tongans think about their weight and about

14:02

the BMI? But

14:31

I think for us here in Tonga,

14:33

even on the Pacific, we need to

14:35

have a different way of

14:37

serving. You know, for

14:41

us to really calculate

14:44

if we are obese or not. Not

14:48

just by how we look and how

14:51

big we are and how big is

14:53

our legs. We love these

14:55

legs. You

14:57

can't stand in front of me if I run straight

14:59

to you. You know you are

15:02

recommended. That's how we love it,

15:04

you know. We do like we can run

15:06

quick and run really fast.

15:09

So we don't measure us by how we look. I've

15:12

been involved in a few weight loss

15:14

programs and whenever we

15:16

go to weigh in, they give us

15:19

the recommended BMI for one's

15:21

height. And I'm kind of like one of

15:23

those taller Tongan women, 1.75 meters. When

15:27

they tell me my recommended weight for

15:29

my height, I look at that

15:31

and I think to myself, I'm never going to

15:33

get there. I'm going to starve before I actually

15:36

achieve that weight. And what

15:39

is just naturally

15:43

taller or has a bigger physique. So there

15:45

needs to be some thought given

15:47

into constructing a BMI that's probably based on

15:49

the genetics of those people. Rather

15:52

than prescribing something where

15:54

one feels like a failure from the

15:56

start. from

16:00

Tonga speaking to us there about their

16:02

BMIs. What they've highlighted

16:04

makes me think back to listener

16:07

Mike's dog analogy. Maybe BMI

16:09

is not picking up on the

16:11

difference between a slender greyhound type

16:13

or a solid pitbull type. And

16:16

yet when I look at the health

16:19

stats for Tonga obesity does seem to

16:21

be an issue. Life expectancy

16:23

in Tonga is below the global average

16:25

at just over 71 years and

16:28

diabetes which is strongly linked to

16:30

obesity is the leading cause of

16:32

death there. There

16:35

are clearly all sorts of factors

16:37

at play here from body type

16:39

to lifestyle to availability of healthy

16:41

food. But at this point

16:43

I still want more clarity on how

16:45

much the BMI measurement is bringing to

16:47

the table. What does it teach

16:49

you about your health? The BMI

16:52

doesn't tell you anything about how your

16:54

organs work or do not work which

16:57

is what normally defines whether a person

16:59

has an ongoing illness. And

17:01

so BMI itself is a measure of risk

17:03

but it's not a measure of health. Meet

17:06

Dr. Francesco Rubino. He's

17:08

chair of bariatric and metabolic surgery

17:11

at King's College London. That means

17:13

he specialises in surgery related to

17:15

obesity. He's also leading a

17:18

commission or group at the medical

17:20

journal Valancet looking at the current

17:22

obesity epidemic and asking useful questions

17:25

like what is a medically useful

17:27

definition of obesity and should we

17:29

replace the BMI? What

17:32

does he make of the high BMI

17:34

scores across many islands of the South

17:36

Pacific like Tonga? Yes

17:38

I think what is important to say

17:40

is that we don't actually know exactly

17:42

what is causing this epidemic and pandemic

17:44

of obesity that we have seen in

17:47

the last many decades. We have assumed

17:49

that it's a personal decision to eat

17:51

more or exercise less but every

17:53

scientific piece of evidence tells

17:55

us a different story. The reason why there

17:58

is a pandemic is I'm not completely

18:00

understood, but it's clear that there

18:02

are multiple factors that contribute. So

18:04

certainly our genetic makeup makes some

18:06

people more predisposed to develop obesity

18:08

even in the same environment. And

18:11

then there's probably something that changed in

18:13

recent years and the most recent times,

18:16

like in the last three to four

18:18

decades in the food environment that perhaps

18:20

is fueling this pandemic. So reducing obesity

18:22

to a matter of lifestyle choices is

18:25

just inconsistent with scientific evidence. There

18:27

is an implication that we trust the

18:30

BMI because it's a scientific tool used

18:32

by doctors. And the suggestion is it's

18:34

a tool we can control. Remember, it's

18:36

our weight divided by our height squared.

18:39

We can't of course control our height,

18:41

but we can, the BMI suggests, control

18:43

our weight. To some

18:46

extent it is true that you

18:48

can modify your weight if you

18:50

indulge in some type

18:52

of food and overeating over a period

18:54

of time or if you join

18:57

a gym and start doing some exercise you

18:59

will see your waistline may actually

19:01

go up and down as you would expect.

19:03

And so you build this idea that you're

19:06

in control. And the problem

19:08

is that we are only in control for

19:10

a limited amount of

19:13

our body weight regulation.

19:15

When you start having a level of weight that is significantly

19:18

elevated and fat mass is no

19:20

longer physiologically normally regulated,

19:22

then thinking that you can

19:25

reduce and change at wish

19:28

and do obesity as you wish is just

19:30

naive. If, as Francesco

19:32

says, we have limited control over

19:34

our weight, is it problematic that

19:37

we're using a blunt tool like

19:39

BMI to advise patients on how

19:41

to approach their health? BMI

19:43

was never meant to be a clinical

19:47

tool and the problem is that we

19:49

have used it as such, mostly

19:51

for insurance purposes because it's an easy tool

19:54

to define who gets coverage for

19:56

a treatment who doesn't. But

19:58

in doing so we have seen... time and

20:00

again for many, many years that people

20:02

can be denied access to treatment based

20:04

on arbitrary definitions

20:07

that take BMI above or below

20:09

certain threshold as the reason why

20:12

people should be treated. That absolutely

20:14

makes no medical sense, but unfortunately

20:16

it's the way insurance coverage in

20:18

private and public health systems still

20:21

work. Yes, I've seen it.

20:23

I've experienced it. I can tell that

20:25

there was a treatment that I was

20:28

up for and I thought because my

20:30

BMI is kind of around 30, I

20:33

thought I know that if this is over 30, this

20:36

is going to be something in the arsenal for them

20:38

to be able to say no, you can't have this

20:40

treatment. So when I knew

20:42

I was being weighed, I just didn't have any

20:44

breakfast and I was

20:46

kind of desperately trying to pee before that. Well

20:50

the paradox is that sometimes the

20:52

BMI of certain level is used

20:55

to say that

20:57

people don't – if they don't meet a

20:59

certain threshold, they cannot get coverage for a

21:01

treatment for obesity. On the other hand, if

21:04

you have a BMI that is too high,

21:07

people don't let you have access to another

21:09

treatment, not for obesity, but for something else

21:11

on the assumption that obesity might actually make

21:13

it more difficult for that treatment

21:15

to succeed. So basically, some

21:17

other world, people with obesity

21:19

are always put in a difficult situation and I

21:22

think they are treated unfairly by society

21:24

at large, but including by

21:27

the healthcare system and medical professionals.

21:29

To me, weight stigma is the single

21:32

most important problem we have in obesity.

21:34

Weight stigma, also known as fatphobia,

21:36

and BMI's role in

21:38

it is the subject of philosopher

21:40

Kate Mann's new book, Unshrinking, How

21:43

to Fight Fatphobia. I

21:45

wondered if she'd go as far as saying that the

21:47

BMI is so crude at all that we should just

21:49

drop it completely. So I think

21:51

many weight-inclusive or weight-neutral physicians do

21:54

believe that for a couple of

21:56

reasons. One is that

21:58

having your BMI calculated

22:00

at every doctor's visit can

22:03

be very stigmatizing and

22:05

especially in a fatphobic society really

22:08

leads to demonstrable results of

22:10

people avoiding healthcare as they

22:12

gain weight. So taking

22:14

that out of the equation can be quite

22:17

helpful in helping people

22:19

not avoid the doctor which we

22:21

have evidence that as women gain

22:23

weight and as they enter higher

22:26

BMI classes they avoid healthcare in

22:28

direct proportion to increases in BMI

22:30

which is really serious. The

22:33

flip side of that would be that

22:36

if you do go to your doctor and

22:38

you do have a high say

22:40

obese BMI that will be the focus

22:42

of whatever you've gone to the doctor

22:44

about because the messaging is

22:47

you need to lose weight rather than addressing

22:49

what else you might have gone to the

22:51

doctor for. Yeah totally and

22:54

that was the other thing I think is

22:56

worth mentioning here. Oftentimes the

22:58

focus of doctors appointments become well

23:00

you need to lose weight but

23:02

the fact is we don't yet

23:04

have humane, effective, feasible, safe solutions

23:07

for people to reliably lose weight

23:09

in a way that is

23:12

actually practical for people and that

23:14

has good results and does more

23:16

good than harm in the majority

23:18

of cases. So we know

23:20

that diets don't work, they have incredibly high failure

23:22

rates of between 95 and 98%. We

23:26

know that actually dieting is a

23:28

really good predictor of long term

23:30

weight gain rather than the converse

23:32

and that comes from not just one

23:35

or two studies but the most robust

23:37

meta-analyses of really every long term diet

23:39

study that's been done to date. So

23:43

it may be that the best

23:45

solution for people is to engage

23:47

in health behaviors that are positive

23:49

like exercise and eating well and

23:51

not taking weight loss as

23:53

a realistic and feasible health

23:55

goal for the majority of

23:57

bodies. You say there's a

23:59

moral panic over the

24:01

so-called obesity epidemic. Is that

24:04

related to the BMI? Yes,

24:06

absolutely. The

24:08

BMI many people don't know, the

24:10

standards for it were changed in

24:12

about 1998 in the US where

24:18

people who were previously categorized

24:20

as having normal weight became

24:23

overweight and similarly people

24:25

who were previously classified as overweight

24:27

became obese overnight because the standard

24:29

for healthy weight was decreased from

24:31

about 27 or 28 depending on

24:33

gender to 25

24:38

being the cutoff for them becoming overweight

24:41

for both men and women. You can't

24:43

just change the classifications can you? Well

24:46

they did, they can and it was

24:48

based on World Health Organization

24:50

recommendations but this wasn't

24:52

based again on the idea that people

24:55

are actually becoming unhealthy at a certain

24:57

weight. It was based partly on a

24:59

purely arbitrary idea that the number 25

25:01

was a nice easy

25:03

number for people to remember. So

25:07

take the BMI out of the equation or

25:09

I don't know it sounds

25:11

like if you were in charge

25:14

maybe there's a lot of

25:16

awareness training you do. We

25:18

desperately need to do physician

25:20

anti-bias training that includes weight

25:22

stigma both because we know

25:24

that physicians are not just

25:26

guilty of implicit bias in this regard.

25:29

Doctors openly say things like they regard

25:32

fat patients as a waste of their

25:34

time and that fat patients are more

25:36

likely to annoy them. They're less likely

25:38

to want to help fat patients and

25:41

they spend less time with us. But

25:44

when I speak to really brilliant

25:46

weight inclusive physicians like Dr. Mara

25:49

Gordon in the US, what she

25:51

has done is take weight out

25:54

of the conversation. She doesn't assess

25:56

patients BMI. She goes directly to

25:58

more precise indicators. of health

26:01

like blood pressure, like blood

26:03

work and particular

26:06

metrics depending on a patient's particular

26:08

symptoms and that both makes patients

26:10

more likely to want to come

26:12

back to a doctor who isn't

26:14

shaming them or making their weight

26:16

which as a fat

26:18

person I can assure you that I'm

26:20

very aware of my weight at any

26:23

particular time but these

26:25

patients are more likely to want to

26:27

return to the doctor and get that

26:29

humane inclusive care that could

26:32

be really life altering potentially life

26:34

saving. So

26:37

the BMI, invented by an astronomer

26:39

which has had its categories overweight

26:41

and obese tinkered with over time

26:43

which was never meant to be

26:45

used as a clinical tool for

26:47

individuals and which as

26:49

we've established doesn't take into account

26:52

different body types and ethnicities is

26:55

still being used as the

26:57

way to sort those at risk of

26:59

ill health from those with a so-called

27:01

healthy BMI. Where

27:03

do all these problems leave the BMI in

27:05

the future? Is it a

27:07

quick tool to help doctors assess potential

27:10

problems related to being overweight or

27:12

is it destined for the scrap heap of medical

27:14

history? I think what

27:17

I can anticipate is that the

27:19

conclusion of this commission is that

27:21

BMI alone cannot be used in

27:23

clinical practice. That's Francesco Rubino

27:25

again. His commission is looking into among

27:28

other things how the BMI should be

27:30

used in the future. We

27:32

cannot use BMI alone for clinical purposes

27:35

to understand if somebody has an illness

27:37

or somebody doesn't or even in

27:39

the first place if somebody has a really

27:41

excess fat tissue or just an excess weight

27:43

due to other reasons. So what we are

27:46

advocating is to have a

27:48

more nuanced assessment. The user's BMI has a

27:50

screening tool but maybe looking at other measures

27:52

as well. But

27:55

what do we even want from whatever new

27:57

form the BMI will take? Is

28:00

the focus about getting a better measure of

28:02

fatness? Or is there a better

28:04

route to measuring health which is less focused

28:06

on measuring fatness at all? Shape

28:09

man has some thoughts for those with a BMI of over

28:11

30 or 35. I

28:14

think that there is a lot of shame and

28:16

blame when it comes to weight. And

28:18

I think a lot of people feel that, well,

28:21

there's something a bit wrong with

28:23

them, that they are heavier because

28:25

they're somehow not doing it right.

28:28

And I really want people to understand that

28:30

bodies just come in a range of shapes

28:32

and sizes that's always been the case in

28:35

human history. I think it always will be

28:37

the case. And I think

28:39

that oftentimes the relationship between weight

28:41

and health is really exaggerated and

28:43

oversimplified. I tell my story in

28:45

the book about having been a person who

28:47

did have a BMI at one point in

28:49

this quote unquote severely obese category,

28:51

a BMI of over 40. And

28:55

I was perfectly healthy. I had excellent

28:57

blood work. I had excellent blood pressure.

28:59

I was very active. And

29:01

then I lost quite a

29:04

lot of weight just through starvation dieting

29:06

which was the only way my body

29:08

would lose weight. And believe me,

29:10

I've tried everything. And I'm now

29:12

a lighter, still overweight,

29:14

but now a lighter and much

29:16

less healthy person because my body

29:19

has really been through the ringer

29:21

of starvation diet. So,

29:28

Listener Mike asked us what the BMI

29:30

could tell him about his health. And

29:33

frankly, given that his BMI is neither

29:35

very low or very high, it doesn't

29:37

tell us very much. Those

29:40

who do use it say it's a

29:42

good gateway tool for assessing if someone

29:44

is at risk of certain diseases. But

29:47

even fans of it admit it was

29:49

modelled on the average white man and

29:51

it's only a rough test of whether

29:54

someone needs further tests. Those

29:56

who aren't fans point out that

29:58

if you are overweight, you face

30:00

enough stigma from society without a

30:02

number on your chart that might

30:04

mean your doctor focuses on your

30:06

weight, not any other medical issue

30:09

you have. I'm not denying that

30:11

carrying excess weight increases your risk

30:13

of dozens of diseases, from type

30:15

2 diabetes to cancer. It's

30:18

just I'm left wondering, given that

30:20

shaming and dieting haven't stopped the

30:22

growing numbers of us who are

30:25

overweight, what is the best

30:27

approach to keeping us healthy? But

30:30

that's another crowd science for another time.

30:33

My thanks to Mike for his question and back

30:35

to him for the credits. That's

30:37

all for this episode of Crowd Science

30:39

from the BBC World Service. This question

30:42

came from Mike in Dresden in Germany.

30:45

And if you'd like to

30:47

ask the team a question, then

30:49

email it to crowdscience at the

30:51

bbc.co.uk. And this programme

30:53

was presented by Marley Chesterton and

30:56

produced by Richard Walker. Thanks

30:58

for listening. Tchuss. I'm

31:25

creating a handbook to life full of

31:27

advice for daughters everywhere. Listen

31:30

now by searching for dear daughter

31:32

wherever you get your BBC podcasts. The

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