Fat or Fiction

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More or Less 9 min 6 speakers 3 chapters transcribed 2 months ago
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What is the main topic discussed in this episode?

BBC World Service promo 0:00
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Ruth Alexander 0:13
Hello and welcome to More or Less on the BBC World Service. I'm Ruth Alexander, tipping the scales in favour of numbers that make sense.

What is the controversy around Body Mass Index (BMI)?

Ruth Alexander 0:22
This week we're looking at the Body Mass Index, the internationally agreed measure which, according to the Centre for Disease Control in the United States, is a reliable indicator of body fatness for most people and, according to the National Health Service in the UK, is a good way to check if you're a healthy weight. Now, I must declare an interest right at the top, because I personally have never found the BMI to be reliable. My BMI has always put me as underweight, and yet I think I'm fit and healthy. Now, the last time I was told this by my doctor was more than 10 years ago, so I'm going to calculate it again with Wesley Stevenson helping me.
Wesley Stevenson 1:02
Hi, Ruth. Yes, so what I need you to do is to step on the scales.
Ruth Alexander 1:05
OK.
Wesley Stevenson 1:05
Yeah, both feet, please. I'm going to give you weight out on the radio. Is that OK?
Ruth Alexander 1:10
Go on, then.
Wesley Stevenson 1:11
It's 54 kilograms. And I also need your height. BMI, as it's known, is calculated by dividing your weight by your height squared. OK. So what's your height? 1.74 metres. 1.74 metres. So you have a BMI of 18.
Ruth Alexander 1:25
Well, looking at the chart, that means I'm still underweight.
Wesley Stevenson 1:31
Would you like a doughnut?
Ruth Alexander 1:32
Not really, because I wouldn't mind actually, but the point is I refuse to believe I'm unhealthily thin.
Wesley Stevenson 1:39
And this is the controversy with BMI. It's not always that good a measure when applied to individuals, and a new formula has been proposed which apparently irons out some of the flaws. It's been put forward by mathematician Professor Nick Trefethen from Oxford University in the UK, and it's had a lot of coverage worldwide.
Nick Trefethen 1:56
The formula I have recommended as something to explore... Changes from weight over height squared to 1.3 times your weight in kilograms divided by your height in metres, to the 2.5 power.
Wesley Stevenson 2:12
When you were trying to recalculate it and come up with the better figure, did you go back and look at the sort of samples of people in order to try to calculate what would be the best numbers?
Nick Trefethen 2:26
No, the truth is that my proposed alternative is not based on careful epidemiology, and that's why I'm trying to emphasise that it's a proposal of a possibility. There is a literature there that suggests that it should be a power of more like 2.5 or even 2 and 2 thirds. Whether that matches medical data, there's been some puzzlement about.
Ruth Alexander 2:48
Well, I'm not sure I'm much clearer as to why this new BMI formula might be better, but what effect does it have?
Wesley Stevenson 2:54
Well, on the whole, it means that some tall people previously deemed overweight are now normal, and some short people who were normal are now overweight.
Ruth Alexander 3:02
And as I'm tall, presumably I've become even more underweight according to this new measure.
Wesley Stevenson 3:08
Yes, calculating your BMI with the new method, your score drops from 18 to 17.8.
Ruth Alexander 3:14
Even though I still feel perfectly fit and healthy.
Wesley Stevenson 3:17
Yeah, afraid so, but as Nick Trefethen has pointed out, he's a mathematician and doesn't have a medical background. So I asked for a second opinion from Tim Cole, Professor of Medical Statistics at University College London in the UK. But first I wanted to know, what is BMI and what does it actually tell us?
Tim Cole 3:35
If you imagine a group of people and you've got their weight and their height, and some people are tall and some are short, but you want to be able to compare the weight of the tall ones and the weight of the short ones, So you can use a statistical technique called regression analysis to adjust for height. And so what you're left with is an index which is weight adjusted for height. Now if you do that calculation, you end up with an index very similar to BMI, and the fact that the power is rounded to two makes it easier to handle. But there's a fair degree of uncertainty in what the power is, and it's not critical.
Wesley Stevenson 4:14
So looking at Professor Nick Trefethen's new equation for BMI, what do you make of it?
Tim Cole 4:21
Well, it's one of a long line of papers that have been published talking about whether BMI is the right index.

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