6 ms·

Interesting article. I don't know that I'd take too much to heart given some of the obvious caveats the author has been nice enough to make explicit, but it sou

Interesting article. I don't know that I'd take too much to heart given some of the obvious caveats the author has been nice enough to make explicit, but it sounds like I'd be hard pressed to argue the suggestions contained within. For the tl;dr crowd: - written by a physician - people often think that heart disease is controllable by our actions whereas they feel that cancer is not - > people can’t change many risk factors of heart disease like age, race and family genetics - > A more recent study published in Nature argues that there is a lot we can do. [about cancer] - > Using sophisticated modeling techniques, the researchers argued that less than 30 percent of the lifetime risk of getting cancer was because of intrinsic risk factors, or the “bad luck.” - > [another study] identified four domains that are often noted to be related to disease prevention: smoking, drinking, obesity and exercise - if you limit that stuff, and not meaning 0 smoking, but "having quit within the last 5 years", no more than 1 drink a day (women) or 2 drinks a day (men), your BMI is >= 18.5 and <= 27.5 (BMI is such a shit and antiquated metric, IMO, incidentally), and perform 150mins/wk moderate intensity excercise or 75mins/wk vigorous intensity exercise, then you're in the low risk group. so the barrier to entry is not super high. HOWever: > No study is perfect, and this is no exception. These cohorts are overwhelmingly white and consist of health professionals, who are not necessarily like the population at large. But the checks against the national data showed that if anything, these results might be underestimating how much cancer is preventable by healthy behaviors. [...] Optimistic conclusion, for a skeptical cheapskate like myself, > As we talk about cancer “moonshots” that will most likely cost billions of dollars and might not achieve results, it’s worth considering that — as in many cases — prevention is not only the cheapest course, but also the most effective. Hard to fault this article. I'm glad you posted it, thank you.

Retric 10y ago
BMI is a surprisingly relevant metric for many things as it's a comparison between volume (weight) and surface area (height ^2). And yes, short people do have an inherent advantage there which for example possibly relates to how small dogs tend to live longer.
- wil421 10y ago
  BMI is a horrible metric because it doesn't take body composition into account. I can't believe I was once almost considered obese with a body fat of less than 5%. 5'10" at 200-210.
  - pkaye 10y ago
    Who considered you obese? Also is it healthy to even have <5% body fat?
    - wil421 10y ago
      According to the BMI scale, over 30 is obese and 25 to 30 is overweight. I'm not sure of the health factors but if you're training for 2 - 2.5 hours a day and dieting it can be normalish. Why the down votes? Check the scales: http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmic...
      - dredmorbius 10y ago
        The swolehate is real. https://swoleacceptance.reddit.com https://swoleacceptance.reddit.com
    - omegaham 10y ago
      My employer had one of those physical checkups for a lowered rate on insurance. I'm 5'10", 215 pounds[1]. The doctor sighed and said that he was required to tell me that according to BMI, I was obese and should consider losing weight. We had a good laugh about it. My body-fat percentage is definitely not 5%, though. My guess is that it's around 14-15%. Everyone drastically underestimates how low their body-fat percentage is, and I am not a bodybuilder. I lift heavy and like pasta. [1] terrible picture of me from a few weeks ago for reference: https://i.imgur.com/42WFEyA.jpg https://i.imgur.com/42WFEyA.jpg
  - sndean 10y ago
    My BMI is 26+ and I run ~8 miles/day. It can be pretty far off for larger built people... I clearly remember asking my gym teacher in middle school why my BMI suggests I was fat even though I clearly wasn't. He then proceeded to tell the entire class "he's a good example of someone who's labeled as fat, but isn't." Somewhat embarrassing.
amock 10y ago
What's wrong with BMI for something like this? It's such a simple measure and it seems to be useful for predicting health issues. From what I've read body fat percentage is what really matters, but accurately calculating that takes expensive equipment. http://www.nytimes.com/interactive/projects/cp/summer-of-science-2015/latest/how-often-is-bmi-misleading http://www.nytimes.com/interactive/projects/cp/summer-of-sci... seems to indicate that BMI does a pretty good job, although it may be too generous on the high end.
- kohanz 10y ago
  The link you provided indicates that BMI is incorrect (when compared to body fat %) roughly 1 in 5 times. That's pretty high, IMHO and that is why many people have a problem with it.
- sosborn 10y ago
  > It's such a simple measure and it seems to be useful for predicting health issues. It is good for predicting in general populations, but can easily fall apart with individuals. It doesn't take into account what the makeup of your mass is. Muscle is denser than fat, so a muscular man and a fat man of the same height and weight would have the same BMI, but vastly different health profiles.
  - sliverstorm 10y ago
    I think the sort of person to be incredibly muscular is probably also one of the most likely groups to get body fat measurements, and be educated about the limitations of BMI. Because that person is almost certainly a bodybuilder, serious athlete, etc.
  - coldtea 10y ago
    >It is good for predicting in general populations, but can easily fall apart with individuals. While it can "easily fall apart with individuals", the difficulty lies in finding an individual to measure that will make BMI fall apart. And that's because the huge majority of us is of the kind of complexion and body type where BMI works well. So, sure it can give false positives, but for a quite small fraction -- besides any other rough medical heuristic does the same (e.g. signs of having the flu can also be caused by 200 other reasons).
eightfourteen 10y ago
BMI is a tool for doctors to use, along with clinical judgement. No doctor is going to look at a lean, well muscled individual and tell them they're at risk for heart disease because their BMI is high. BMI is something that fails in theory and works in practice.
- nchelluri 10y ago
  when you record someone's BMI and it gets thrown in a spreadsheet as patient 123456 has BMI 23.5 the doctor is no longer looking at the patient. perhaps it's good enough, i don't claim to be able to evaluate the methodology of the study (and perhaps using BMI simply results in more skeptical results, by leaving healthy people out of the low risk group, which I'm fine with - not sure this is true though). it really was an incidental note on my part, but i stand by it. i am a little surprised at how much we're talking about it, i guess it is bikeshedding, which is understandable, im not qualified to comment with authority on much of the material myself :)
  - eli_gottlieb 10y ago
    They also record your blood-pressure measurements on the chart. If you've got a mildly high BMI and fine blood-pressure, they know you're actually ok.
  - graeme 10y ago
    See this reply downthread: https://news.ycombinator.com/item?id=12041053 https://news.ycombinator.com/item?id=12041053 The parent was saying BMI is not a good diagnostic tool for individuals, and it was good for populations. You're not addressing that point. You're saying that populations don't consider people individually. Which is true. But you haven't made an argument against the use of population wide BMI, which is the only case it's generally accepted as being valid for. (I agree it's over recommended as a individual measure, or overrecommended without caveats. E.g. BMI + waistline, or BMI + strength test.)
- Trundle 10y ago
  I thought it was a tool for measuring large populations where the lean, well muscled outlier is heavily outnumbered/balanced out by their opposites. Either way though I agree that it's silly for individuals to try to apply it to themselves and then shit on the concept because it doesn't work like that.
coldtea 10y ago
Regarding BMI: >In fact, for most people BMI correlates quite well with adiposity. In one study researchers compared BMI to a more direct measure of body fat percentage using skin-fold thickness. They found that when subjects met the criterion for obesity based upon BMI, they were truly obese by skin-fold thickness 50-80% of the time (depending on gender and ethnicity). When they were not obese by BMI they were not obese by skin-fold 85-99% of the time. So BMI is a rough but useful estimate, good for large epidemiological studies where more elaborate fat percentage measurements are not practical.” https://www.sciencebasedmedicine.org/does-weight-matter/#more-16094 https://www.sciencebasedmedicine.org/does-weight-matter/#mor...
Alex3917 10y ago
For what it's worth, vigorous exercise is barely more than walking: http://www.cdc.gov/physicalactivity/basics/measuring/heartrate.htm http://www.cdc.gov/physicalactivity/basics/measuring/heartra... E.g. if you do an hour on the elliptical machine at 150 bpm then that's already 80% of your exercise RDI for the week.
brandonmenc 10y ago
> BMI is such a shit and antiquated metric BMI combined with body fat percentage is still useful, and likely every single doctor knows when to ignore BMI. This idea that there are doctors looking at bodybuilders and saying, "well this number here says you're obese, so you're obese!" is absurd.
- kaitai 10y ago
  It's not doctors who provide the most trouble, it's rules and regs coming from your health insurance or your job. There are plenty of stories about guys in the Army who can meet all their physical requirements but are getting dinged for having a BMI a smidge too high. Or if your job gives you a discount on health insurance for meeting certain standards, you may not qualify if your BMI is a bit high -- even if you're a champion athlete. When I last went through a health screening with a qualified professional, I was congratulated on my great health and great cholesterol levels. However, on some online screening I had to do for health insurance around the same time, I was warned that my BMI is a smidge high and my cholesterol is 1 point higher than desired. The online screening did not take into account activity level, functional health, or the differences between HDL and LDL. When health or financing decisions are made algorithmically there are some real traps.

Retric 10y ago

BMI is a surprisingly relevant metric for many things as it's a comparison between volume (weight) and surface area (height ^2). And yes, short people do have an inherent advantage there which for example possibly relates to how small dogs tend to live longer.

wil421 10y ago
BMI is a horrible metric because it doesn't take body composition into account. I can't believe I was once almost considered obese with a body fat of less than 5%. 5'10" at 200-210.
- pkaye 10y ago
  Who considered you obese? Also is it healthy to even have <5% body fat?
  - wil421 10y ago
    According to the BMI scale, over 30 is obese and 25 to 30 is overweight. I'm not sure of the health factors but if you're training for 2 - 2.5 hours a day and dieting it can be normalish. Why the down votes? Check the scales: http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmic...
    - dredmorbius 10y ago
      The swolehate is real. https://swoleacceptance.reddit.com https://swoleacceptance.reddit.com
  - omegaham 10y ago
    My employer had one of those physical checkups for a lowered rate on insurance. I'm 5'10", 215 pounds[1]. The doctor sighed and said that he was required to tell me that according to BMI, I was obese and should consider losing weight. We had a good laugh about it. My body-fat percentage is definitely not 5%, though. My guess is that it's around 14-15%. Everyone drastically underestimates how low their body-fat percentage is, and I am not a bodybuilder. I lift heavy and like pasta. [1] terrible picture of me from a few weeks ago for reference: https://i.imgur.com/42WFEyA.jpg https://i.imgur.com/42WFEyA.jpg
- sndean 10y ago
  My BMI is 26+ and I run ~8 miles/day. It can be pretty far off for larger built people... I clearly remember asking my gym teacher in middle school why my BMI suggests I was fat even though I clearly wasn't. He then proceeded to tell the entire class "he's a good example of someone who's labeled as fat, but isn't." Somewhat embarrassing.

amock 10y ago

What's wrong with BMI for something like this? It's such a simple measure and it seems to be useful for predicting health issues. From what I've read body fat percentage is what really matters, but accurately calculating that takes expensive equipment. http://www.nytimes.com/interactive/projects/cp/summer-of-science-2015/latest/how-often-is-bmi-misleading http://www.nytimes.com/interactive/projects/cp/summer-of-sci... seems to indicate that BMI does a pretty good job, although it may be too generous on the high end.

kohanz 10y ago
The link you provided indicates that BMI is incorrect (when compared to body fat %) roughly 1 in 5 times. That's pretty high, IMHO and that is why many people have a problem with it.
sosborn 10y ago
> It's such a simple measure and it seems to be useful for predicting health issues. It is good for predicting in general populations, but can easily fall apart with individuals. It doesn't take into account what the makeup of your mass is. Muscle is denser than fat, so a muscular man and a fat man of the same height and weight would have the same BMI, but vastly different health profiles.
- sliverstorm 10y ago
  I think the sort of person to be incredibly muscular is probably also one of the most likely groups to get body fat measurements, and be educated about the limitations of BMI. Because that person is almost certainly a bodybuilder, serious athlete, etc.
- coldtea 10y ago
  >It is good for predicting in general populations, but can easily fall apart with individuals. While it can "easily fall apart with individuals", the difficulty lies in finding an individual to measure that will make BMI fall apart. And that's because the huge majority of us is of the kind of complexion and body type where BMI works well. So, sure it can give false positives, but for a quite small fraction -- besides any other rough medical heuristic does the same (e.g. signs of having the flu can also be caused by 200 other reasons).

eightfourteen 10y ago

BMI is a tool for doctors to use, along with clinical judgement. No doctor is going to look at a lean, well muscled individual and tell them they're at risk for heart disease because their BMI is high. BMI is something that fails in theory and works in practice.

nchelluri 10y ago
when you record someone's BMI and it gets thrown in a spreadsheet as patient 123456 has BMI 23.5 the doctor is no longer looking at the patient. perhaps it's good enough, i don't claim to be able to evaluate the methodology of the study (and perhaps using BMI simply results in more skeptical results, by leaving healthy people out of the low risk group, which I'm fine with - not sure this is true though). it really was an incidental note on my part, but i stand by it. i am a little surprised at how much we're talking about it, i guess it is bikeshedding, which is understandable, im not qualified to comment with authority on much of the material myself :)
- eli_gottlieb 10y ago
  They also record your blood-pressure measurements on the chart. If you've got a mildly high BMI and fine blood-pressure, they know you're actually ok.
- graeme 10y ago
  See this reply downthread: https://news.ycombinator.com/item?id=12041053 https://news.ycombinator.com/item?id=12041053 The parent was saying BMI is not a good diagnostic tool for individuals, and it was good for populations. You're not addressing that point. You're saying that populations don't consider people individually. Which is true. But you haven't made an argument against the use of population wide BMI, which is the only case it's generally accepted as being valid for. (I agree it's over recommended as a individual measure, or overrecommended without caveats. E.g. BMI + waistline, or BMI + strength test.)
Trundle 10y ago
I thought it was a tool for measuring large populations where the lean, well muscled outlier is heavily outnumbered/balanced out by their opposites. Either way though I agree that it's silly for individuals to try to apply it to themselves and then shit on the concept because it doesn't work like that.

coldtea 10y ago

Regarding BMI: >In fact, for most people BMI correlates quite well with adiposity. In one study researchers compared BMI to a more direct measure of body fat percentage using skin-fold thickness. They found that when subjects met the criterion for obesity based upon BMI, they were truly obese by skin-fold thickness 50-80% of the time (depending on gender and ethnicity). When they were not obese by BMI they were not obese by skin-fold 85-99% of the time. So BMI is a rough but useful estimate, good for large epidemiological studies where more elaborate fat percentage measurements are not practical.” https://www.sciencebasedmedicine.org/does-weight-matter/#more-16094 https://www.sciencebasedmedicine.org/does-weight-matter/#mor...

Alex3917 10y ago

For what it's worth, vigorous exercise is barely more than walking: http://www.cdc.gov/physicalactivity/basics/measuring/heartrate.htm http://www.cdc.gov/physicalactivity/basics/measuring/heartra... E.g. if you do an hour on the elliptical machine at 150 bpm then that's already 80% of your exercise RDI for the week.

brandonmenc 10y ago

> BMI is such a shit and antiquated metric BMI combined with body fat percentage is still useful, and likely every single doctor knows when to ignore BMI. This idea that there are doctors looking at bodybuilders and saying, "well this number here says you're obese, so you're obese!" is absurd.

kaitai 10y ago
It's not doctors who provide the most trouble, it's rules and regs coming from your health insurance or your job. There are plenty of stories about guys in the Army who can meet all their physical requirements but are getting dinged for having a BMI a smidge too high. Or if your job gives you a discount on health insurance for meeting certain standards, you may not qualify if your BMI is a bit high -- even if you're a champion athlete. When I last went through a health screening with a qualified professional, I was congratulated on my great health and great cholesterol levels. However, on some online screening I had to do for health insurance around the same time, I was warned that my BMI is a smidge high and my cholesterol is 1 point higher than desired. The online screening did not take into account activity level, functional health, or the differences between HDL and LDL. When health or financing decisions are made algorithmically there are some real traps.