The debasing of BMI as a stand-alone assessment of weight is long overdue given its significant limitations and lack of meaningfulness with respect to overall health. This coincides with a bigger societal and cultural shift towards inclusivity which involves redressing bias against people with diverse body sizes and compositions.
And how do we, as integrative health professionals, continue to uphold our principles of prevention and treating the cause when excess adiposity may be a very real contributor? While ensuring we ‘see’ and treat each individual in front of us, not our assumptions about adiposity, not our body size bias nor blind spots?
One part of the answer: read and be led by their lab results – because pathology is nothing if not personalised.
So when a graduate of our MasterCourse I in Comprehensive Diagnostics recently asked me for “a quick reminder and some direction regarding how to adjust her expectations regarding the pathology results of a 67YOF” who by all measures (BMI, WC, BF% etc.) is experiencing severe excess adiposity, she had already demonstrated her deep grasp of everything this training endeavours to teach. In particular, her question reflects her understanding of the importance of being conscious and careful in choosing ‘who you compare your patients with’.
Because if we blindly compare the results of someone of very different adiposity to our ‘regular’ reference ranges – we will be led astray as to their true meaning.
We will miss much due to false negatives – such as renal impairment because the eGFR formula is actually based on an assumption of a particular body size. And false positives will produce pathologising of things that are in fact physiological not pathological.
So how can we accurately interpret the pathology results of someone with excess adiposity – in fact – let’s go back one step and ask: how can we know whether the amount and nature of adipose tissue for an individual is even ‘excessive’ for them? It’s all there in their results. But first, you have to adjust your lens. This is a 3 step process that starts with acknowledging the trends in biomarker movement with increasing adiposity established by good research (not BMI as the sole marker and stratifier) and reviewing how patient results do or don’t align with these trends and from there gets you to consider bidirectionality and independence! Sound difficult? It isn’t. And if we don’t? Well, we’re just generating nonsense data and perpetuating prejudice and bad medicine based on bias.