Vishal Gentle isn’t the avid gym-goer he was before his daughter was born a few months ago.
But the new dad said he does what he can to stay active — carrying the baby up and down stairs to get a bit of a workout, lots of walking and using a stand-up desk.
Gentle said he feels healthy, but according to the body mass index, or BMI, he’s overweight.
“Honestly, I don’t feel overweight. I mean, except a little bit near my waist. But like I’m fully active. I can do anything and everything,” he said during an interview in his Toronto home.
Gentle isn’t alone when it comes to questioning if his BMI is an accurate way of measuring health. The BMI is under growing scrutiny — both for its usefulness as a measure of health and its problematic origins.
BMI is calculated by dividing weight in kilograms by height in metres squared. The result can be compared to the BMI chart, easily found all over the internet, social media and in doctors’ offices, that instantly advises the user if their result is underweight, normal, overweight or obese.
Last month, the American Medical Association (AMA) formally recognized BMI’s shortcomings and created a new policy advising caution when using it.
In a news release in June, the AMA warned that the BMI is an “imperfect way to measure body fat in multiple groups given that it does not account for differences across race/ethnic groups, sexes, genders, and age-span.”
WATCH | The problem with BMI:
Using BMI to assess your health can be misleading, experts warn
6 days ago
Duration 2:03
The American Medical Association warns BMI or body mass index can be a misleading health indicator, and some health-care experts instead favour things like waist circumference. Health Canada still promotes BMI on its website but says the tool is imperfect.
It also notes that the BMI, which dates back to the 19th century, has a problematic foundation.
“Under the newly adopted policy, the AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations,” the news release states.
The AMA encouraged clinicians to use other factors such as waist circumference, fat distribution and genetic factors when assessing a patient’s health.
The inability to distinguish between mass created by fat, muscle and bone has been noted as a shortcoming by experts and health authorities, as is the lack of distinction for where fat is distributed on the body.
They note abdomen fat can be a risk factor for conditions like diabetes and heart disease, while hip and thigh fat is less associated with health issues.
Dr. Sanjeev Sockalingam is the scientific director of Obesity Canada. The organization’s latest practice guidelines leave BMI out of the definition of obesity. (Obesity Canada)
Dr. Sanjeev Sockalingam, the Toronto-based scientific director of Obesity Canada, said he hopes the AMA’s position accelerates work to find better ways for assessing health, and specifically for evaluating obesity as a medical condition.
“I’m hoping that this will actually spawn a bit more research as well in this area, which I think is much needed given all the challenges and issues that we’ve identified with BMI,” he said.
Obesity Canada’s latest practice guidelines leave BMI out of the definition of obesity, and instead describe it as a chronic medical condition that results in disability and impairment.
The agency has recommended using BMI along with measuring waist circumference since 2003, spokesperson Nicholas Janveau said in an email.
“While BMI has some limitations, it still tends to be the preferred measure of excess body fat for population-level surveillance and epidemiologic studies because of its simplicity and the ease with which it can be estimated,” Janveau said.
Despite all of Sockalingam’s misgivings about BMI, he said it can’t be abandoned just yet because it’s deeply integrated into clinical trials and other aspects of health care.
“We don’t want to remove it right now without anything to replace it because it’s been so difficult to get people to recognize obesity as a chronic medical condition and to think about patient-centred approaches and treatments that are now emerging for people living with obesity,” he said.
He advises people to think of BMI as a high-level screening tool, but not to rely on it for diagnosing an individual.
What’s the alternative?
Dr. Sonia Anand, a vascular medicine specialist at McMaster University in Hamilton, Ont., said she agrees that it would be difficult to untangle BMI from its place in clinical settings, research and the weight-loss industry.
She knows it won’t go away any time soon, but said she’d like to see it replaced by waist circumference as the go-to free, simple measurement.
“It is entrenched in our way of thinking. But it is now reasonable, a good time for different health-care practitioners, agencies, trialists and individuals to start measuring waist circumference and use that together with body weight,” Anand said.
Dr. Sonia Anand, a vascular medicine specialist at McMaster University, says continuing to rely on BMI for people with different backgrounds and lifestyles means risking missing signs to test for metabolic changes. (Turgut Yeter/CBC)
Anand has done research into how South Asian people experience metabolic changes such as increases in blood sugar, blood pressure and cholesterol at a lower cut off point than white Europeans do.
She said continuing to rely on BMI for people with different backgrounds and lifestyles means risking missing signs to test for metabolic changes, or could lead to a person with a lot of muscle mass and a high BMI being wrongly advised to lose weight.
By itself, waist circumference isn’t the gold standard in assessing health, either, Anand said, but she added it does a better job of assessing whether someone has excess body fat in a specific area that can increase the risk of health issues.
A holistic approach
When it comes to diagnosing and treating obesity, Sockalingam said he would like to see more holistic assessment.
“Ultimately we want to look at how obesity is impacting an individual in terms of their day-to-day living, their functioning and their co-occurring conditions, whether it be physical or mental health,” he said.
Anand and Sockalingam agree that even if discontent with BMI as a measurement of health grows, it’ll take quite a while for widespread change to happen. Sockalingam said he hopes that people who hear about the problems with BMI will be empowered to ask their health-care practitioners for different kinds of assessments.
Vishal Gentle said he has had those conversations with his family doctor in Toronto, who told him he’s not overweight.
He said it’s important to him to keep a close eye on his health because his father died at age 67 during cardiac arrest.
Gentle said his father carried weight on his belly and so his doctor’s advice to focus on eating well, exercising and keeping an eye on waist circumference makes sense to him.
“As long as I’m able to feel good and carry on my day-to-day, I have no issues,” he said.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
