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Patients, physicians should take note of ethnicity-specific Body Mass Index (BMI) guidelines

Since BMI originated with the measurements of European men, we know that it leaves a wide range of people out of the equation.

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Photo by Bill Oxford from Unsplash.com

While body mass index (BMI) as a body composition assessment tool has long had its critics, recent research has highlighted a new potential drawback in that it could prevent people of certain ethnicities from having their risk for Type 2 diabetes assessed earlier. A psychologist and weight management specialist at a top American hospital, Cleveland Clinic, stresses the importance of physicians and patients being aware of different cut-off points based on their ethnicity.

Leslie Heinberg, PhD, MA, explains that recently, researchers in the U.K. discovered that the cutoff BMI number associated with a higher risk of Type 2 diabetes varies between different patient populations. For example, a BMI of 30 or above was linked to a higher risk for white people. For Black people, the cutoff number was 28 or above. For South Asian people it was 23.9 or above and for the Middle Eastern population, the BMI cutoff was 26 or above. 

The problem? Some healthcare providers might only be making recommendations for diabetes-related lifestyle changes or treatment options based on the risk level for white people. This means that other populations might not get the medical interventions they need in time. 

Here, Dr. Heinberg, explains why BMI is still used and gives some tips for how people of color can make sure they’re on the right track despite the discrepancies. 

Where did BMI come from?

The formula for calculating body mass was the creation of a Belgian mathematician, astronomer, sociologist and statistician named Lambert Adolphe Jacques Quetelet. Quetelet wasn’t focused on studying obesity when he developed what was first known as the “Quetelet Index” (your weight in kilograms divided by the square of your height in meters, or Kg/M²). He was looking at years of crime data that he compiled to link crime to social conditions. In doing so, he noticed a relationship between an adult’s height and weight. 

In 1972, American physiologist Ancel Keys gave the Quetelet Index a new name as he thought the formula was a good way to identify obesity. He referred to it as the body mass index. 

“It’s a ratio that takes height into account because taller people weigh more than shorter people,” says Dr. Heinberg. “It was developed more for actuarial tables and to determine which people are at a higher risk for mortality. It’s something that makes sense when you look at a very large population.”

Dr. Heinberg adds that today, many organizations and businesses still rely on BMI when it comes to providing things like insurance or medical procedures. 

The drawbacks of BMI

Dr. Heinberg says that BMI can be a pretty blunt instrument for health because it leaves a lot of physical attributes out of the equation. 

“It doesn’t take into account a lot of things about an individual. You can ask somebody for their height and weight and it becomes a very easy assessment in comparison to a full and comprehensive evaluation. When we think about an individual’s health and their health risks, taking their background information into account is helpful. But when you’re looking at a million people, you just can’t do that.”

Other physical signs of health risks

While BMI is one way of measuring risks, Dr. Heinberg says there are other physical clues to watch out for. 

“We do know things like waist circumference, waist-to-hip ratio and where you hold excess weight might play an even more important role when it comes to metabolic diseases,” she says.

For instance, if you have an apple body shape or a pear shape, the excess abdominal weight of an apple shape is associated with more cardiovascular risks and metabolic disease. “Also, with things like obstructive sleep apnea, neck circumference seems to be important. It all goes way beyond just BMI.”

How people can advocate for their health

Since BMI originated with the measurements of European men, we know that it leaves a wide range of people out of the equation. However, since it is just one piece of information, Dr. Heinberg recommends getting the full picture of your health. 

“What’s helpful about this study is that it helps illustrate that BMI should not just be used to determine if someone is healthy, unhealthy, lean or obese. Instead, it should be considered as another vital sign. If a provider sees someone with an elevated BMI, particularly if they are from a population that is at higher risk for Type 2 diabetes, that should suggest doing some lab work and making additional assessments. It would also be good to discuss any factors that can keep a patient out of that pre-diabetic or full diabetic range.” These factors might include sleep habits, stress management, dietary changes and increased physical activity.

If you already know that your family has a history of diabetes, high blood pressure or other health concerns, discuss it with your provider. The more information they have, the better equipped they are to monitor your health and help you manage any conditions. 

The main thing to keep in mind about BMI 

Dr. Heinberg says the other important message when it comes to BMI or weight is that you do not have to lose a large amount of weight to improve your health.

“There’s this unfortunate message that everyone has to be within this little window. But even a small amount of weight loss — around 2.5kg to 4.5kg — is associated with really significant improvements in metabolic risk or cardiovascular risk.”

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How to help children build a growth mindset

Consider these three tips to help children build a growth mindset.

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A new year is a perfect time to consider the habits you want to keep and the ones you’d like to develop. One resolution to consider is helping your children develop a growth mindset this year.

“We know one of the greatest boosts to parents’ confidence over the past year came from knowing their children’s whole selves are being nurtured, and we want to see that trend continue,” said Carter Peters from KinderCare Learning Center’s education team. “A growth mindset helps children try new things despite fear of failure. It’s the kind of thinking that allows inventors and creative thinkers to get excited about trying something new and ensures they have the cognitive flexibility and problem-solving skills to work through hurdles.”

Adults can often easily spot when children are engaged in creative thinking and prideful of their work, but that confidence may be lost as failures turn into insecurities. By nurturing a growth mindset and showing children they can learn and develop new skills in any area, it better sets them up for long-term success.

Consider these three tips to help children build a growth mindset:

Photo by Markus Spiske from Unsplash.com

1. Praise effort

It’s easy to fall into the habit of praising successes. However, praising effort encourages children to try new things without the fear of failing. It also teaches children personal growth and achievement are possible, even if their overall effort wasn’t a success.

“Young children often get excited to try something new,” Peters said. “By praising effort and showing children they’ll still be loved and valued despite the outcome, you can reframe how they approach challenges and teach them that difficult doesn’t mean impossible.”

2. Encourage the process

People often withhold praise until there’s a result, which leads children to hurriedly scribble a picture to hold up for a “good job” instead of taking time to focus on their efforts. When children know adults will encourage them during the process, instead of only upon the achievement, they’re more likely to try new things or master a new skill. For example, try providing encouragement such as, “I can see you’re focused on drawing that tree. It looks so lifelike because you’re putting so much thought into what you’re doing.” Once their project is finished, continue the encouragement by hanging up their artwork or school projects in a prominent place.

3. Model a growth mindset

You can model a growth mindset for children by narrating your actions when you are facing a challenge: “I am having a difficult time putting this shelf together, but it’s OK. I’ll take a break then read the instructions again.” Remove negative words from your vocabulary, such as “I can’t” or “I’m stupid.” Even when you are joking, children may not be able to tell the difference. You can also ask your children to join you in problem-solving. Take time to hear their ideas and try them even if you think they won’t work. This not only supports the development of their growth mindset, but the quality time and encouragement reinforces their sense of self-worth and builds confidence.

For more tips to help children develop a growth mindset, visit kindercare.com.

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Signs of a Healthy Marriage

Although there are many different ways to define a healthy marriage, these three qualities are essential for any lasting and fulfilling relationship.

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A healthy marriage is built on trust, respect, and communication. Couples with these qualities in their relationship tend to be more satisfied with their marriage and overall life. They also report feeling closer to their partner and having stronger well-being. With 2.3 out of every 1000 people in the US experiencing divorce in 2022, it is important to frequently check in on the health of your marriage.

Although there are many different ways to define a healthy marriage, these three qualities are essential for any lasting and fulfilling relationship.

Signs of a Healthy Marriage

A healthy marriage is built on trust, communication, and mutual respect. If you and your partner can effectively communicate and share a mutual level of respect, then your relationship is off to a good start. Trust is also important in a healthy marriage, as it allows you and your partner to feel secure in your relationship and rely on each other.

Many other signs can indicate whether or not a marriage is healthy. For example, couples who can spend quality time together and enjoy shared activities usually do well. Couples who can openly discuss their relationship with each other and work through difficulties together are also more likely to have a happy and healthy marriage. Finally, marriages, where both partners feel like they can be themselves without judgment from their spouse tend to be the strongest and most lasting.

Freedom to be yourself

In a healthy marriage, partners feel free to be themselves. They don’t have to put on a facade or pretend to be someone they’re not. They can be open and honest with each other and feel comfortable sharing their thoughts, feelings, and desires.

Both partners should pursue their interests and hobbies without compromising or sacrificing for the sake of the relationship. There’s no need to agree on everything – in fact, it’s healthy to have some separate interests – but overall, both partners should feel like they’re able to be true to themselves within the relationship.

Lots of good communication

In a healthy marriage, partners can communicate effectively. It means expressing needs and wants and listening and responding to what the other person is saying. There are mutual respect’s opinions, even if there are disagreements. Couples in a healthy marriage feel comfortable communicating with each other about both the good and the bad.

Good sex life

A good sex life can be a major sign of a healthy marriage. A lack of sexual activity can be an early warning sign that something is wrong in the relationship. Often, couples who have a good sex life are more connected emotionally and physically. They are also more likely to trust each other and communicate openly.

Trust in each other

In any relationship, trust is essential. Without trust, there is no foundation for the relationship to grow. In a marriage, trust is even more important. Trusting your spouse means you feel confident in their ability to support you emotionally and financially. It also means that you feel safe sharing your innermost thoughts and feelings with them.

When you trust your spouse, you know they have your best interests. You feel comfortable being yourselves around each other and sharing your hopes, dreams, and fears. Openness and honesty in your relationship allow you to be vulnerable with each other. This vulnerable honesty creates a deeper level of intimacy in your marriage.

When you trust each other, you can be more forgiving when mistakes are made. You know that everyone makes mistakes and that nobody is perfect. You also understand that your spouse is human and capable of making mistakes like anyone else. If they make a mistake, you are more likely to forgive them because you know they are sorry and will try not to make the same mistake again.

Trust is one of the most important foundations of a healthy marriage. If you want your marriage to thrive, build trust in each other.

A successful, strong marriage takes work, but with communication, trust, respect, vulnerability, and affection as its core components, you can together create a partnership that will be long-lasting.

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Obesity linked to macular degeneration

Immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.

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A Canadian study published in the prestigious journal Science elucidates a new molecular mechanism that may cause age-related macular degeneration (AMD).

The research at Hôpital Maisonneuve-Rosement, in Montreal, shows how life stressors such as obesity reprogram immune system cells and make them destructive to the eye as it ages.

“We wanted to know why some people with a genetic predisposition develop AMD while others are spared,” said Université de Montréal ophtalmology professor Przemyslaw (Mike) Sapieha, who led the study by his postdoctoral fellow Dr. Masayuki Hata.

“Although considerable effort has been invested in understanding the genes responsible for AMD, variations and mutations in susceptibility genes only increase the risk of developing the disease, but do not cause it,” Sapieha explained.

“This observation suggests that we must gain a better understanding of how other factors such as environment and lifestyle contribute to disease development.”

AMD is a major cause of irreversible blindness worldwide and affected approximately 196 million people in 2020. It comes in two forms:

  • dry AMD, characterized by the accumulation of fatty deposits at the back of the eye and the death of nerve cells in the eye,
  • and wet AMD, which is characterized by diseased blood vessels that develop in the most sensitive part of the sight-generating tissue, called the macula.

Contact with pathogens

It is already known that the immune system in the eye of a person with AMD becomes dysregulated and aggressive. Normally, immune cells keep the eye healthy, but contact with pathogens such as bacteria and viruses can make them go awry.

At the same time, immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.

In their study, Sapieha and Hata used obesity as a model to accelerate and exaggerate the stressors experienced by the body throughout life.

They found that transient obesity or a history of obesity leads to persistent changes in the DNA architecture within immune cells, making them more susceptible to producing inflammatory molecules.

“Our findings provide important information about the biology of the immune cells that cause AMD and will allow for the development of more tailored treatments in the future,” said Hata, now an ophthalmology professor at Kyoto University, in Japan.

The researchers hope their discovery will lead other scientists to broaden their interest beyond obesity-related diseases to other diseases characterized by increased neuroinflammation, including Alzheimer’s disease and multiple sclerosis.

About this study

“Past history of obesity triggers persistent epigenetic changes in innate immunity and exacerbates neuroinflammation,” by Mike Sapieha and Masayuki Hata, was published in Science.

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