Body Mass Index

My BMI Isn't "Normal". What Does That Mean?

OK, so your BMI isn't "normal". So what? You feel great. It's just "doctor talk". It doesn't really mean anything--or does it? Let's take a look a some of the long term results of having a BMI above the "normal" range¹:

Let's say you're a woman whose BMI classifies you as

	overweight: your relative risk of having a heart attack is double compared to someone whose BMI is normal (heart disease is the number one killer of women in America); or
	obese: your relative risk of a heart attack triples!

Let's say you're a man. For each one unit increase in your BMI over 22, there is a 10% increase in the rate of coronary events. This is from a study in British men; similar relationships exist in U.S. populations.

Now for the "fun" stuff: the relative risk of diabetes increases by about 25% for each additional unit of BMI over 22. Diabetes is associated with serious long term complications that affect almost every major part of your body. It can cause blindness, heart disease, stroke, kidney failure, nerve damage, sometimes resulting in the amputation of your toes, foot, or leg. These amputations unfortunately are up 38% between 1998 and 2002 because of the current diabetes epidemic².

And there's more: how about a stroke? or maybe a little sleep apnea?

Finally, we Americans are facing our first sustained drop in life expectancy because of the obesity epidemic, according to a recent article in the New England Journal of Medicine³. Had enough?

Still convinced that this is just "doctor talk"? In that case, don't waste your time on this webpage. However, if you've come to realize that the only thing the doctors are doing is reporting what has happened to patients like you, then read on!

It's simple to lower your BMI; you can either lose weight or grow taller.

If it is weight loss that you want, we're here to help you. Remember, you are not the first person to face these challenges; many others before you have realized that they needed to lose weight, and they successfully did. Here's one way to walk down that all-important weight loss path (remember, you have to walk down this path, not run, because it's a long journey for most of us and you don't want to get tired and quit before you're finished):

Month 1--Start by Limiting High Glycemic Foods & Trans Fats

Oh, boy, things are starting to get complicated fast--obviously, a couple of definitions are in order, so let's begin:

High glycemic foods are those that contain lots of simple sugars that are absorbed (or metabolized) quickly by our body. They typically contain lots of calories, and give us a "quick fix", followed unfortunately by more hunger. Here are some examples:

	sugared soft drinks (sodas)
	sweets
	white bread, white rice, potatoes
	snack foods & junk foods

Most of the trans fats in our diet are produced during the partial hydrogenation of unsaturated fats. Trans fats have been popular with food manufacturers because they give foods containing them a very long shelf-life coupled with a "correct" taste. For a really clear explanation of all of this, check out our webpage, Chewing the Fat!. Bottom line--trans fats are bad for your heart and contain lots of calories not needed in your diet. Here are some examples of foods that are high in trans fats:

	french fries
	most cookies
	most crackers
	baked goods, including cakes, danish, and pies
	donuts, including Krispy Kremes©
	the "stuff" in Oreos©
	Crisco© shortening

Month 2--Reduce Red Meat, Butter, & Alcohol in Your Meals

Hmmm, you've stayed with the program for a month. Congratulations! You're making progress--and you obviously are interested in taking care of your health. This weight loss journey is long, and, with the month's training you've successfully completed, it's now time to pick up the pace a bit. This next month we are additionally going to concentrate on red meat, butter, and alcohol. Red meat and butter are high in saturated fats, bad for your heart, as discussed in our webpage, Chewing the Fat!. And booze is chock full of calories. Now's the time to start limiting your consumption of all three of them.

We suggest trying fish, poultry, egg whites (or egg beaters), or meat alternatives, such as soy or tofu, instead of red meat. Do some recipe exploring and experimentation--remember, it's your health.

There are lots of wonderful alternatives to butter. Why don't you try one of the following:

	the spread Smart Balance contains no trans fats.
	Promise makes a variety of spreads, all with no trans fats, but with Omega-3 and Omega-6 oils. One even has no fat.
	If you'd like to see a comparison of many of the spreads currently available, check out the chart on the Nutrition Action website.

Alcohol contains a lot of calories--there is just no getting around it. It doesn't make a difference whether it comes from beer, wine, whiskey, gin, vodka, or port--it's all the same--the calories are in the alcohol content. For more information on this, see our webpage on Weight Control Basics. We're not asking that you skip the occasional glass of red wine from your diet, we are merely suggesting that it be limited (unless your physician has stated that alcohol is to be eliminated completely).

Month 3--Let's Start Putting It Together

Well, you've made it this far. You really must be serious about losing weight. It's a very difficult task, as we all know. You're in the process of changing some pretty ingrained habits--there's considerable behavior modification that has to occur, all of which takes time.

May we be so bold as to suggest that, beginning in month three, you incorporate ideas from the New Food Pyramid⁴ when planning your daily meals. This Pyramid came from work done by Harvard's School of Public Health^5,6 and by others⁷, adapted by Dr. Don Hall, DrPH.

This pyramid is a helpful way to visualize relative serving sizes of the various food groups in your daily menu. Foods that should be limited are placed near the top of the pyramid, where they constitute a small portion of the total pyramid. Daily exercise and weight control is at the bottom--the foundation of a good diet.

A few comments need to be made about what constitutes a "serving". The pyramid is unclear when it comes to that. Unfortunately, it depends entirely on you and your metabolism. Keep in mind that absolute serving sizes are very important if you want to lose weight; if your weight isn't going down, you've got to cut back on serving sizes--no way around it. This is basic weight control.

We also highly recommend, if you have heart disease, that you keep the following in mind when viewing this pyramid and planning your meals:

	Use healthy oils (liquid canola and olive) sparingly.
	Note that the vegetable and fruit groups are larger and below the dairy and protein groups; this implies that you should have more vegetables and fruits in your diet.
	Always pick non-fat dairy products.
	Egg-beaters (or egg whites, which are actually cheaper than egg-beaters) are much better for you because they contain no cholesterol, all of which is in the yolks.
	Cheese is high in saturated fats, which are bad for your heart. Consider using cheese only as a garnish; choose hard instead of soft cheeses.
	Experiment with "good", i.e., non-fat, condiments and spices; they can really perk up a dish. Use salt moderately.
	Choose vegetables over fruit as a snack because they have less sugar--therefore fewer calories--important if you are trying to loose weight.
	Bothered by a sweet tooth? Sprinkle some Splenda© on your high-fiber cereal for your breakfast.
	Include whole wheat bread and pasta, brown rice, and other grains in your meals.
	Drink lots of non-caffeinated and sugar-free beverages, including water, during the day.
	Skip the fruit juice--contrary to what the TV ads say, it's crammed with calories.
	Don't forget the exercise! As a member of CTF, you should be going to our exercise classes three times per week at a minimum.

Month 4--I Need More Help

You're now four months out and nothing has happened. Your weight hasn't budged. Maybe its time to bring in some others to help. Here are a couple of suggestions:

The Cardiac Therapy Foundation offers its members the opportunity to:

	Meet with its Registered Dietitian, Sarah Ellis. Make use of her knowledge and resources--you just might be overlooking something obvious; and
	Take the LEARN Lifestyle Change Program that focuses on dietary change and behavior modification, necessary for those who want to lose weight.

Perhaps you might want to give Weight Watchers a try. Their program is easy to understand, allows you to eat the foods you choose, is relatively inexpensive, and offers group support.

Above all, don't give up. If your weight needs to be reduced, discuss this with our professional staff; they are here to help you. Finally, one of the great things about being a member of the Cardiac Therapy Foundation is that the other members want to help you. Problems just don't seem to be that big when you bring in your buddies to give you a boost!

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References:

1. http://www.doctorsforadults.com/topics/dfa_obes.htm?dfa

2. Wall Street Journal, Michael J. McCarthy, Feb. 23, 2005, Page D1
http://online.wsj.com/article/0,,SB110912117222061575,00.html
(Note, you must be an online subscriber to the Wall Street Journal to connect to the above hyperlink.)

3. http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/03/17/MNGDLBQMVQ1.DTL&type=health

4. http://www.wellsource.com/foodguide.pdf

5. http://www.hsph.harvard.edu/nutritionsource/pyramids.html

6. Scientific American, Dec 12, 2002

7. The DASH Diet, NHLBI of NIH, Health Information Center, 2003, and Dietary Guidelines for Americans, 2000.