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Comment by henryfjordan | Hacker News Reader

You risk alienating people by focussing on BMI though. Weight has been moralized in the US (being fat is seen as a moral failing). People do not easily accept advice that is given through a moral lens.

The data shows that there is a better measure than BMI which doesn't carry all the stigma, so why not use that one?

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> why not use that one?

Taking any of the more accurate measurements of body composition requires effort, unlike BMI. It's easy and lazy and not yet acknowledged as an ineffective practice so doctors do it. It's also not always wrong, just because BMI and obesity do correlate.

My understanding is the argument is not whether to use someone's fatness as a measure of health if there's a much better, specific metric besides being fat (ie. resting insulin levels) to prescribe exercise and diet over.

I don't think it'll reduce stigma or whatever of fat people, but I do agree that if someone is fat but their insulin is normal maybe a doctor can pay attention to something else like if they came in for an allergy test or something they may not need the diet/exercise spiel. Similarly if someone's thin but their insulin is crazy its time to talk diet/exercise.

There is a rare, rare, rare chance you can some weird diseases that mess up insulin sensitivity, so you can be skinny and have issues. Those are rare and not solved by diet and exercise.

Otherwise if your insulin is high, you need to diet and exercise. Measuring blood insulin is a lab procedure - you go to a collection lab, you get jabbed, they mail it for testing.

Measuring BMI requires stepping on a scale and knowing how tall you are.

> Measuring BMI requires stepping on a scale and knowing how tall you are.

There are contradicting posts in this very thread that say high BMI and obesity aren't necessarily the same thing, because apparently you can be tall and be only mildly into lifting and suddenly you have a high BMI. If that's the case [I'm not a lifter] then it makes total sense to me to track resting blood glucose, not obesity, because it's simply the more accurate measurement.

> because apparently you can be tall and be only mildly into lifting and suddenly you have a high BMI.

Very unlikely. BMI is a standardized model. Unless you are dramatically out of the parameters (you're 7'2" or you are an olympic lifter) it is pretty accurate.

You can also use calipers in that case - you need someone to help you because you can't reach it yourself but it's very fast and accurate.

Again, insulin testing is expensive, invasive and time consuming. You might get insulin tested once a year.

I'm merely pointing out that it's apparently not as simple as stepping on a scale because no one can get their heads straight about high BMI's causation to begin with or what to do about it.

It just seems much simpler to me to take an actually accurate test once a year and prescribe purely based on the accurate testing. That way we also get skinnyfat people.

Imagine if once a year, your boss sat you down and went "Hey, you did a terrible job this year. No promotion."

You might ask him why he didn't give you any feedback earlier so you could have fixed the issue. "Oh, well I only give feedback once a year since it is hard to do".

You need regular (weekly, biweekly) feedback on your diet.

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