1 00:00:00,520 --> 00:00:03,240 Speaker 1: Already and this is this is the Daily Off. 2 00:00:03,400 --> 00:00:04,520 Speaker 2: This is the Daily OS. 3 00:00:05,120 --> 00:00:15,680 Speaker 1: Oh, now it makes sense. Good morning and welcome to 4 00:00:15,680 --> 00:00:18,360 Speaker 1: the Daily OS. It's Friday, the twenty fourth of January. 5 00:00:18,360 --> 00:00:21,720 Speaker 1: I'm Sam, I'm Zara. This week, a group of researchers 6 00:00:21,800 --> 00:00:25,200 Speaker 1: have called for doctors to stop using the body mass index, 7 00:00:25,360 --> 00:00:29,200 Speaker 1: or BMI to define obesity. It's a measurement system that's 8 00:00:29,240 --> 00:00:32,360 Speaker 1: been around since the eighteen thirties, but now experts say 9 00:00:32,520 --> 00:00:35,319 Speaker 1: it might be doing more harm than good. Today we're 10 00:00:35,360 --> 00:00:37,800 Speaker 1: going to break down why this matters and what could 11 00:00:37,840 --> 00:00:38,320 Speaker 1: replace it. 12 00:00:41,640 --> 00:00:44,320 Speaker 2: Sam, this is such an interesting topic and one people 13 00:00:44,360 --> 00:00:47,440 Speaker 2: have very firm opinions on. But I think that before 14 00:00:47,479 --> 00:00:49,920 Speaker 2: we get to I guess this latest news and how 15 00:00:49,960 --> 00:00:51,920 Speaker 2: people are feeling about it, I do just want to 16 00:00:51,960 --> 00:00:53,880 Speaker 2: start at the beginning, and I think a good place 17 00:00:53,920 --> 00:00:57,560 Speaker 2: to start is by defining what exactly BMI is. It's 18 00:00:57,560 --> 00:00:59,640 Speaker 2: one of those things that we throw around as an 19 00:00:59,680 --> 00:01:02,960 Speaker 2: acron but perhaps don't think about very often. And also 20 00:01:03,120 --> 00:01:06,200 Speaker 2: how BMI calculates obesity, what goes into it. 21 00:01:06,319 --> 00:01:09,360 Speaker 1: So it's basically a mathematical formula that takes into account 22 00:01:09,360 --> 00:01:12,360 Speaker 1: your height and weight and gives you a weight range 23 00:01:12,600 --> 00:01:15,720 Speaker 1: and a scale that shows whether you're underweight in the 24 00:01:15,760 --> 00:01:18,440 Speaker 1: target range or overweight. And it was developed in the 25 00:01:18,440 --> 00:01:21,040 Speaker 1: eighteen thirties. It's a very long time, very long time 26 00:01:21,080 --> 00:01:23,640 Speaker 1: ago by a mathematician who was trying to find what 27 00:01:23,800 --> 00:01:26,960 Speaker 1: he called the average male body. So as we were 28 00:01:27,000 --> 00:01:30,000 Speaker 1: learning more about medicine in eighteen thirties, there was only 29 00:01:30,040 --> 00:01:32,440 Speaker 1: about men only, of course, Yeah, then there was this 30 00:01:32,560 --> 00:01:35,240 Speaker 1: drive to figure out a metric that took into account 31 00:01:35,640 --> 00:01:39,160 Speaker 1: more than one measurement. And so even today, what's considered 32 00:01:39,240 --> 00:01:42,720 Speaker 1: a normal BMI is between eighteen point five and twenty five. 33 00:01:43,120 --> 00:01:45,760 Speaker 1: A person with a BMI between twenty five and thirty 34 00:01:45,840 --> 00:01:48,640 Speaker 1: is considered overweight, and a person with a BMI over 35 00:01:48,720 --> 00:01:52,400 Speaker 1: thirty is considered obese. A person is considered underweight if 36 00:01:52,440 --> 00:01:55,840 Speaker 1: the BMI is less than eighteen point five. But here's 37 00:01:55,840 --> 00:01:59,480 Speaker 1: where it all gets a little potentially problematic. Experts say 38 00:01:59,560 --> 00:02:03,040 Speaker 1: it's an incredibly simplified way of looking at health. So 39 00:02:03,120 --> 00:02:06,360 Speaker 1: the Butterfly Foundation, for example, which is Australia's national eating 40 00:02:06,400 --> 00:02:09,799 Speaker 1: disorder charity, has called it outdated because it doesn't take 41 00:02:09,800 --> 00:02:13,760 Speaker 1: into account things like muscle mass, bone structure, age, sex 42 00:02:13,919 --> 00:02:14,679 Speaker 1: or ethnicity. 43 00:02:15,000 --> 00:02:17,160 Speaker 2: I mean, it's incredible when you think about all the 44 00:02:17,280 --> 00:02:19,640 Speaker 2: advancements we've had in so many areas of health. The 45 00:02:19,680 --> 00:02:22,480 Speaker 2: fact that we are using a metric that was conceived of, 46 00:02:22,919 --> 00:02:26,360 Speaker 2: you know, in the eighteen hundreds is fascinating. There was 47 00:02:26,400 --> 00:02:29,520 Speaker 2: a study this week that called into question whether BMI 48 00:02:29,760 --> 00:02:33,760 Speaker 2: is actually the best way to define obesity. Talk to 49 00:02:33,760 --> 00:02:36,240 Speaker 2: me about what they actually found in that study. 50 00:02:36,600 --> 00:02:39,840 Speaker 1: So this study was a cumbination of a number of 51 00:02:39,840 --> 00:02:43,119 Speaker 1: different streams of research, and in twenty twenty two researchers 52 00:02:43,280 --> 00:02:45,839 Speaker 1: essentially made a commission where they were attempting to bring 53 00:02:45,919 --> 00:02:49,440 Speaker 1: together all of these findings to almost once and for all, 54 00:02:49,480 --> 00:02:52,880 Speaker 1: workout whether BMI is the right way to be measuring obesity. 55 00:02:53,320 --> 00:02:56,399 Speaker 1: They had fifty six leading experts in this from different countries, 56 00:02:56,639 --> 00:02:58,720 Speaker 1: and what they found is pretty striking. So they found 57 00:02:58,720 --> 00:03:02,200 Speaker 1: that under the current BMI system, someone might be classified 58 00:03:02,240 --> 00:03:05,560 Speaker 1: as obese but show no evidence of health problems or 59 00:03:05,600 --> 00:03:08,960 Speaker 1: limitations in their daily activities. And on the flip side, 60 00:03:09,000 --> 00:03:13,760 Speaker 1: somebody might develop obesit related diseases without technically being classified 61 00:03:13,800 --> 00:03:16,880 Speaker 1: as obese under the BMI structure. And if you expand 62 00:03:16,919 --> 00:03:19,679 Speaker 1: it beyond that study and look at an analysis from 63 00:03:19,720 --> 00:03:22,960 Speaker 1: other sources over the years, including Harvard University has done 64 00:03:23,040 --> 00:03:26,240 Speaker 1: a lot of work in this space. Then other issues erase. 65 00:03:26,480 --> 00:03:29,120 Speaker 1: You know the fact that a BMI calculation doesn't take 66 00:03:29,120 --> 00:03:33,240 Speaker 1: into account whether you're pregnant an athlete with large muscle mass, 67 00:03:33,280 --> 00:03:36,920 Speaker 1: and that historic calculations were not only, as you said before, 68 00:03:36,960 --> 00:03:39,640 Speaker 1: based on the male, the average male, but the average 69 00:03:39,640 --> 00:03:42,680 Speaker 1: white male. And now we know that body composition can 70 00:03:42,760 --> 00:03:45,760 Speaker 1: vary a lot by race and ethnic group. So I 71 00:03:45,760 --> 00:03:48,480 Speaker 1: guess if you were to bundle up these findings, really simply, 72 00:03:48,880 --> 00:03:51,720 Speaker 1: it's taking something very complex and trying to make it 73 00:03:51,760 --> 00:03:53,440 Speaker 1: simple but potentially failing. 74 00:03:53,880 --> 00:03:57,080 Speaker 2: Okay, So there has been recognition that perhaps the system 75 00:03:57,080 --> 00:03:59,920 Speaker 2: that we've been using for hundreds of years is falling 76 00:04:00,160 --> 00:04:03,080 Speaker 2: short at the moment, and that it is oversimplifying a 77 00:04:03,160 --> 00:04:06,080 Speaker 2: complex matter, as you said, But there needs to be 78 00:04:06,160 --> 00:04:10,240 Speaker 2: some sort of indication as to how somebody's health is faring. 79 00:04:10,760 --> 00:04:14,360 Speaker 2: What are these researchers proposing could be in place of BMI, 80 00:04:14,400 --> 00:04:15,520 Speaker 2: for example, So. 81 00:04:15,480 --> 00:04:19,240 Speaker 1: They haven't agreed upon what measurements specifically should be taken 82 00:04:19,560 --> 00:04:24,280 Speaker 1: to define obesity. You know, whether it's waste measurements, bone density, 83 00:04:24,839 --> 00:04:28,800 Speaker 1: body fat percentage, height, weight, multiples of that, etc. But 84 00:04:28,880 --> 00:04:32,280 Speaker 1: what they have said with some clarity is the definitions 85 00:04:32,360 --> 00:04:35,680 Speaker 1: of obesity, and they've got two different definitions. They've got 86 00:04:35,880 --> 00:04:38,599 Speaker 1: pre clinical obesity and clinical obesity. 87 00:04:39,040 --> 00:04:42,240 Speaker 2: And sorry, so to clarify, that's because the current definition 88 00:04:42,400 --> 00:04:45,360 Speaker 2: is so closely linked to BMI exactly. Okay, So they're 89 00:04:45,360 --> 00:04:48,719 Speaker 2: separating this and they want new definitions of how someone 90 00:04:48,800 --> 00:04:50,839 Speaker 2: can be classified as obese. 91 00:04:50,920 --> 00:04:52,480 Speaker 1: Yeah, and they've kind of done away with the term 92 00:04:52,520 --> 00:04:54,880 Speaker 1: overweight as well, so they're replacing it with this term 93 00:04:54,960 --> 00:04:58,320 Speaker 1: pre clinical obesity and that would be considered a risk 94 00:04:58,360 --> 00:05:02,039 Speaker 1: factor for diseases. Clinical obesity would be treated as a 95 00:05:02,040 --> 00:05:06,000 Speaker 1: standalone illness caused by how body fat affects organs and tissues. 96 00:05:06,480 --> 00:05:09,359 Speaker 1: And so instead of just using BMI, they want doctors 97 00:05:09,400 --> 00:05:12,040 Speaker 1: to be looking at a whole range of measurements, things 98 00:05:12,080 --> 00:05:15,080 Speaker 1: like waste circumference, actual body fat measurements, or something called 99 00:05:15,080 --> 00:05:17,800 Speaker 1: the waste to height ratio. They don't have clarity on 100 00:05:17,839 --> 00:05:21,840 Speaker 1: which one should be the universally recognized measurement. Essentially, it's 101 00:05:21,880 --> 00:05:24,200 Speaker 1: about having as many measurements as possible and as many 102 00:05:24,200 --> 00:05:25,360 Speaker 1: indicators as possible. 103 00:05:25,480 --> 00:05:28,640 Speaker 2: And I guess the issue that lies with that is 104 00:05:28,720 --> 00:05:32,279 Speaker 2: that with BMI, there is an agreed upon universal way 105 00:05:32,320 --> 00:05:35,520 Speaker 2: of measuring this, and it's accessible, it's understands, super easy, 106 00:05:35,560 --> 00:05:38,200 Speaker 2: and it's easy. But I guess that's one of the shortfalls. 107 00:05:38,640 --> 00:05:41,520 Speaker 2: But there's no consensus on what replaces it. So where 108 00:05:41,520 --> 00:05:44,160 Speaker 2: does that leave us? Where does that leave health practitioners? 109 00:05:44,400 --> 00:05:47,520 Speaker 1: Well, I think the research recognized that convenience is a 110 00:05:47,600 --> 00:05:50,039 Speaker 1: large part of why BMI is so popular. If you 111 00:05:50,240 --> 00:05:54,240 Speaker 1: google BMR calculator, you're given hundreds of different calculators which 112 00:05:54,240 --> 00:05:57,320 Speaker 1: all get the same inputs, and they're very easy to 113 00:05:57,360 --> 00:06:00,240 Speaker 1: measure inputs weight and height, that kind of thing. But 114 00:06:00,640 --> 00:06:03,600 Speaker 1: it does lack the nuance that they're looking for here, 115 00:06:04,120 --> 00:06:07,200 Speaker 1: And it's really important because the output of all of 116 00:06:07,200 --> 00:06:09,960 Speaker 1: this is that some people might be getting unnecessarily limited 117 00:06:10,279 --> 00:06:13,359 Speaker 1: in their access to certain kinds of healthcare, while others 118 00:06:13,440 --> 00:06:16,320 Speaker 1: might have their real health issues overlooked. So let's say 119 00:06:16,320 --> 00:06:19,160 Speaker 1: that there's an insurance company that offers a particular type 120 00:06:19,160 --> 00:06:22,080 Speaker 1: of cover to those who, by the BMI standards, are 121 00:06:22,120 --> 00:06:25,200 Speaker 1: classified as obese. There might be somebody who doesn't fit 122 00:06:25,240 --> 00:06:28,560 Speaker 1: that BMI classification, who misses out on particular coverage, even 123 00:06:28,600 --> 00:06:31,920 Speaker 1: though by other measurements they've got obesity related health issues. 124 00:06:32,440 --> 00:06:35,640 Speaker 2: So you just touched on the way in which definitions 125 00:06:35,839 --> 00:06:39,680 Speaker 2: of obesity can touch other areas of society, as you said, 126 00:06:39,760 --> 00:06:43,120 Speaker 2: like private health insurance, but also I guess policy and 127 00:06:43,800 --> 00:06:47,159 Speaker 2: data collection and all of that. So can you just 128 00:06:47,200 --> 00:06:50,200 Speaker 2: talk to me about what would happen if the definition 129 00:06:50,279 --> 00:06:52,680 Speaker 2: were to change and if the metric of obesity were 130 00:06:52,720 --> 00:06:53,120 Speaker 2: to change. 131 00:06:53,240 --> 00:06:56,200 Speaker 1: Yeah, you're right. I mean there's major funding decisions being 132 00:06:56,240 --> 00:07:00,000 Speaker 1: made on how we understand the demographic makeup of Australa 133 00:07:00,320 --> 00:07:02,960 Speaker 1: and what percentage of Australia would be classified as obese. 134 00:07:03,120 --> 00:07:05,559 Speaker 1: It's a really interesting question. As I was looking into 135 00:07:05,680 --> 00:07:09,080 Speaker 1: both health insurance companies and government policy, what I actually 136 00:07:09,080 --> 00:07:12,400 Speaker 1: found was right now, they're not that reliant on BMI, 137 00:07:12,560 --> 00:07:14,440 Speaker 1: and it made me think that maybe we're stuck in 138 00:07:14,480 --> 00:07:16,880 Speaker 1: a bit of a transition zone anyway, and this research 139 00:07:17,040 --> 00:07:20,240 Speaker 1: kind of affirms that. So most private health companies have 140 00:07:20,280 --> 00:07:24,360 Speaker 1: their own BMR calculators, they do their own BMI calculations 141 00:07:24,360 --> 00:07:26,120 Speaker 1: when you're asked to put in your weight and height 142 00:07:26,160 --> 00:07:29,080 Speaker 1: when you register for health insurance, and they're all caught 143 00:07:29,080 --> 00:07:30,920 Speaker 1: in that tension, I think. So I looked at Booper, 144 00:07:31,000 --> 00:07:34,400 Speaker 1: for example, they've got their BMR calculator on the same 145 00:07:34,440 --> 00:07:37,960 Speaker 1: page as an article about the problems of BMI calculations, 146 00:07:38,480 --> 00:07:40,200 Speaker 1: and then you go to a government level and look 147 00:07:40,240 --> 00:07:44,600 Speaker 1: at policy. I was reading the Australian government's National Obesity Strategy, 148 00:07:44,600 --> 00:07:46,360 Speaker 1: which was made in twenty twenty two. It's a ten 149 00:07:46,440 --> 00:07:49,560 Speaker 1: year strategy. In the eighty four page document, BMI is 150 00:07:49,600 --> 00:07:52,080 Speaker 1: only mentioned once, and it's only mentioned once in a 151 00:07:52,120 --> 00:07:54,880 Speaker 1: list of resources that could be offered to the general 152 00:07:54,880 --> 00:07:58,120 Speaker 1: public as an easy way to track health. So a 153 00:07:58,240 --> 00:08:01,600 Speaker 1: change in the wide scale use of BEMI potentially wouldn't 154 00:08:01,640 --> 00:08:04,680 Speaker 1: have that much of an impact on the way our health, 155 00:08:04,720 --> 00:08:07,680 Speaker 1: insurance or government policy systems work. I think it would 156 00:08:07,680 --> 00:08:09,840 Speaker 1: more in the way that we talk about this topic. 157 00:08:10,880 --> 00:08:14,600 Speaker 2: Keen to understand how the health care industry or community 158 00:08:14,640 --> 00:08:16,840 Speaker 2: has responded to this. What have we heard so. 159 00:08:16,920 --> 00:08:20,320 Speaker 1: Dieticians Australia came out strongly in support of the research. 160 00:08:20,400 --> 00:08:23,679 Speaker 1: This week, their president, doctor Fiona Willer, made an interesting 161 00:08:23,680 --> 00:08:26,680 Speaker 1: point about how people in larger bodies often have their 162 00:08:26,680 --> 00:08:30,480 Speaker 1: health concerns either ignored or automatically blamed on their ways, 163 00:08:30,960 --> 00:08:33,360 Speaker 1: and so they're particularly supportive of moving to what they 164 00:08:33,440 --> 00:08:36,240 Speaker 1: call a more modern approach that brings in those factors 165 00:08:36,320 --> 00:08:37,160 Speaker 1: that we've talked about. 166 00:08:37,520 --> 00:08:41,079 Speaker 2: Okay, so this big body of research has been released, 167 00:08:41,280 --> 00:08:44,160 Speaker 2: It's established that there is an issue with the way 168 00:08:44,160 --> 00:08:48,520 Speaker 2: that we are at the moment both measuring and defining obesity. 169 00:08:48,880 --> 00:08:52,640 Speaker 2: It has put forward some suggestions about changing the way 170 00:08:52,640 --> 00:08:54,839 Speaker 2: that this is defined, but hasn't got any I guess 171 00:08:54,920 --> 00:08:58,920 Speaker 2: agreed upon all universal ways to change that metric of 172 00:08:58,960 --> 00:09:01,080 Speaker 2: be and I where does that leave us? 173 00:09:01,480 --> 00:09:04,600 Speaker 1: So I think what the researchers say is the next 174 00:09:04,640 --> 00:09:09,720 Speaker 1: step is to actually implement more complex definitions of obesity 175 00:09:10,120 --> 00:09:12,680 Speaker 1: on top of the research we've already got. And what 176 00:09:12,720 --> 00:09:14,880 Speaker 1: they're trying to get to there is what percentage of 177 00:09:14,960 --> 00:09:18,160 Speaker 1: the population of whichever country they're operating in is actually 178 00:09:18,200 --> 00:09:22,800 Speaker 1: obese by a more nuanced, complex, medically accurate standard. Once 179 00:09:22,800 --> 00:09:25,320 Speaker 1: they have that data that gives a more accurate portrait 180 00:09:25,440 --> 00:09:29,199 Speaker 1: of how the population is health wise, that's when they 181 00:09:29,240 --> 00:09:32,200 Speaker 1: want to then do further research into other options for 182 00:09:32,280 --> 00:09:35,320 Speaker 1: measurement that are available. I have to say that this 183 00:09:35,400 --> 00:09:38,000 Speaker 1: next part of the project, I think for them, is 184 00:09:38,040 --> 00:09:40,880 Speaker 1: going to be complicated because how do you bring in 185 00:09:40,920 --> 00:09:44,440 Speaker 1: other factors of health amongst a population that's already been 186 00:09:44,440 --> 00:09:46,800 Speaker 1: told they are obese or not. It's going to take 187 00:09:46,840 --> 00:09:50,280 Speaker 1: a lot of you know, closed experimentation on working out 188 00:09:50,400 --> 00:09:53,800 Speaker 1: health outcomes and whether there's a particular pattern in people 189 00:09:53,880 --> 00:09:56,520 Speaker 1: who have a certain type of heart disease and whether 190 00:09:56,559 --> 00:09:59,120 Speaker 1: that was related to one measure of obesity that was 191 00:09:59,160 --> 00:10:02,120 Speaker 1: available and not used. It's complicated, and that's why I 192 00:10:02,120 --> 00:10:05,200 Speaker 1: think it's taken forty eight bodies from forty eight different 193 00:10:05,320 --> 00:10:08,160 Speaker 1: organizations to come together for this sort of research. But 194 00:10:08,240 --> 00:10:11,040 Speaker 1: I do think that the overarching theme of all of 195 00:10:11,040 --> 00:10:14,120 Speaker 1: this in terms of the next steps is a broader 196 00:10:14,200 --> 00:10:17,800 Speaker 1: change in how we all think about obesity. And the 197 00:10:17,800 --> 00:10:20,480 Speaker 1: goal that they have set for us is to move 198 00:10:20,520 --> 00:10:23,240 Speaker 1: away from a one size fits all approach. And that's yeah, 199 00:10:23,280 --> 00:10:26,200 Speaker 1: as I said, already happening on a government policy level, 200 00:10:26,440 --> 00:10:28,360 Speaker 1: but we all need to be thinking about how to 201 00:10:28,400 --> 00:10:30,760 Speaker 1: represent a more complex picture of human health. 202 00:10:31,080 --> 00:10:33,320 Speaker 2: And of course we're talking about obesity today, but that 203 00:10:33,480 --> 00:10:37,240 Speaker 2: same kind of nuance based evidence approach can be applied 204 00:10:37,280 --> 00:10:40,880 Speaker 2: to all sorts of different health conditions across the spectrum. 205 00:10:40,960 --> 00:10:43,320 Speaker 2: So Sam, thank you for taking us through that and 206 00:10:43,360 --> 00:10:47,600 Speaker 2: for explaining more on this really significant research. Thanks Sarah, 207 00:10:47,640 --> 00:10:49,920 Speaker 2: thank you for joining us for another episode of The 208 00:10:50,000 --> 00:10:52,679 Speaker 2: Daily os. If you learned something new from today's episode, 209 00:10:52,679 --> 00:10:54,800 Speaker 2: why not send it to a friend. It's the way 210 00:10:54,840 --> 00:10:57,800 Speaker 2: that our independent media company can grow, and we so 211 00:10:57,920 --> 00:11:00,880 Speaker 2: appreciate your support. We'll be back again this afternoon with 212 00:11:00,880 --> 00:11:02,760 Speaker 2: the headlines, but until then, have a great day. 213 00:11:06,960 --> 00:11:09,320 Speaker 1: My name is Lily Maddon and I'm a proud Arunda 214 00:11:09,520 --> 00:11:14,319 Speaker 1: Bunjelung Kalkadoon woman from Gadighl Country. 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