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Author Topic: BMI for Accurate Diagnosis?    (Read 2667 times)
G_C
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« on: July 24, 2010, 12:18:08 pm »

Hi folks,

I'm a 27 year old guy, and I've been overweight my entire life. In fact, I was at 35 BMI only six months ago (that's how bad it was). As you can imagine, my breasts too have been enlarged for as long as I remembered (I was embarassed of wearing T-shirts as far back as when I was 17).

Finally, at the beginning of the year, I embarked on an aggressive weight loss course, and brought my BMI down to 27.8. Unfortunately, I can't tell whether my breasts have become smaller or not (I never took before and after pictures). I know that my belly has definitely gotten smaller (I've dropped multiple jeans sizes!) and so far, on side shots, my belly still sticks out more than my breast does.

Bottom line is, I know that BMI 27.8 is not sufficient, and I'm working hard to get to at least 22, maybe even 20. But my question is - at my current BMI, can I already draw conclusions that what I have is gland-related gynecomastia, rather than fat-related? It does stick out very prominently.

On a side note - how I'd dearly love to do something terribly painful to my grandmother, who helped bring me out and stuffed my face full of sweets, sugary stuff, cakes and what not every single day, until I was obese by the time I was 14....
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Dr. Elliot Jacobs
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« Reply #1 on: July 26, 2010, 08:48:36 am »

BMI is a rough guide to general health and obesity.  A BMI of 20-25 is considered healthy, 25-30 is overweight, 30-40 is obese, and over 40 is morbidly obese (and perhaps ready for a very strict diet or weight loss surgery).

It is a ROUGH guide -- a better guide is body fat analysis (BFA). BMI can be calculated simply from your height and weight while BFA requires some instrumentation at a doctor's office.  BMI may be more elevated in very muscular men with thick bones -- ie it doesn't truly reflect their overall health.

Congratulations on reducing you own BMI so substantially, however.  You are undoubtedly healthier and happier.  And while a goal of reducing it further is admirable, do not set unobtainable goals such as BMI of 20 or 22 -- this can lead to frustration. What you want to do is to reach a comfortable weight for your frame as well as build up your muscles.  For you, that may be 24 or even 25 -- which is definitely attainable.

In the end, though, we shouldn't lead our lives "by the numbers."  You should lose weight until you are comfortable in your own body -- then stabilize there.

As for your gyne, any obese male will have fat deposited in the chest area.  And with obesity, there is a secondary effect of increased estrogen production, which in turn leads to the production of breast tissue as well -- so obesity is a double whammy!  When you lose weight, the fat component of your chest may decrease, but the breast tissue remains.

Thus, at your present weight, your breasts are probably somewhat smaller due to the loss of the fat component but they will remain due to the residual breast tissue.  Once your weight has stabilized, look at your chest and if you are motivated, then consult with an experienced gyne surgeon -- there are a number of them around the country.

Best of luck!

Dr Jacobs
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Elliot W. Jacobs, MD, FACS
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  gynecomastiasurgery.com
Website:  gynecomastianewyork.com/revision
DrBermant
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« Reply #2 on: July 28, 2010, 12:12:52 am »

Hi folks,

I'm a 27 year old guy, and I've been overweight my entire life. In fact, I was at 35 BMI only six months ago (that's how bad it was). As you can imagine, my breasts too have been enlarged for as long as I remembered (I was embarassed of wearing T-shirts as far back as when I was 17).

Finally, at the beginning of the year, I embarked on an aggressive weight loss course, and brought my BMI down to 27.8. Unfortunately, I can't tell whether my breasts have become smaller or not (I never took before and after pictures). I know that my belly has definitely gotten smaller (I've dropped multiple jeans sizes!) and so far, on side shots, my belly still sticks out more than my breast does.

Bottom line is, I know that BMI 27.8 is not sufficient, and I'm working hard to get to at least 22, maybe even 20. But my question is - at my current BMI, can I already draw conclusions that what I have is gland-related gynecomastia, rather than fat-related? It does stick out very prominently.

On a side note - how I'd dearly love to do something terribly painful to my grandmother, who helped bring me out and stuffed my face full of sweets, sugary stuff, cakes and what not every single day, until I was obese by the time I was 14....

Congratulations on the weight loss so far. Doesn't it feel good getting that weight off?  Unfortunately, you cannot pick where the fat comes from.  Male Body Fat Patterns is to put fat on first on the belly and chest in a band about each region. We take it off those sites last.

Here are Standard Pictures to evaluate Male Chest after Weight Loss that I evolved to show the possible loose skin issues. These images are a good way to document progress of weight loss.

I have been trying to educate the public for many years about BMI, body fat analysis, and weight loss issues. Check out the date of this post in this forum:

Wearing the extra fat is not healthy.  Check out your risks with a BMI Calculator (Body Mass Index)

Plastic surgery is better after weight loss, losing weight is a coarse tool. Plastic surgery is better used for refinement.

Weight Loss, Dealing With Excess Skin of the Chest and Body is also a major emotional issue.

Check out this new section on the emotion of body lift surgery for those after massive weight loss:

Personal experiences and emotions of dealing with weight, loose skin, and body lift surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

And then check the date for this post:

In general I recommend that my patients get to a weight / body fat percentage with which they are comfortable.  That number varies from individual to individual.  The exception is for those dealing with extraordinary low body fat such as my Olympic athletes, marathon runners, and bodybuilders.  For these patients, I prefer their "off season" body fat.  Too little fat and options to target gland first are limited.  The only way I can get rid of almost all gland requires a little fat to move into the defect.

Body Fat Percentage Analysis does not necessarily correlate with Body Mass Calculation  The most accurate way to determine body fat is an Archimedes water displacement tank available to very few and not practical for most.  Calipers have a steep learning curve and are not effective for the loose skin issues after massive weight loss.  The most practical are impedance devices but these are the least accurate.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Surgery

The BMI or Body Mass Index is just a raw calculation of height and weight and does not differentiate between, fat, muscle, or bone. That is why understanding body fat analysis is so important. I recommend Body Fat Analyzers for this. The impedance units are very easy to use although skin resistance is not as accurate as water displacement, the measurements are easy and the device inexpensive. In comparison try to find the cost of a Bod Pod measurement, a single test will set you back more than the cost of one of these analyzers. No you do not need to go to a doctor's office for an analysis: a good profit center for the doctor trying to make money but hard on a patient's pocket. For many years I have been educating my patients that the best way to deal with this issue is to have your own body fat analyzer and minimize the variables such as skin moisture, room humidity and such or accept a small degree of inaccuracy of a very reasonably priced impedance unit.  The one we have been using for many years in our office cost us $40. It is still functioning fine and I have seen the same unit on the web for a  little as $25. But be careful, at a drugstore the other day I saw it for $65, the same unit!

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction
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bill1177
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« Reply #3 on: August 01, 2010, 02:28:20 am »

bmi question.

is 19.5 a good bmi for a 13 year old?
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less than 30 days till im 14
DrBermant
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« Reply #4 on: August 01, 2010, 08:52:51 am »

bmi question.

is 19.5 a good bmi for a 13 year old?

It depends on how it was calculated. Check the link on my BMI Calculator for children and young adults. The simple equation for adults breaks down for the young. If you follow that link and enter the appropriate details, you can get a better calculation than the simple calculators. If the number is correct, 19.5 is underweight for a 13 year old male.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia
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bill1177
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« Reply #5 on: August 05, 2010, 10:29:44 pm »

thanks, it said i was at 19.7 on your bmi link
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less than 30 days till im 14
DrBermant
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« Reply #6 on: August 08, 2010, 12:26:41 pm »

thanks, it said i was at 19.7 on your bmi link

That pediatric and young adult link also has where that BMI fits for what is reasonable for that age.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction
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« Reply #7 on: August 08, 2010, 03:44:29 pm »

According to the BMI Calculator, Emmitt Smith, the most productive NFL running back of all time, is currently in the "overweight" category, and according to the calculator, was also overweight while he was a professional football player.

Obviously, it would not be correct to say that Emmitt Smith, a professional athlete, is overweight, either now or in his playing days.  To suggest such a thing would be ridiculous.

So the question is.....why do you consider the BMI calculator to be a valid indicator of body weight, when it cannot possibly take all the different factors into consideration?  We are not all the same; we are individuals, and when determining a person's ideal weight, all factors must be taken into consideration, not just weight and height. The calculator doesn't even factor in differences between being a male or female!  Men and women who are the same height do NOT have the same ideal weight ranges! 

According to the BMI calculator, I (a middle aged male) could weigh as little as 118 pounds and I would still be in the "normal weight" category.  But the reality is....this weight would be extremely unhealthy for me.  If I weighed 118 pounds, I would look like a skeleton; I would look anorexic. 

Frankly, I think that BMI calculator is trash. Yes, maybe it's supposed to give someone an "idea" of their ideal weight, but it doesn't do that.  False, inaccurate readings are just as common as accurate readings.  Unless it's highly accurate, I don't believe it should be recommended as a valid source for measuring what it's supposed to be measuring.
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DrBermant
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« Reply #8 on: August 08, 2010, 05:03:46 pm »

According to the BMI Calculator, Emmitt Smith, the most productive NFL running back of all time, is currently in the "overweight" category, and according to the calculator, was also overweight while he was a professional football player.

Obviously, it would not be correct to say that Emmitt Smith, a professional athlete, is overweight, either now or in his playing days.  To suggest such a thing would be ridiculous.

So the question is.....why do you consider the BMI calculator to be a valid indicator of body weight, when it cannot possibly take all the different factors into consideration?  We are not all the same; we are individuals, and when determining a person's ideal weight, all factors must be taken into consideration, not just weight and height. The calculator doesn't even factor in differences between being a male or female!  Men and women who are the same height do NOT have the same ideal weight ranges! 

According to the BMI calculator, I (a middle aged male) could weigh as little as 118 pounds and I would still be in the "normal weight" category.  But the reality is....this weight would be extremely unhealthy for me.  If I weighed 118 pounds, I would look like a skeleton; I would look anorexic. 

Frankly, I think that BMI calculator is trash. Yes, maybe it's supposed to give someone an "idea" of their ideal weight, but it doesn't do that.  False, inaccurate readings are just as common as accurate readings.  Unless it's highly accurate, I don't believe it should be recommended as a valid source for measuring what it's supposed to be measuring.

I have never ever used BMI Calculator by itself. Since I take care of many Professional Athletes and Bodybuilders with Gynecomastia and work with up to 8 gynecomastia patients a day, I realized many years ago the failings of societies' BMI tools. I always caution my patients it is a matter of muscle, bone, vs. fat. Weight and height does not take body fat percentage into account, Body Fat Analyzers do. Analyzers also by themselves are worthless. Then clinical examination comes into play as a key factor, body fat distribution about the body is measured by neither methodology. So I use a combination in explaining to my patients about weight, fat, and what makes them happy. If I was arrogant enough, I would devise a BBMI or Bermant Body Mass Index that mathematically combined the results of body fat and BMI to a usable number for people to hang their basis to what to strive for. The separate measurement are not multiplicative nor simple additive, but my guess is that with massive numbers of how long people lived, how they felt about themselves, and other factors, someone someday will be able to combine both systems to a better tool. However, I would then need to get society to adopt my system. So we are currently stuck with what society currently uses for their standards. My patients trying to feel better about themselves need something right now, not some future system that may be better. The combination of these with how someone feels about themselves does work for assessment of direction about weight and weight loss. That observation is based on decades of my own clinical experience with trying to help patients look and feel better.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction
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