How to Know if Weight Loss is Right for You

Jim Hill: Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt: And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

Jim Hill: Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt: Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

Jim Hill: Ready for the “And” factor?

Holly Wyatt: Let's dive in.

Jim Hill: Here we go. Welcome to Weight Loss and Holly, we've been getting a lot of questions from people who want to know, how do I know if I should lose weight or not? So I thought we might talk a little bit about how you assess your weight status. How do you know if weight loss would be good for you?

Holly Wyatt: How do you measure your body weight or your body state? I get lots of questions, what should I be using? How do I know if I need to lose a little bit of weight? Great question! Kind of a basic question, but a lot of people I think have that.

Jim Hill: So probably we should start by talking about the body mass index or BMI. Now, BMI is something that's been used in this field for a long, long time. Do you want to tell us a little bit about how people can measure their BMI and what it might tell you about your need to lose weight?

Holly Wyatt: So the way we measure someone's body state in a medical setting is with body mass index or BMI. There are calculators out there, so it's a calculated number. It's based on your weight and height. So you can go out there, just put in BMI. There's a ton of calculators. Put in your weight, put in your height, and it will give you back a number, and that is your body mass index. The medical profession assesses whether your weight poses a risk and if losing some weight would be beneficial from a medical standpoint.

So there are numbers and everybody gets that number. We will categorize you as obese, overweight, or healthy based on your number. The numbers that we use, there are lots of different numbers, but the two big ones that I like to remember are if your body mass index is 25 or greater, you're in the overweight category. If your BMI gets to 30 though, 30 or greater, that's when we put you in the obese category, which simply means a little bit more aggressive treatment.

There's a little bit more reason, a little bit more risk. A higher body mass index usually indicates a higher risk to your health caused by your body weight or state. And therefore, from a medical standpoint, weight loss is indicated. We need to at least think about our weight and potentially lose some weight.

Jim Hill: So maybe it's like a green, yellow, and red category. So if your BMI is 30 or above, then probably you would benefit from weight loss. If you're in that yellow category, which is above 25 and less than 30, it's iffy. Having other health issues like high blood pressure, elevated cholesterol, diabetes, or pre-diabetes might mean it's more important for you to lose weight compared to someone without these conditions.

Holly Wyatt: Right. If you have conditions like diabetes, high blood pressure, heart disease, high cholesterol, or sleep apnea, there are many health issues to think about. If you already have one of those, then you're already at risk, and we want to even be a little bit more aggressive in terms of saying that losing some weight could be helpful. In the yellow zone, a BMI of 25 to 30, weight loss should be considered with your doctor as it may help treat existing conditions. When you get to a BMI of 30, sometimes we're even just about preventing, treating, and preventing. But at BMI 25 to 30, if you already have one of those, we're wanting to, we can treat it, we can make it better with the weight loss. But I always get feedback and this is, I think, something we need to discuss: is BMI a good tool? Is it really helpful? Are there some individuals or BMI isn't going to be very helpful?

Jim Hill: Holly, you always get the people that come in and say, well, my BMI is high because I have a lot of muscle, right?

Holly Wyatt: Absolutely. Maybe somebody who was an athlete when they were younger. Now, it's 30 years past when they were an athlete working out, but they say there's a lot of muscle under this little bit of layer of fat. And so the weight, when you get your weight, just measuring your weight doesn't distinguish between fat and muscle. You could have a high weight on the scale, and it could be all muscle or a large percentage of muscle.

Jim Hill: Is there any way to tell the difference between a high BMI that's too much muscle and a high BMI that's too much fat?

Holly Wyatt: That is where waist circumference comes in.

Jim Hill: Ah, waist circumference.

Holly Wyatt: What I love to do. So if I have someone sitting in my office, and they're saying, this is a muscle, and they're convinced it's a muscle, then the easy thing is not for me to say it's not. I don't even really have to measure it. Let's focus on your waist circumference. If it's large, you likely have excess body fat. You don't put muscle on your waist. So if your waist is small, then you might be correct. You might be correct that the increased weight we see on the scale is muscle. But if your waist is big, the increased weight we see on the scale, at least a good part of it is probably body fat, which is really what we're trying to measure.

Jim Hill: How do people measure their waist circumference?

Holly Wyatt: So just a tape measure. I use a ribbon. I like people when they go home. Sometimes I send them home with a ribbon because this is something they can do pretty easily. I like there are a couple of different methods, but to me, it's about measuring it the same way each time. So if you kind of push on the high part of your hip bone, we call that the Iliad crest, but the high part of your hip bone on both sides, you can kind of feel that bony landmark. It's not going anywhere even when you lose weight. Some people say, let's measure it at the belly button, but the belly button can move. If you lose some weight, the belly button can kind of shift around. Find the top of the hip bone on both sides, put the surrounding ribbon, cut it, and then measure it with a measuring tape. This way you can track any changes over time.

Jim Hill: Holly, if measuring your waist circumference isn't a simple task, chances are you have an excessive amount of body fat. The people who have too much muscle, it's not going to be that hard to get a waist circumference.

Holly Wyatt: That's true. And we have some numbers.

Jim Hill: Oh, what are the numbers?

Holly Wyatt: So unlike BMI, the same number for men and women, right? We use the 25 for overweight and the 34 for obese. Same for men and women.

Jim Hill: When you're calculating your BMI, it doesn't matter if you're a man or a woman.

Holly Wyatt: Right. It's really simple.

Jim Hill: Before we got into the waist, I pulled up the calculator. The National Institute of Health has a good one. You can Google the BMI calculator.

And so I'll give people examples, so you know you're on the right track. If you're five feet and 10 inches tall and weigh 200 pounds, your BMI would be 28.7. So if you're calculating your BMI, it's probably going to be a number in the 20s or higher.

If you weigh less than 20, you probably don't have an issue with being overweight and might not be interested in this podcast. But your number is going to be 20 or higher. And again, those categories, 25 less than 30, is that yellow range where some weight loss is going to help, particularly if you have other conditions. But if you're in that range, you want to keep from getting in the 30 range. And it's 30 and above.

Holly Wyatt: And I love waist circumference in that range too, right?

Jim Hill: Right. So a BMI of, again, 28 with a high waist circumference is a little bit more concerning than a BMI of 20 with a lower waist. And if you're 30 or above, then weight loss would probably be helpful for you. So now let's give them the numbers on waist circumference.

Holly Wyatt: So there are two different numbers, one for women, and one for men. If for women, if your waist circumference is 35 inches or greater, then you're potentially at a higher risk. That kind of says I've got some extra body fat, and I've got it in a central distribution. And we should talk about that in a minute. For a man though, it's 40 inches. So there are two different reasons for that. So 35 for female, 40 for a male in terms of when we start to use that as a red flag, concerned that there may be too much body fat.

Jim Hill: If my body mass index (BMI) is 27, yet my waist circumference measures 35, there would be less cause for concern. This indicates a possibility that there might not be excess fat present in my body. I might have some extra muscle.

Holly Wyatt: As a man, yes.

Jim Hill: As a female, that same number in a female would be different because men and women put on fat differently. And in general, women have more body fat. There are probably a lot of reasons for that or a higher percentage of body fat.

Holly Wyatt: Higher total percentage of body fat. But once again, we've kind of looked at these numbers, and we see when the risk starts to go up. There's good data. We didn't talk about that. Why do we use body mass index if it could be off? But we have such good data in the field to show when you get to a BMI of 30, your risk of diabetes goes up. Your risk of this goes up. We have a lot of data to kind of gauge our risk on. And that's one of the reasons I think we use it.

Jim Hill: What we're concerned about is people that have too much body fat, but it's not easy to measure body fat. And most people at home can't do it very accurately. And BMI, it's a good substitute. So BMI doesn't measure fat directly, but we know that it's correlated with having extra fat. So it's not perfect, but it's the best instrument we have for people to sort of figure out if they need to lose weight or not. If your BMI is low and your waist circumference is also low, you can feel pretty good. It's not 100%, but it can feel pretty good that you probably don't need to lose weight. But if your BMI is high and your waist circumference is high, weight loss would probably help you health-wise.

Holly Wyatt: I agree with that. And I think for the majority of people, even though BMI kind of gets a bad rap for the majority, I'd say 95% of my patients’ BMI is spot on. There are a few. If you're extremely short or extremely tall, or you have a lot of edema (which is fluid, you retain a lot of water), or you're very muscular (you are a bodybuilder), BMI may not be. For the majority of people, especially when you put it with the waist circumference, it's easy, and it does get at what we want is a health risk.

Jim Hill: I can't wait for the day when we have a scanner like they have on Star Trek that instantly shows a person's body fat percentage. We might not be too far away from that, but right now, we don't have a good way of doing that. And probably the best way, if you're listening to this and you're wondering if you should lose weight, is to measure your BMI and measure your waist circumference. And those two things together can give you a pretty good indication of whether weight loss would improve your health or not.

Holly Wyatt: And they're easy. And they're easy. You can do them multiple times and there's no risk, and it doesn't cost a lot. So there are so many good things. I like to think about it as the BMI has, let me question, potentially do I have too much body fat? It's a surrogate, like you said, it's correlated. Do I have too much body fat? And then you add in the waist, and it says, am I carrying that body fat in a place that may be worse for me, right around the central, that visceral fat?

Jim Hill: So you talked about that earlier. You alluded to that earlier that where the fat is might be important.

Holly Wyatt: It's not just how much, it's how much and where you carry it. Too much body fat in general is at risk. Carrying fat around your waist increases the risk of developing diabetes, heart disease, and other related diseases. A large waist circumference can indicate this risk.

Jim Hill: And in general, it's more of a male pattern to put on a lot of fat around the middle. And oftentimes for females, they will have a lot of lower body fat. And lower body fat is probably not as negative health-wise. But again, it makes a difference in how you look and how you feel. And so just because you don't have central fat doesn't mean weight loss wouldn't be a good thing for you.

Holly Wyatt: Absolutely. I'm the opposite. I carry mine in my waist. So not everybody says that in general, we talk about apples. Men tend to be more apples and women tend to be more pear-shaped. But then you look at me, I gain weight.

Jim Hill: There are exceptions to it.

Holly Wyatt: I'm an apple. And then even going through menopause, women become more like an apple.

Jim Hill: So there's a podcast in itself of what happens around menopause. Boy, the hormones, the hormones change and it can change body weight.

Holly Wyatt: We have to do another one on that. That's a whole, a whole other thing everybody always says. What about what's going on with those hormones? Jim, have you considered the various devices available at gyms or health food stores that can measure body fat? Some scales even provide you with a percentage of body fat or the total pounds of body fat. Why not use that instead of BMI and waist circumference?

Jim Hill: There are a lot of those out there. And I wouldn't say don't use them, but they're a little bit less accurate and highly variable. So what these things do, Holly, is they run a small current through your body. Fat and muscle conduct electricity differently. An algorithm can be used to estimate the amount of body fat and non-fat or fat-free mass. The problem is they're affected by so many things like hydration, time of day, et cetera. If you use it, just double-check your BMI and waist circumference. I would be worried if the scale shows low body fat but your BMI and waist circumference are high. And then the second thing is we don't have measures. So you get on the scale and it says you're 25% body fat. Is that good? Is it bad? What should it be? We don't have good standards such as we do with BMI. So those scales might be useful if you're losing weight, for example, to watch how things change and improve. But right now, I would feel a little better looking at BMI and waist circumference as an answer to whether I should think about losing weight.

Holly Wyatt: I truly believe that utilizing BMI and waist circumference is a superior approach to evaluating the risks, as we currently lack sufficient data on percent body fat. I also, though, personally don't like them to look at changes over time because that's when hydration and your status, so many things can make it go up and down that isn't related. And so you have to be careful. I've had people get disappointed because they're following that, and their hydration status is changing. They're weighing at different times, and it's just not as accurate as to me sometimes just the scale.

Jim Hill: You and I are planning another episode on setting goals and a time course on weight loss. But one of the things is when you're looking at your success in weight or fat or whatever, don't look at one or two points because it isn't linear. So if you were to plot your weight each day that you're on a weight loss program, it wouldn't be a straight line down. It would be all over the map. And so don't look at one or two things. You have to look at the long-term pattern. And again, we're going to go into another episode in deep dive on looking at patterns of weight loss and time course and setting goals, etc.

Holly Wyatt: I think that's a great point. To assess if I should lose weight, I consider BMI, waist circumference, and a couple of other factors. The other to me is are you gaining weight? I like to see which direction are you going. So BMI says potentially too much fat. Waist circumference, too much fat in a position in my body that may be negative. And then the third is, am I gaining weight? If you're gaining weight, I'd like to help you prevent further gain or even lose a little weight, before reaching a BMI of 30 or 40. Can we intervene early?

Jim Hill: Well, that's a great point. I think we know that a lot of the U.S. population is in a weight gain scenario, gaining a little bit of weight each year. And one measure of success would be stopping that. And so at some level, if you weigh the same next year that you weigh right now, that's success at one level. Now, it doesn't mean you shouldn't try to lose weight, but maybe as a first step, make sure you aren't gaining weight.

Holly Wyatt: So I like to look at that. Those are the three things I do - BMI, waist circumference, am I gaining weight from year to year, month to month? What's my path? Which direction am I facing? And then the last thing that I think is just as important as these three, I mean, the three things we just talked about have a lot of science behind them. But how do you feel? Your body state, this is how you, your body is how you enter, you live your life. It impacts your experiences. And so bringing in, yes, my numbers from a science standpoint, from a health standpoint look like this. But also, how do I feel? Am I feeling good? Can I reach down and tie my shoes? Can I interact and move about and go hiking? Or is my weight at a place that interferes with what I want to do and how I feel?

Jim Hill: That's a good point because, at the end of the day, the reason you want to lose weight is you feel better. Yes, your metabolic profile may improve. But at the end of the day, a lot of the reason people want to lose weight is they feel better after they've lost weight. So that's important.

Holly Wyatt: Doctors want to say you should lose weight. And let me tell you why you should lose weight. Your BMI is this, you're at risk for diabetes, and your waist circumference is big. And I agree. We should be educated. We need to know that. But ultimately, it's going to be how you want to feel and live your life. So just asking yourself that, I think, is just as important, equally important as calculating that body mass index.

Jim Hill: Well, we've given folks some practical tips. To measure your BMI, go online and find various methods. Additionally, measure your waist circumference and assess if you're gaining weight. And then how do you feel? If you feel great, and you're in that overweight category, maybe you're okay. Maybe now's not the time to do it. But if you say, I really can't do the things I want to do, maybe weight loss might be helpful.

Holly Wyatt: I think you've got to put it all together. Once again, it isn't simple. It isn't a yes or no, it's an and.

Jim Hill: Weight loss And - the and is the interesting stuff.

Holly Wyatt: Always. Always.

Jim Hill: Well, great, Holly. Thanks. And thanks to all of you out there. Continue to give us your questions. We want to know what you want to know about this topic. And we will do our best to address that. So until next time, this is Weight Loss And…

Holly Wyatt: See you all. Bye.

Jim Hill: And that's a wrap for today's episode of Weight Loss And… we hope you enjoy diving into the world of weight loss with us.

Holly Wyatt: If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

Jim Hill: We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

Holly Wyatt: And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.