25 August 2014

There are three simple measurements – weight, fat percentage, and waist-hip ratio – that every adult Malaysian should be made aware of if we want to go to the next level of improving the nation’s health.

THE Health Ministry is actively trying to educate and remind Malaysians about our generally poor health, as reflected in the rising prevalence of non-communicable diseases like obesity, hypertension, heart disease, stroke, cancer, and diabetes.
I prefer to call these “chronic lifestyle diseases” as they are chronic diseases directly due to unhealthy diet and lifestyles.
Apart from reminding Malaysians about the importance of a healthy diet (including eating more fruits and veggies), doing sufficient exercise, not smoking, avoiding alcohol, managing stress, and living a healthy lifestyle, the Health Ministry has also encouraged us to be more aware about our health condition through being conscious about our weight, as obesity is becoming an increasingly common problem.
I would like to give some suggestions about creating a better awareness and understanding about the body measurements as a guide to our health.
Ideal weight vs ideal BMI
The Health Ministry is campaigning for people to know their BMI (Body Mass Index). I think the campaign should aim for more practical and easier measurements for people to understand, and relate to.
BMI has little meaning to the average man-on-the-street. Telling a fat 90kg, 170cm tall man that his BMI is 31 (kg/m²), which means he is obese (25 and above is overweight; 30 and above is obese), may confound him. Although there are BMI-weight-height charts and slide-rules that can give instant readings, asking him to know and monitor his BMI may be too much.
BMI is useful for doctors and health professionals to classify and advise the patients/clients accordingly. However, the layman should not be burdened by it. He should instead be given the simple advice that he is obese (and the health risks that come with it), and what his ideal weight is so that he has a clear target to aim for.
The current guideline is that the normal BMI is between 18.5 and 24.9, which means, for this man, the normal weight is between 53.5 and 72kg. That is a very big range (almost 20kg), and is again not practical advice to give. It may also encourage him to stop at 72kg (if he manages to slim down) since that weight is already “normal”, even though he is actually still on the borderline of being overweight.
It is simpler for everyone to have one target figure to remember, and that figure should be his ideal weight.
The BMI of 25 and 30 for overweight and obesity respectively, are figures for Westerners/Caucasians. Many health experts have proposed that the benchmarks for Asians should be lowered to 23 and 28, considering our smaller frames. If the National Health and Morbidity Surveys (NHMS) had used these as the criteria, the figures would have been even worse. The NHMS III (2006) would have shown about 55% (my estimate) being overweight and obese, instead of the 45% recorded. The problem is actually bigger than we think.
Since the Asian benchmark for overweight is proposed to be a BMI of 23, I use BMI of 22.5 to calculate the ideal weight. Thus, the ideal weight for this man is 65kg. He has a clear target to reach, and he knows that the further away he is from this target, the greater is his health risk.
Except for young people (below 30), this may be a tough target for many to achieve, because more than 50% of us are already overweight (or obese) by this criterion. But if we want to be healthy, we have no choice but to aim for this target.
If we decide to retain BMI of 25 for overweight, than I propose a BMI of 24.5 be used to calculate the ideal weight. So for this man, his ideal weight is 71kg.
I propose that the Health Ministry change its campaign from “Know your BMI” to “Know your ideal weight”. Everyone can understand and remember their ideal weight, and those who are overweight should use that as their target to slim down to.
Those who are underweight need only be advised to achieve a weight equivalent to a BMI of 22.5, as it is not necessary to gain weight up to BMI of 24.5. Although a BMI of 18.5 is still considered normal, anyone with a BMI below 22 is skinny and may not appear healthy.
Body fat percentage
For those who are more concerned about their health, they should also know how much of their weight is actually due to fat. Most clinics, health centres, and pharmacies have weighing machines or stand-alone gadgets that give the body fat percentage reading.
The fat percentage is an important component of health assessment because it is actually excess fat, not excess weight, that is unhealthy. For example, by BMI standards, all body builders are “unhealthy”, when they are actually healthier than the rest of us. Muscle is twice heavier than fat; burns more calories; improves carbohydrate and fat metabolism; and also improves the body’s sensitivity to insulin.
Most of us actually need to lose fat and gain muscle. In doing so, our weight may not reduce. Instead, we may even gain weight, but the body will become trimmer, firmer, and more shapely.
The normal body fat percentage is up to 25% for men, and up to 30% for women. The ideal percentages are (up to) 20% and 25% respectively. Award winning body builders (but not weightlifters) have about 5-10% fat only. That’s why you can see every vein and every muscle fibre on their sculptured bodies!
In fact, when your fat percentage goes below 20%, you need not worry about having a high BMI. BMI is only relevant to those who don’t have enough muscles.
There are sophisticated machines that also give the percentages of body water, lean mass (ie excluding fat) and even their distribution. Those who are really serious about their health can now know their body composition in detail and use these to monitor their progress as they embark on a weight-loss and muscle-building programme.
Waist-hip ratio
Another simple yet useful measurement to know is the waist-hip ratio (WHR), which is your waist measurement divided by your hip measurement. This gives an indication of where most of the fat is being deposited.
A high ratio means that there is central (abdominal) obesity, leading to a higher health risk because there is more visceral fat (fat deposited within the abdominal cavity) that is associated with an increased risk of cardiovascular diseases and diabetes.
The normal WHR for men is up to 1.0, and for women, it is up to 0.9. However, for good health, it should be 0.9 and 0.8 respectively, and the ideal is 0.8 and 0.7 respectively. You will know what I mean when you consider that a pin-up model’s figure is usually 36-24-36 (inches) or thereabouts, giving a WHR of 0.67. Likewise, a typical male model’s figure is 44-32-40 or thereabouts, giving a WHR of 0.8.
If you just look around, you will find many men and women walking around with protruding tummies that give them WHRs exceeding 1.5, and they are indeed unhealthy.
These are the three simple measurements (weight, fat percentage, and WHR) that every adult Malaysian should be made aware of if we want to go to the next level of improving the nation’s health. Health campaigns must now include monitoring measurable and achievable goals that are easy to understand.
At the clinics, the blood pressure and glucose levels should be regularly measured, and suitable advice given. The campaigns to create awareness about non-communicable diseases (or chronic lifestyle diseases) should continue, but it is not enough just for people to know. They must actively participate in monitoring their physical health – they should be educated about these vital measurements, and the importance of achieving and maintaining the ideal values.
I hope the Health Ministry starts by making sure its own officials know their BMI and ideal weight, and those who are overweight or obese put their advice into practice so that the rest of the nation can be encouraged to follow.
That also means the nurses and other staff manning any health-promotion counters should themselves not be fat.
Good results can only be achieved if we lead by example.
For the rest of you – if you don’t know your weight, fat percentage, and WHR yet, get these measured, and if your figures show that you are not healthy, start a healthy diet and exercise programme to achieve your ideal targets. Good luck!
This article was first published in The Star Online on 22 August 2013.