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I hope you are not implying in your comments about BMI's imperfection as a universal health standard that I hold the contrary position. Since I did elucidate that in the deleted discussion which you agreed about. It would be dishonest then if there was an attempt to misrepresent my use of BMI where I clearly never used it as an absolute law of health but as an objective physical metric for thermodynamic calculation and in the other discussion as an approximative supporting evidence in my argument about who held the burden of proof. Which I know this time was understood and agreed upon. I still continue to offer you benefit of the doubt, I am sure that you were not implying my position but just edifying other readers.
I am extremely well aware of the nuances in dieting and energy consumption. We clearly agree on the nuances about BMI in my last post, where I elucidated our disagreements and agreements and you liked my response, and its funny that when we finally agreed the admins deleted the entire conversation, even though it was up for like over a week while we were in disagreement (or misunderstanding).
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In previous deleted posts you mentioned normal BMI like a support for idea that girls are healthy.
It caught my eye. Because I didn't meet this opinion for the first time. If people will follow the idea of normal BMI and normally looking body = healthy athlete scheme, then it will most likely lead to bigger number of athletes underdiagnosed with eating troubles. It may also lead to downplaying the seriousness of their troubles.
In next post you explained that BMI does not prevent from eating troubles as well as that saying that "girl is healthy" doesn't mean that she MUST be healthy (I hope I understood it well). I liked the explanation. You made it clear.
In Adam Rippon's case you used BMI once again in different meaning, everything OK. My reaction was general because your note reminded me how people can see some problems differently (not wrongly).
I am glad that you shared your ideas and opinions here.
So my notes are not directly towards you, please, take these like general notes.
Overall YOUR attitude towards Eating Disorders is strict and serious,

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My general notes:
BMI is great tool for many things and it is widely used in medicine as well. BUT...
1) BMI is general and not precise.
I have many patients who are obese based on BMI, but some of them are people with wide shoulders and hips, big muscles, some even with athletic looking body - I don't expect their body fat to be high (but I didn't measure it) - they are simply that kind of body type which means higher weight. But higher weight automatically means higher BMI.
To support my opinion:
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"...Pro athletes often have BMIs that could get them in trouble with a workplace wellness plan. Their muscle mass can boost them into the obese range, even though they're healthy and physically fit..."
Having similar height - more muscular skaters will ALWAYS have higher BMI (weight) comparing to skaters with lean and visuakky thinner muscles. Skaters with wide shoulder - chest - hips will ALWAYS have higher BMI (weight) than those with tiny chest and narrow shoulders and hips.
BMI is not able to express differences in muscle mass and skeletal differences.
2) BMI does not predict whether an athlete is healthy / fit, it also doesn't determine body composition.
scholar.google.cz
- science study from 2019
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"...The relationship between risk of eating disorders, age, gender and body mass index in medical students: a meta-regression...
- ...Results from this sample of medical students (3512 students) provided evidence for the role of interactions between risk factors (e.g., age × gender × BMI) in predicting individuals at risk for eating disorders, whereas these variables individually failed to predict eating disorders..."
From the article above - BMI alone is not able to predict eating disorders.
Eating Disorders (ED) have more types: Anorexia Nervosa, Bulimia, Binge-eating Disorder, Avoidant / Restrictive food intake Disorder. With exception of the first type if ED people suffering from all other types can have normal BMI. People with mild symptoms of eating troubles (and are in danger to get into EA in future) can have normal BMI as well.
scholar.google.cz
- science study from 2012
- total of 669 athletes and 607 controls participated
- BMI and body fat percentage correlation was examined
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"...Our data show that BMI is not a valid measure for assessing or monitoring body composition in female elite athletes, and it should be used carefully in female nonathletes...
- ...what was another surprising finding: females representing both under- and overfat athlete groups reported weight fluctuation, use of PWCM (pathogenic weight control methods), menstrual disorders, and stress fractures and had low BMD (bone mineral density) and clinical eating disorders..."
3) BMI has its "normal range" which may give the idea of getting on the low level of normal range and still be "healthy". But this is not going to work.
I will use
Adam Rippon as an example.
- 170 cm = 5'7", 150 pounds = 68 kg, 140 pounds = 63.5 kg
- BMI with 150 pounds - 23.53
- BMI with 140 pounds - 21.97
To reach BMI 18.5 (lowest level of normal range)......118 pounds = 53.5 kg
From the articles about Adam's story we do know that cooperating with nutritionist and finding proper nutrition ideal for Adam led to weight of 150 pounds. This is BMI 23.53. We also do know that having 140 pounds - Adam had to starve more days (with one day of overeating then), he was tired all the time, he suffered from stress fracture. We don't know his IDEAL WEIGHT (weight with the highest performance level), but we may suggest that such weight will be around or slightly over 150 pounds. Definitely NOT 140 pounds or lower. But having from 118 to 140 pounds, based on BMI, he would still be in "normal range"...
So I would like to point out that despite having normal BMI, the weight of the skater can already be too low leading to health troubles or in worse case to body functions collapse.
Another example:
Mae Berenice Meite (
https://youtu.be/XGhxEljPQog?si=wO9qov9VZAcvc_RD )
- 169 cm = 5' almost 7", 69.8 kg =153 pounds
- body fat 12.2%
- BMI 24.44
Body Fat Percentage: A Complete Guide
www.forbes.com
- Forbes article from August 2023
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"...Body fat...It can safely go as low as 10% for women and 3% for men, according to the American College of Sports Medicine (ACSM)..."
Different sports have different requirements in terms of body composition. What is the proper body fat percentage for the average population versus that for athletes?
us.humankinetics.com
- an excerpt from Sport Nutrition-2nd Edition
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"...In general, the total body fat percentage (essential plus storage fat) is between 12% and 15% for young men and between 25% and 28% for young women.
- Gymnastics - body fat percentage : male - 5-12%, female - 10-16%..."
(figure skaters were not included)
While in BMI Mae is on higher level of normal range, based on body fat she is on very low level. Try to imagine that she would be suggested to go on "normal" BMI of 18.5. It would mean weight of 53 kg = 116.8 pounds. I do suppose that today Mae is on proper nutrition, so she would be forced to malnutrition again to reach lower weight. Which is a nonsense of course.
As a doctor I do think that losing more kilograms in her case would definitely lead to body fat percentage going under 10%, which would be dangerous for her life.
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You seem to have made a comment about other situations in which you vaguely predict they would falsify my BMI analysis of calorie intake and the associated thermodynamics. Something about a normal girl only eating pineapple and potatoes. ...
My idea was not to falsify any of your claims. I just wanted to present that malnutrition can still lead to normal BMI despite burning a lot of calories on training daily.