Ragen’s Bad Science: The Imaginary BMI Conspiracy

In 1998, the NIH and CDC lowered the BMI cutoff for “overweight” by 2.8 points for men, and 2.3 points for women. This had the effect of suddenly making millions of Americans overweight. Ragen often points to this event as a diet industry conspiracy perpetuated by a group of corrupt doctors. As usual, Ragen is misrepresenting the facts.

The reasoning for altering the definition of overweight is explained in great detail in the 230-page 1998 NIH report, Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. To interpret the change, it is important to understand the previous BMI cutoffs had nothing to do with mortality risks, and were actually completely arbitrary values chosen for the sole purpose of statistical comparison between NHANES releases.

Nationally representative U.S. health examination surveys, in which weight and height were measured in samples of the population, date back to 1960. Beginning with the Second National Health and Nutrition Examination Survey (NHANES II) (1976-1980), the definition of overweight that has been used to compare these epidemiologic surveys has been a statistical one that corresponded to the 85th percentile of body mass index (BMI) for men and women aged 20 through 29 years in NHANES II with no particular relation to a specific increase in disease risk.

Clinical Guidelines, page 6

For men, this was a BMI of 27.8, and for women, 27.3. Because the previous cutoffs were completely meaningless in clinical practice, the committee sought to define a BMI cutoff actually based on epidemiological data. After extensive review of the literature (almost 800 scientific references in total), a cutoff of 25 was chosen as the approximate point where mortality tends to increase. This brought the NIH and CDC guidelines up to date with the World Health Organization’s existing guidelines.

The NIH report is careful to note that BMI cutoffs for overweight and obesity are somewhat arbitrary, and that the increase in mortality is modest until a BMI of about 30 is reached. It also advises clinicians to use sex-specific waist circumference cutoff for patients with BMIs of 25 to 34.9 to identify increased disease risk. There is no suggestion to rely solely on BMI unless a patient is extremely obese.

Ragen doesn’t tell her readers any of this. In fact, she puts more spin on it by making it a great big conspiracy against fat people.

Three members of the committee responsible for making the recommendation had direct ties to pharmaceuticals that manufactured diet pills for profit.  A fourth member was the lead scientist for the program advisory committee of Weight Watchers International.

What Ragen doesn’t say in this scare quote is that the committee had 36 members, all PhDs and/or MDs and experts in their fields. Ragen wants her readers to believe 4 committee members with supposed links to the diet industry were able to first influence the WHO to change the BMI cutoff for overweight, then convince 32 other committee members and both the NIH and CDC to discard all the evidence and also change the cutoff, all as some kind of conspiracy to get “potential clients”. It sounds completely absurd in its proper context, but this is the kind of evidence Ragen relies on as a “trained researcher”.

The other thing Ragen and other fat acceptance advocates frequently do is completely misrepresenting what actually happened in 1998, as well as how data before and after the change is compared.

Talking about a change in “obesity” levels since 1980 without discussing the fact that the measurement was changed in 1998, altering millions of people’s BMI classification overnight (on recommendations from a committee that included representatives from pharmaceutical companies that manufacture diet drugs and the chief scientist of weight watchers) does not have the ring of sound science.

This particularly egregious bit of misinformation comes from today’s Dances with Fat post. Ragen is implying the definition of obesity was changed in 1998, which is entirely false. The 1998 NIH report did not redefine the BMI cutoff for obesity, and had no effect on obesity levels, which were already rising dramatically and continued to rise.

Ragen also likes to imply that in retrospective studies, old data uses the old BMI cutoffs, while new data uses the new cutoff, which would mean data before 1998 is not comparable to data after 1998. Essentially, the obesity crisis is somehow manufactured by data manipulation. This is total nonsense of course. In fact, when comparing historical data with new data with both using the BMI 25 cutoff, it is immediately obvious prevalence of overweight under the new definition was stable from at least 1960, even if it meant more Americans were technically considered overweight. The real issue was the enormous jump in obesity prevalence, which has now reached almost 36% in present day.

Screen Shot 2015-10-07 at 4.43.06 AM

The average prevalence of overweight using the BMI 25 cutoff has actually dropped significantly in recent years as more people become obese. This is an obesity crisis, not an overweight crisis, and bumping down the BMI cutoff for overweight slightly made no difference whatsoever.

Ragen likes to childishly write out the equation for BMI for her followers as “weight in pounds times 703 divided by height in inches squared” to imply a completely arbitrary relationship between height and weight. This is quite telling about how much she respects their intelligence, and as usual her “science” is worth about as much as her non-existent college degree.

11 thoughts on “Ragen’s Bad Science: The Imaginary BMI Conspiracy

  1. I also enjoy how Ragen uses the “weight in pounds times 703 divided by height in inches squared” as if 703 is some kind of arbitrary number that a bunch of fat-shaming scientists pulled out of their asses, when in reality the 703 is there for the same reason it’s called a “Royale with cheese” in Paris: the metric system. BMI is kilograms of mass divided by meters squared of height. There are 39.37 inches in a meter and there are 2.205 pounds in a kilogram. Since it’s height squared, you take 39.37 squared divided by 2.205 and you get 703.

  2. Some ‘trained researcher’ This high school level reasoning and ‘science’ on her part. Also of interest, my Uni was discussing potential speakers Student Health and Wellness Week. Her name came up once, as a joke, to the great amusement of our department head who herself is overweight. “That woman is a joke!” This blog is really helping get the word out.

    • So glad to hear that this blog is making an impact on her reputation and hopefully will stop her being able to spread lies and misinformation through her speaking gigs.

      As usual, an excellent post by IFC. Comparing the analysis and facts in this post to her blog should make anyone with half a clue immediately aware of her lack of credibility. How she can write this off as “haters” without doing a point by point rebuttal is laughable.

  3. This is another masterful dissection of Raen’s inability to interpret any sort of scientific data. Her ignorance of science coupled with her rampant egomania does a huge disservice to the very people she claims to be supporting. Shame on you, Ragen.

  4. All the complaining about BMI standards changing shows a lack of understanding of science and policy (and their relationship), but it’s mostly just misdirection. Get people riled about about a change that affected the definition of people who had maybe 10 lbs of extra fat and then conflate that to say that the BMI numbers are irrelevant for someone who has 200 lbs of extra fat.
    When your BMI is 60, wtf does it matter? Shouldn’t not fitting in this world tell you that there’s something wrong there? I know it was my wakeup call.

  5. I agree with hawther. You can use any measurement system you like, it won’t change the facts that (1) Ragen’s level of body fat is dangerously unhealthy; and (2) the percentage of people in the United States with dangerously high levels of body fat has increased significantly over the last 20 or 30 years.

    If I were having a serious debate with Ragen, I would ask her the following questions:

    Do you agree that for scientific or medical purposes, it is appropriate to measure people or populations in terms of their levels of body fat? Do you agree that for scientific or medical purposes, it is appropriate to group people into categories based on their levels of body fat?

    If so, how would you propose that such measurements and categorization be done?

    If not, then why do you believe that body fat is different from every other characteristic of the human body which is medically significant?

    • She wouldn’t answer. She’d go off on some tangent that we’re all people and not just numbers and measurements and if Joe doesn’t care that he has a BMI of 40 and BF of 45%, why should anyone else? Who cares if Sally needs the motor scooter to get around the grocery store to get her Diet Coke because her body can’t support her weight long enough to walk around the store for 15 minutes. They’re happy so why can’t you be happy for them and leave them alone? It doesn’t matter that there are mountains of research connecting obesity and body fat with heart disease, arthritis, respiratory problems, depression and so much more. The doctors should just shut up and replace her joints every 3 years like an oil change in her car. And any doctor who refuses to do so or suggests moderate weight loss is fat shaming and an idiot, or working for the evil diet companies.

      Its the new American way. Everyone else should have to conform to the few and we should all just accept it because its the way of the future. Anyone seen Wall-E? Yea…that’s where people like here are going.

  6. I actually find the BMI very generous, in terms of acceptable weight, at least for myself. The upper range is really too heavy for me, even though I genuinely have “thick” bones. Unless you are a *real* athlete (Regan is not) going *significantly* over the recommended BMI, as I am certain she is, really isn’t defensible. I have seen the stories of people who look slim with “high BMI” but honestly, they also look quite small boned and there are always exceptions to such general metrics. But they will rail against any such recommendations, given their belief that a person can literally never be “too fat”. Which is insane.

  7. While I’m not a fan of her attitude or general lack of honesty, who gets to show up and complete at a race and how that looks is determined by the race officials and rules. So yes, if the event allows it, she can just show up and compete. She can even do it badly. People not liking it or agreeing with it or wishing it wasn’t true doesn’t change anything. If the race rules allow her to do what she did then they need to change the rules. They can do that, much as Reagan can take a leisurely stroll down the race course. There are supposedly people trained to keep unsafe equipment off the course and protect the riders in Tempe. Hopefully they do their jobs and do that. But unless they do, she’s free to ride

    • No one here is saying Ragen isn’t allowed to show up and participate in a half IM or full IM. This blog is largely convinced she simply will *not* do it, and is lying about her plans and preparation to do so. She has based her career around claims of being a “trained researcher” and “elite athlete”, making outrageous claims about her qualifications and fitness in order to scam money from people who want to believe that they don’t have to lose weight in order to be healthy.

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