Wellness Refocused Education

Wellness Refocused Education: Weight versus Body Fat and other health status tools

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When talk about getting healthy, many of us immediately think about our weight as being the ultimate tool for measuring. This is how society discusses health, but it’s really about the act of gravity and there are many other more important numbers we could examine.

Weight on Mars: 51.83 pounds

Weight on Earth: 137 pounds

It took me a long time to realize that there are and should many tools utilized to determine progress.

Tools that I use for myself and with clients are:

  • the scale – Weight fluctuations can tell us bits of the story like hormonal fluctuates during menstrual cycle can result in water retention and bloating.
  • measurements – How much space we take up is more meaningful because muscle mass takes up a little less space than fat mass.
  • body feels liked bloating, digestion – I know some will think this one is weird, but if you’re feeling good i.e. less bloated and your clothes are feeling better i.e. looser, isn’t that meaningful too?
  • sleeping habits – When we feel good, we’re able to accomplish more. Not just in the gym, but if we’re getting through the day with a good amount of energy we’re less likely to rely on caffeine and our bodies are truly able to reset.
  • mental health – If guilt is associated with eating behavior and activity then there’s a bigger problem that needs to be discussed. If there’s confidence and purpose in decision-making, less second-guessing and an ability to participate in your environment then there’s some kind of balance happening.

I’m in a Facebook group and someone posted that she had questions about “macros”. She was recently told that she had to follow this protocol to see any kind of progress, so she was curious if it was true because it seemed like way too much food. I sent her message privately and asked her what her goals were and what she had tried in the past. Here’s what I learned:

  • She wanted to see muscle definition i.e. she wanted to see her 6-pack.
  • She not only does circuit training, but she also does gymnastics. Her weekly training is high cardio, and totals almost 10% of her week activities.
  • She had misconceptions about lifting in general – not just lifting “heavy” (again, reflective term).
  • She was told macro counting was the only way to reach her goals.
  • She had been told by an online trainer that she must be around 26% body fat…without having provided any actual measurements of herself.
    • This led her to think she was fat, which hadn’t been a thought of hers prior to speaking with this person… and I’m over here thinking how the hell does something throw out numbers like that without having any details other than age, gender and height on this girl. BMI doesn’t equate body fat and this person didn’t even know her weight.

This conversation also solidified that I really do hate people who prey on those who are seeking knowledge and expertise of others. It’s okay to not know something and to tell someone that. It’s also okay to bring in other professionals who may know more than you. If you don’t believe me, check out this TED Talk. If you still don’t believe me, you should read the ACE Health Coaching Manual – there’s a chapter about making connections with other health professions.

Here’s what her and I did from there:

  • We talked about the different measurements that go into body fat calculations.
  • We talked about macronutrients and that with her level of activity she’s possibly undereating and not realizing it.
    • There’s a different between physical fullness and energy needs.
  • We also talked about how healthy she currently is at 21% body fat (I calculated it), but that I also understood she wanted to be a little leaner for aesthetics. Healthfully, she could lose a few percentage points of body fat, but she also needs to make sure that her nutritional needs are matching her energy levels as well as her desired body goals. I mentioned to her that under-eating and conducting a high level of cardiovascular activity could lead to decrease muscle mass unintentionally over time.

We ultimately decided that it would be fine for her to track calories and increase her overall nutrition and try to include foods that are micronutrient dense, decrease her cardio outside of gymnastics a little bit, and increase her resistance training.

You can read about my thoughts on carbohydrates, protein or fats in previous posts. You’ll get the sense that I’m very pro “do what you can adhere to.” It doesn’t matter what a trainer or coach suggests – if you can’t execute it then it’s a shitty plan because it doesn’t really take you into consideration.

So, enough about my opinion – this post. Let’s talk about the scale versus body fat and why there should be many different measures for progress.

  • What is BMI and where did that come from? Is it really relevant anymore or for all populations?
  • Should both weight and body fat be looked on occasion?
  • Does one have more meaning than the other?
  • Best body fat testing techniques

BMI stands for body mass index. It was developed in the 1830s by mathematician Lambert Adolphe Jacques Quetelet.

Here’s the equation for BMI:

BMI (kg/m^2) = weight (kg) / height (m)^2

Its purpose is to help health experts determine what weight category a person should be categorized in and the potential health associations with each category (Thompson & Manore, 2015). There are five categories: underweight, normal weight, overweight, obesity, morbid obesity. Many health experts use BMI to determine risk for disease, but also risk for premature death that can be caused by disease in association with high bodyweight (CDC, 2018).

As you can tell from the equation – it only takes into consideration the individuals weight and height – not where the weight is coming from, the age of the individual, gender, vitals, etc. However, it’s easy to use, which is why it’s still utilized by doctors and health experts worldwide.

The use of BMI predates modern technology that has allowed health experts to examine all these other components of the body such as muscle mass, bone density, organs, blood volume, that give a more clear picture of a person’s health status. 

As a general tool, BMI can be helpful for individuals who are categorized as obese and morbidly obese, however, as an individual becomes more lean, develops muscle mass, there’s potential for error in the BMI since it’s only a ratio of weight and height (Jonnalagadda, Skinner & Moore, 2004).

Body composition testing is an estimate of a person’s body fat and lean body mass. There are different methods for testing with different purposes and each come with their own limitations. For these reasons, body composition shouldn’t be solely utilized to determine a person’s health status. Each method’s limitations should be considered when determining the best one for an individual (Duren, et al., 2008).

Underwater weighing is typically used in a research setting and has between a 2-3% error range, which means if you test at about 20% body fat, you have a potential range of 17% to 23% body fat.

Skinfolds utilizing calipers is a very common body fat measuring tool especially among trainers, however, it is not a accurate measurement for obese individuals and may not be accurate for those with loose skin. Caliper testing should never be conducted on oneself. This tool is less accurate unless performed by a very skilled technician then there’s a 3-4% error range.

Bioelectrical impedance analysis (BIA) sends a very low electrical current through a person’s body. This can be done with electrodes attached to the feet and hands, there are also hand-held and scale devices utilizing this technology. Body fluids must be normal meaning testing with this method is best after 48 hours fasting of alcohol, prior to or 12 hour after exercise has been done, prior to or 4 hour after eating. Women are not recommended to conduct this during certain times of menstruation because of water retention and fluctuations. Under the best circumstances there’s a 3-4% error range.

Dual-energy x-ray absorptiometry (DXA/DEXA scan) utilizes very-low-level x-rays to differentiate bone tissue from muscle tissue and adipose (fat) tissue. Testing can be done while fully clothed. There is a 2-4% error range and this tool cannot be used to measure extremely tall, short or obese individuals because they don’t fit in the scanning area.

Bod Pod uses air displacement similarly to underwater weighing uses water. It’s been found to overestimate body fat in some African American men, but many be a good alternative to underwater weighing in many populations. It’s margin of error is between 2-3%.

Other tools to consider for determining progress or health status include an assessment of fat distribution (Thompson & Manore, 2015). Different fat distributions are associated with disease risk.

Apple-shaped fat patterning, also called upper-body obesity is associated with increased risk for chronic diseases like type 2 diabetes, heart disease and high blood pressure. Research has indicated that this may be a reflection of fat and carbohydrate metabolism (how fats and carbohydrates are broken down and utilized in the body), which “can lead to unhealthy changes in blood cholesterol, insulin, glucose and blood pressure”(Thompson & Manore, 2015).

Pear-shape fat patterning, also called lower-body obesity doesn’t seem to increase risk for chronic diseases. I

Waist-to-hip ratio will help indicate risk for chronic disease and will help indicate which fat distribution your body has.

To determine waist-to-hip ratio have someone else measure your natural waist at the narrowest part of your torso from the front. Then measure your hip circumference at the maximal width of the your butt from the side. Divide the waist measurement by your hip measurement. 

  • In men, a ratio higher than 0.90 indicates higher risk for disease
  • In women, a ratio higher than 0.80 indicates higher risk for disease

While the scale, BMI, body fat composition and even waist-to-hip ratio are good tools for measuring visible health, they aren’t great tools for internal health, they just get the conversation started.

Other tools that can and should be considered are blood pressure, hormone balance, emotional and mental health status in a dieting environment, sleeping patterns and energy levels/fatigue, digestion, strength and endurance during activity. Some of these can be done directly by the individual like emotional check-ins and documentation of sleeping patterns and digestion, but others like blood work and blood pressure need to be done by a medical professional.

There are some limitations that can impact whether other measures of progress are utilized such as cost and access to professionals/facilities as well as our own bias. It’s hard to be objective about our own progress including emotional state. It’s easy for us say we’re fine, when we’re not. It’s easy for us to be absorbed into diet culture that puts emphasis on our visible health rather than internal and emotional health.

There’s no one dominating measure of health and progress, so when you’re making your plan – whatever it is – make sure that you’re including different perspectives of progress because the scale won’t always move, but your size may – your clothes may fit better, your cholesterol may go down. There may be times when your size and the scale don’t change, but your stress is down and your more effective in your activity – don’t discredit these things.


Centers for Disease Control and Prevention. (2018, July 6). Healthy Weight: Body Mass Index (BMI).Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/healthyweight/assessing/bmi/

Duren, D.L., Sherwood, R.J., Czerwinski, S.A., Lee, M., Choh, A.C., Siervogel, R.M., & Chumlea, W. (2008) November 2). Body Composition Methods: Comparisons and Interpretation. Journal of Diabetes Science and Technology from basic science to clinical practice, pp. 1139-1146.

Jonnalagadda, S., Skinner, R., & Moore, L. (2004, August 3). Overweight athlete: fact or fiction? Current Sports Medicine Report, pp. 198-205.

Thompson, J., & Manore, M. (2015). Nutrition: An Applied Approach. San Francisco: Pearson Education.