Know your numbers – but which ones?

It’s that time of year when many employers are strongly encouraging their employees to complete their biometric screening, typically as part of an employee wellness incentive program. According to the CDC, a biometric health screening is defined as “the measurement of physical characteristics such as height, weight, body mass index, blood pressure, blood cholesterol, [and] blood glucose…that can be taken at the work site and used as part of a workplace health assessment to benchmark and evaluate changes in employee health status over time.” Many organizations use this screening as a way to increase benefit offerings, improve employee health, and decrease health plan costs at the same time. Given the amount and variety of measurements involved in such screenings, making sense of the numbers can be challenging for many people.

I recently came across an article in the Washington Post written by a registered dietitian, who surveyed 20 experts in her field for their suggestions of which numbers are the most important when it comes to monitoring health. Interestingly, many of the numbers they believed to be most important are not even part of the usual biometric screening. For example, the first two recommendations focused on daily fruit, vegetable and fiber intake:

  • When it comes to a healthy diet, a simple method to use is the plate model, with appropriate proportions of fruits, vegetables, proteins, and grains. The rule of thumb is to fill half your plate with mostly vegetables and some fruit, which may be easier than trying to track how many servings of each you’ve eaten. Using this plate method can also help you get the recommended daily amount of fiber, which is 25-35 grams. Fiber is important for regularity, managing cholesterol and blood sugar levels, and prevention of certain cancers including colorectal cancer. It is also helpful in weight management as it keeps you feeling full for longer. Fiber-rich foods include most vegetables (the darker the color, the better), fruits, beans, nuts/seeds and whole grains.

The article did reference two of the typical biometric tests as being important for health management: fasting blood glucose (sugar) level and blood pressure:

  • The fasting blood glucose test is used to check for Type 2 diabetes and the goal is for it to be less than 100 mg/dL. These days, it seems more and more people are diagnosed with “pre-diabetes,” which corresponds to a blood sugar level of 100-125 mg/dL. The good news is that you can often reverse the effects of Type 2 diabetes (and pre-diabetes) through eating a healthy diet and exercising regularly. Therefore, it’s important to conduct this test at least annually to monitor your blood sugar level so you’ll be able to make necessary lifestyle changes to prevent or reverse a diagnosis of diabetes.

 

  • High blood pressure is commonly referred to as the silent killer because it often has no clear symptoms. However, if untreated, high blood pressure can lead to a heart attack or stroke. Therefore, it’s important to monitor your blood pressure regularly so you can seek treatment if necessary. This measurement is more important than ever as new guidelines from the American Heart Association lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. Previously, a measurement of 140/90 or greater was considered high. Now, the threshold has been lowered to 130-139/80-89 and even 121-129/<80 is considered “elevated” and an early warning that blood pressure should be lowered through non-medication approaches (primarily diet modification and exercise).

 

The author also addressed some measurements that she and her colleagues believe don’t matter as much when it comes to monitoring health. I agreed with all of them, but the one I want to address is body mass index or BMI, as there has been lively debate for some time now as to whether it is an accurate measure of health, particularly of obesity. As the author notes, BMI is a tool used to classify people into categories of normal weight, overweight or obese depending on height and weight. Individuals with BMI results in the latter two categories are often encouraged to lose weight by their healthcare provider and many are incentivized to do so through workplace wellness programs. However, BMI does not consider factors such as age, gender and bone structure, nor can it distinguish between muscle and fat. Thus, you can have a healthy, athletic person who exercises regularly but has a high BMI due to muscle mass. Or conversely, you can have a person with a normal BMI who does not eat well or exercise at all and is generally unhealthy. Going by BMI only, the athlete would be considered the obese or unhealthy one.

Scientists have recognized that what really matters is not body weight but body fat, and thus given the limitations of BMI, they now recommend a different measure for body fat/obesity: waist circumference. Measuring your waist to learn if you have abdominal obesity and excess visceral fat (fat surrounding your internal organs) is important as excessive fat inside the abdomen is a major contributor to cardiovascular disease. You have a higher risk of developing obesity-related conditions if you are:

  • A man whose waist circumference is more than 40 inches
  • A non-pregnant woman whose waist circumference is more than 35 inches

The one drawback to waist measurement is that it is more prone to errors than measuring height and weight. Click here to learn the proper way to measure waist circumference. It may also help to have a family member or a healthcare professional measure it for you, to be as accurate as possible.

There are numerous ways to measure and monitor your health and wellbeing. It’s important to look at a variety of screening test results to understand the complete picture of your health, but it’s also important not to get hung up on measurements that may not be all that accurate. I encourage you to discuss the options with your healthcare provider at your next physical or checkup so that together you can determine the best measures of your health.

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