Por qué el IMC es una forma defectuosa de considerar la salud personal

el sardinero
El Sardinero

Cuando se trata de salud, ¿importa el índice de masa corporal (IMC)? Esa pregunta ha sido un tema de debate durante décadas. Una fórmula matemática desarrollada originalmente por para observar las tendencias en la salud de la población, hoy en día muchos proveedores de atención médica usan el IMC como nunca fue diseñado: para diagnosticar pacientes individuales.

De hecho, no faltan expertos y no expertos en salud (yo los llamo trolls u entrometidos) que afirmen con un aire de certeza que si tienes un IMC de 30 o más («obeso»), vas a morir antes. que alguien que tiene un IMC por debajo de 25 («normal»). Pero usted, querido lector, no es una estadística. Como sociedad, debemos centrarnos en los comportamientos que promueven la salud y las políticas que promueven la equidad en la salud en lugar de centrarnos tanto en el peso. La mayoría de las conversaciones sobre el peso realmente tienen poco que ver con la salud … lamentablemente.
Del índice de Quetelet al índice de IMC

La historia del origen de la tabla de IMC comienza en 1835 con Lambert Adolphe Jacques Quetelet, un matemático, astrónomo, sociólogo y estadístico belga. Quería una manera fácil de medir el grado de gordura en la población general, pero la fórmula que se le ocurrió (peso en libras dividido por la altura en pulgadas al cuadrado, luego todo eso multiplicado por 703) no tiene base en la fisiología humana.

De hecho, Quetelet no solo manipuló la fórmula para tratar de hacer coincidir los datos (que es un trabajo muy deficiente), sino que dijo explícitamente que su fórmula no debería usarse para medir el nivel de gordura en un ser humano individual. Después de todo, él no era un experto en el cuerpo humano, incluso en la medida limitada en que entendíamos el cuerpo humano en ese entonces.

Avancemos hasta 1972, y el Índice de Quetelet se reinició como el Índice de Masa Corporal, y los investigadores convirtieron los números de las antiguas tablas de altura y peso de Metropolitan Life Insurance Company en la fórmula de Quetelet. En la década de 1990, la Organización Mundial de la Salud comenzó a utilizar el IMC y se fue a las carreras.

Pero aquí está la cuestión: una fórmula diseñada para evaluar la distribución del peso de una población realmente no sirve para nada más. Ciertamente, no puede evaluar la salud de una persona individual. La idea de que «bajo peso», «peso normal», «sobrepeso» y «obesidad» son categorías distintas y que pasar de una categoría a otra por un simple punto decimal significa que algo para su salud es una tontería. Sí, el IMC suena científico, pero he escuchado que se lo conoce como aceite de serpiente matemático.

Para colmo de males, los datos utilizados para desarrollar la fórmula de Quetelet y las tablas de MetLife se basan en gran medida en los cuerpos de las personas blancas, especialmente en los cuerpos masculinos blancos. No es exactamente representativo de la diversidad humana.

Piense en los comportamientos, no en el IMC

Incluso si ignora el pequeño problema de que «los humanos individuales no son estadísticas», existe otro problema. El IMC no puede diferenciar entre músculo, hueso y grasa, o dónde se distribuye esa grasa en nuestro cuerpo. Eso es enorme, porque mantener los músculos apoya la salud, especialmente a medida que envejecemos. Si bien el exceso de grasa corporal puede aumentar el riesgo de enfermedades crónicas, eso depende en gran medida de dónde se encuentre esa grasa. Se cree que la grasa subcutánea (grasa debajo de la piel) conlleva el menor riesgo, mientras que la grasa visceral (grasa alrededor de los órganos abdominales del cuerpo) conlleva un mayor riesgo, y los depósitos de grasa en el hígado y los músculos conllevan el mayor riesgo.

Si desea mejorar o mantener su salud (y la salud de los demás), entonces centrarse en los comportamientos que promueven la salud y la justicia social es mucho más importante que preocuparse por lo que el IMC puede o no decir sobre la salud.

Si bien comer bien y realizar una actividad física placentera son importantes, también lo es dormir lo suficiente, controlar el estrés, mantenerse en contacto social y recibir atención médica preventiva.

En cuanto a si la pérdida de peso mejora la salud, eso depende. Las investigaciones muestran que para las personas que tienen un IMC en el rango «obeso» y tienen niveles normales de presión arterial, azúcar en sangre y colesterol, no se ha demostrado que la pérdida de peso mejore más esos biomarcadores y, en algunos casos, contribuye a problemas físicos y efectos psicológicos, incluido un mayor aumento de peso.

Un hallazgo desafortunado de los estudios de investigación a largo plazo es que entre la mitad y dos tercios de las personas sanas que se encuentran en el rango de IMC «obeso» eventualmente se vuelven insalubres de alguna manera. (Por supuesto, también lo hacen muchas personas en el rango de IMC «normal»). Si bien no está claro por qué sucede esto, el aumento de la edad y la disminución de la actividad física son factores probables … y también lo son el estigma del peso y el nivel socioeconómico.

El estigma y los bajos ingresos (que pueden llevar a vivir en vecindarios menos seguros que no son transitables) pueden ser fuentes profundas de estrés. El estrés contribuye a los problemas de salud (inflamación crónica, presión arterial alta, azúcar en sangre alta) que aumentan el riesgo de enfermedades cardiovasculares y diabetes. Desafortunadamente, casi ningún estudio que analice las asociaciones entre el peso y la salud realmente evalúe estos importantes factores.

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