BMI versus abdominal CT computerized tomography
abdominal CT one out it's no big surprise we've known for a long time that BMI has a
lot of problems so why do I still use it well I've actually never really asked a patient
to what their RFM was relative fat mass that's a formula that was supposed to be simple but it's
not and it's not going to replace BMI what I do wish though what I'd love to see is something more
accurate than BMI out there we have ways to do it we have abdominal CT now we've had DEXA scan and
we've had RFM for a while which was developed out of DEXA scan now why is BMI a problem
well this was an image of Arnold Schwarzenegger at about the time that he won Mr. Olympia we'll
talk about it in a few minutes but and we'll show a different image but he was a beast according
to the BMI now he did have a lot of weight on his body but it was muscle weight it wasn't fat weight
and fat weight makes a difference fat is not inert tissue it is endocrine tissue that creates a lot
of bad things most specifically insulin resistance prediabetes and even diabetes so let's talk about
the study just a second they did single slice CT at the third lumbar vertebra for those of you who
care and it beat bmi not a hard thing to do as a predictor of cardiovascular risk it was reported
December 2nd at the Radiological Society of North America the study was done using CTs from 2012 at
Harvard who did it Kirta Magudia she's an MD PhD she's faculty now at UCSF and I believe she was a
resident at Harvard when she did the study 33,182 abdominal CT scans 50% women so it was
a great mix it wasn't just men and looking at men in a large gut it was a lot of people and a
good mix five-year follow-up there were 1,560 heart attacks 938 strokes and so here's how they do this
and it gives you a little bit of perspective on what AI is they got all of these studies they
got all of the outcomes and then they let the machine go back and start using the outcomes to
measure what sort of things matter and then go back and test that against prediction so what's
another way of looking at that what we've had up until the AI age the artificial intelligence age
is that we've had what we call expert rules system or expert logic systems you get a bunch of experts
you set them around the table and they argue out do their politics or whatever they come to some
sort of a consensus or agreement on the rules that or logic that will populate the software
well with AI you have something slightly different that's the starting point but it's really only the
environment those expert rules are logic create the environment or the playground for the computer
the computer then goes in and starts looking at tens and hundreds of thousands of examples
to check that to see exactly which of these rules work and which ones don't and are there things
that the experts never picked up so is it working in medicine it's already working in medicine
actual health care as opposed to side parts of medicine Harvard reported on some improvement in
medical records with it I've done several reports on things like making a diagnosis I work with
a company called KHealth they use true AI for helping docs make a better quicker more effective
diagnosis and again it works so how about BMI does it work it's not a great predictor but
again why do i use it because the other predictors just aren't gaining ground we've had DEXA scans
which are better we've had RFM relative fat mass which was relatively simple formula but maybe
not simple enough to unseat BMI and now we've got abdominal single slice CT we've got a bunch
of different better ways to do this but BMI is still hanging in there I had four conversations
with four patients yesterday and we talked about BMI so thanks for listening to my rant
so I'd like to talk with you a minute about the webinar people don't understand what the webinar
is it's actually a great way to get some access to health care that you're just not going to
get any other way you actually get the lab tests yourself for at a local lab a Quest lab near you
for the inflammation panel and the OGTT and the insulin survey these are things inflammation and
prediabetes that your doctor just does not know about and here's the thing Harvard health and many
others have said look sudden death is not always so sudden the Hollywood picture that it's a bolt
out of the blue is not realistic it's more like real lightning preceded by clouds wind and rain
stop that metabolic storm before the lightning strikes and here's where that metabolic storm
comes from it's inflammation and it has to do usually with prediabetes so again we actually
get labs we go over them in the webinar and then you can start finding out how you can
prevent that heart attack others said that you couldn't even predict we can show you how thanks