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    Time to Say Goodbye to the B.M.I.?

    The body mass index has long been criticized as a flawed indicator of health. A replacement has been gaining support: the body roundness index.Move over, body mass index. Make room for roundness — to be precise, the body roundness index.The body mass index, or B.M.I., is a ratio of height to weight that has long been used as a medical screening tool. It is one of the most widely used health metrics but also one of the most reviled, because it is used to label people overweight, obese or extremely obese.The classifications have been questioned by athletes like the American Olympic rugby player Ilona Maher, whose B.M.I. of 30 technically puts her on the cusp of obesity. “But alas,” she said on Instagram, addressing online trolls who tried to shame her about her weight, “I’m going to the Olympics and you’re not.”Advocates for overweight individuals and people of color note that the formula was developed nearly 200 years ago and based exclusively on data from men, most of them white, and that it was never intended for medical screening. Even physicians have weighed in on the shortcomings of B.M.I. The American Medical Association warned last year that B.M.I. is an imperfect metric that doesn’t account for racial, ethnic, age, sex and gender diversity. It can’t differentiate between individuals who carry a lot of muscle and those with fat in all the wrong places.“Based on B.M.I., Arnold Schwarzenegger when he was a bodybuilder would have been categorized as obese and needing to lose weight,” said Dr. Wajahat Mehal, director of the Metabolic Health and Weight Loss Program at Yale University.“But as soon as you measured his waist, you’d see, ‘Oh, it’s 32 inches.’”So welcome a new metric: the body roundness index. B.R.I. is just what it sounds like — a measure of how round or circlelike you are, using a formula that takes into account height and waist, but not weight.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Are Some Ultraprocessed Foods Worse Than Others?

    A new study may offer the biggest clues yet.Name a common condition — heart disease, Type 2 diabetes, cancer, dementia, irritable bowel syndrome — and chances are good that following a diet high in ultraprocessed foods has been linked to it.But the ultraprocessed food category is large and wide-ranging. It makes up an estimated 73 percent of the U.S. food supply, and contains stereotypically “unhealthy” products like sodas, candies and hot dogs as well as seemingly “healthy” ones like whole grain breads, breakfast cereals, flavored yogurts and plant milks.It’s a “hodgepodge of foods,” some of which are likely more harmful than others, said Josiemer Mattei, an associate professor of nutrition at the Harvard T.H. Chan School of Public Health.On Monday, Dr. Mattei and her colleagues published one of the largest and longest studies on ultraprocessed foods and heart health to date. In it, they analyzed the risks of consuming these foods, and teased out the worst offenders.An Overall Risk of Ultraprocessed FoodsThe new study, published in a Lancet journal, included more than 200,000 adults in the United States. They filled out detailed diet questionnaires beginning in the 1980s and early 1990s, and completed them again every two to four years for about 30 years. Most of the participants in the study were white and worked as health professionals. The researchers looked at how the participants’ ultraprocessed food consumption related to their chances of developing cardiovascular disease.After adjusting for risk factors like smoking, family health history, sleep and exercise, the researchers found that those who consumed the most ultraprocessed foods were 11 percent more likely to develop cardiovascular disease and 16 percent more likely to develop coronary heart disease during the study period, compared with those who consumed the least ultraprocessed foods. The highest consumers also had a slightly, but not significantly, elevated risk of stroke.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    How Your Body and Mind Change in Midlife

    Midlife, typically defined as ages 40 to 60, is an inflection point. It’s a time when our past behaviors begin to catch up with us and we start to notice our bodies and minds aging — sometimes in frustrating or disconcerting ways. But it’s also an opportunity: What our older years will look and feel […] More

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    Akira Endo, Scholar of Statins That Reduce Heart Disease, Dies at 90

    The Japanese biochemist found in the 1970s that cholesterol-lowering drugs lowered the LDL, or “bad” cholesterol, level in the blood.Akira Endo, a Japanese biochemist whose research on fungi helped to lay the groundwork for widely prescribed drugs that lower a type of cholesterol that contributes to heart disease, died on June 5. He was 90.Chiba Kazuhiro, the president of Tokyo University of Agriculture and Technology, where Dr. Endo was a professor emeritus, confirmed the death in a statement. The statement did not give a cause or say where he died.Cholesterol, mostly made in the liver, has important functions in the body. It is also a major contributor to coronary artery disease, a leading cause of death in the United States, Japan and many other countries.In the early 1970s, Dr. Endo grew fungi in an effort to find a natural substance that could block a crucial enzyme that is part of the production of cholesterol. Some scientists worried that doing so might threaten cholesterol’s positive functions.But by 1980, Dr. Endo’s team had found that a cholesterol-lowering drug, or statin, lowered the LDL, or “bad” cholesterol level, in the blood. And by 1987, after other researchers in the field had published additional research on statins, Merck was manufacturing the first licensed statin.Such drugs have proven effective in reducing the risk for cardiovascular disease, and millions of people in the United States and beyond now take them for high levels of LDL.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    What to Know About CKM, the Link Between Heart Health, Diabetes and Kidney Disease

    And they’re increasingly common. Here’s what to know about the shared risk factors for these diseases.Heart disease, diabetes and kidney disease are among the most common chronic illnesses in the United States — and they’re all closely connected.Adults with diabetes are twice as likely to have heart disease or a stroke compared with those who don’t have diabetes. People with diabetes — Type 1 and Type 2 — are also at risk of developing kidney disease. And when the kidneys don’t work well, a person’s heart has to work even harder to pump blood to them, which can then lead to heart disease.The three illnesses overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these diseases, or are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show some early signs of these connected conditions.While only 15 percent of Americans meet the criteria for advanced stages of C.K.M. syndrome, meaning they have been diagnosed with diabetes, heart disease or kidney disease or are at high risk of developing them, the numbers are still “astronomically higher than expected” said Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women’s Hospital in Boston and co-author of the study.The research suggests that people should pay attention to shared risk factors for these diseases early on — including excess body fat, uncontrolled blood sugar, high blood pressure and high cholesterol or triglyceride levels.A Dangerous CycleYour kidneys, heart and metabolic system (which helps process the food you eat into energy and maintains your blood sugar levels) work closely together. If something goes awry with one, it can lead to problems with the others.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    What Is VO2 Max?

    VO2 max has become ubiquitous in fitness circles. But what does it measure and how important is it to know yours?Fitness is full of numbers meant to help you become faster and stronger. There’s your mile run time, your resting heart rate and measures of strength and flexibility. But perhaps the gold standard is VO2 max.A handful of years ago, the test — which tracks how much oxygen your body absorbs — was an obscure tool mainly used by elite athletes. Today, it’s touted by fitness professionals and wellness experts like Peter Attia as being a useful measure for all exercisers.But getting an accurate number requires an expensive and exhausting lab evaluation. And estimates provided by wearable devices might not tell you much. So how useful is it to invest time and money in the full work-up, and how important is knowing your VO2 max?For everyday people who want to be healthy and live a long time, the measurement is “the best piece of empirical information we have on health and longevity,” said Kate Baird, a clinical exercise physiologist and the coordinator of running and metabolic services at Hospital for Special Surgery in New York.The key, she said, is acting on what the data tells you.What is VO2 Max?“VO2 max” is a two-digit number that expresses how effectively your body metabolizes oxygen. The measurement itself is the milliliters of oxygen consumed in a minute per kilogram of body weight.As you exercise, your body needs ever more oxygen. The more you can efficiently consume, the more energy your muscles will have, increasing the time and intensity you can exercise. Generally speaking, someone with a higher VO2 max will be able to sustain a run or an aerobic activity at a given pace longer than someone with a lower VO2 max.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Death of David Gail, ‘Port Charles’ Star, Was Drug Related, Publicist Says

    The 58-year-old actor, who was also on “Beverly Hills, 90210,” died last month in a Tampa, Fla., hospital days after going into cardiac arrest.David Gail, the “Port Charles” and “Beverly Hills, 90210” actor who died in a Tampa, Fla. hospital on Jan. 16, had been intoxicated from a mix of drugs and alcohol that caused him to go into cardiac arrest, his publicist said on Tuesday.A number of drugs were found in Mr. Gail’s system, including amphetamines, cocaine, alcohol and fentanyl, according to a statement from the publicist, Linda Brown. The cardiac arrest led to a brain injury, which ultimately caused his death days later, she said.The Hillsborough County Medical Examiner did not immediately respond to a request for Mr. Gail’s autopsy report on Tuesday evening.The family previously said that Mr. Gail, 58, had died from complications from a sudden cardiac arrest.Paramedics who found Mr. Gail after he went into cardiac arrest performed CPR and used a defibrillator to try to revive him, but he ultimately wound up on life support at the hospital, according to Ms. Brown.Mr. Gail’s mother, Mary Painter, said in the statement that her son had for years been reliant on medication to manage pain from hand and wrist surgeries that kept him out of work for nearly a decade.“It breaks my heart to learn my son died this way,” Ms. Painter said, adding, “I can only assume that his former dependence played a part in self-medicating from uncontrolled sources.”Her son’s death, she said, highlighted victims of pharmaceutical addiction and the fentanyl epidemic.Mr. Gail had a bountiful television acting career in the mid- to late 1990s, including his most prominent role, as Dr. Joe Scanlon on the “General Hospital” spinoff show “Port Charles.” Mr. Gail played Dr. Scanlon in 216 episodes in one season, which ran in 1999 and 2000, according to IMDb.Years before that, Mr. Gail appeared on eight episodes of “Beverly Hills, 90210,” playing a minor part in an episode in the first season and returning to the show for the fourth season in a more established role.“When I came back it was such a shock, I was asking, ‘How could I possibly come back?’” Mr. Gail said about his return on the “Beverly Hills Show Podcast” in 2021.“But it worked,” he added.He also made dozens of appearances in a variety of television shows throughout the 1990s and several films in the 2000s. More

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    Biden Wants to Be President Into His 80s. How Might Age Affect His Health?

    Experts weigh in on octogenarian health.President Biden has announced his plans to run for re-election in 2024. If he wins, he will be 82 when he takes office and 86 when his term ends — which would establish him, for a second time, as the oldest person to assume the U.S. presidency. (Donald Trump is not far behind; he will be 78 during the 2024 election and would enter octogenarian territory during another presidential term.)President Biden is “a healthy, vigorous 80-year-old male,” according to a February report from the White House physician, Dr. Kevin C. O’Connor. Although he was recently treated for basal cell carcinoma, a common and slow-growing skin cancer, Mr. Biden has no major medical problems, doesn’t smoke or drink and exercises at least five days a week.“The spectrum of health at older ages varies so widely,” said Dr. Holly Holmes, a professor and the chair in gerontology at the University of Texas Health Science Center at Houston. “As we get older, we are more and more unlike our peers, and it becomes harder to generalize what a ‘typical’ 80-year-old would be like.”Dr. R. Sean Morrison, a professor and the chair in geriatrics at the Icahn School of Medicine at Mount Sinai in New York, added that the changes that occur during aging happen to different people at different times. Some 85-year-olds have healthier bodies than some 65-year-olds, and much of the variation comes down to genes and a person’s lifestyle before the age of 60.Yet, as people enter their 80s, and even their mid-to-late 70s, some standard age-related shifts tend to occur, like muscle loss and a drop in bone strength, that make people more prone to disease and injury.Here’s a head-to-toe snapshot of the body and mind of an octogenarian and the potential problems doctors look out for.BrainMost healthy people in their 80s don’t have trouble performing complex cognitive tasks such as problem-solving and planning, Dr. Morrison said, but they may find it harder to multitask and learn new things. Some may struggle to remember words. Reaction time can also slow, but usually only slightly — on the order of fractions of a millisecond, Dr. Morrison said.Scientists don’t know exactly why these changes happen, but the brain does get slightly smaller with age because of brain cell loss, so that could be playing a role, said Dr. Scott Kaiser, director of geriatric cognitive health at Pacific Neuroscience Institute in Santa Monica, Calif. Interestingly, certain cognitive skills — such as vocabulary and abstract reasoning — may stay constant or even improve with age, also for unknown reasons, he said.Dementia does become more common with age, but it still only affects a minority of adults in their 80s. According to the National Health and Aging Trends Study, 10.9 percent of adults ages 80 to 84, and 18.7 percent of adults ages 85 to 89, dealt with dementia in 2019. “These conditions are not a normal or inevitable part of aging,” Dr. Kaiser said.Eyes and earsVision tends to worsen over time. Octogenarians often need reading glasses and become more sensitive to glare, Dr. Morrison said. Nearly 70 percent of adults over 80 have cataracts, a clouding of the lens of the eye, but the condition can be treated effectively with surgery, he said.Age-related hearing loss is another common problem. First, people lose the ability to hear high-frequency sounds such as bird chirps and alarm clocks; this can start early, even in a person’s 30s or 40s. Low-frequency changes, affecting the ability to hear men’s voices and bass sounds in music, come later. Hearing loss can be treated with hearing aids — now available over the counter — or other devices, and it’s crucial to do so: “We have increasing data now that suggests that people who go longer with untreated hearing loss and don’t get hearing correction are more likely to develop dementia or diseases like Alzheimer’s disease,” Dr. Morrison said.Heart and lungsAs a person ages, heart rate slows slightly, and the heart can’t beat as fast during physical activity, which can make aerobic exercise more challenging. That said, an aging healthy heart typically “functions quite well,” said Dr. Lona Mody, a geriatrician at Michigan Medicine.Doctors monitor for heart disease in their octogenarian patients. “Blood vessels become stiffer with age, and this leads to higher blood pressure,” Dr. Mody said, which can increase the risk of hypertension and heart disease. According to the American Heart Association, 83 percent of men and 87 percent of women age 80 and older have heart disease, sometimes requiring the use of medications or surgery. Mr. Biden has asymptomatic atrial fibrillation — an irregular heartbeat — and takes apixaban (Eliquis), an anticoagulant drug that is often prescribed to help prevent blood clots and strokes. He also takes rosuvastatin (Crestor) to lower his cholesterol.Lung capacity often slightly drops with age because of changes in the strength and elasticity of the lung tissue and diaphragm, which can make breathing a bit harder, Dr. Mody said. One disease doctors look out for is chronic obstructive pulmonary disease, an inflammatory lung disease seen in just under 11 percent of people 65 and over.Digestive systemPeople in their 80s tend to eat less than they used to, in part because “food doesn’t taste quite the same,” Dr. Morrison said. Over time, people lose taste buds and their sense of smell, he said, both of which affect how much they enjoy eating. This helps to explain why older adults have an increased risk of nutritional deficiencies.But seniors also need fewer calories than younger people because of losses in lean muscle mass and slowing metabolism. According to the government’s Dietary Guidelines for Americans, women age 60 and older should consume a minimum of 1,600 calories a day, and men age 60 and older a minimum of 2,000 calories a day (as opposed to a minimum of 1,800 for women and 2,400 for men ages 19 to 30).Older people are at greater risk for heartburn and gastrointestinal reflux. Mr. Biden’s occasional coughing and throat-clearing are tied to gastroesophageal reflux, and he takes famotidine (Pepcid) as needed to treat his symptoms.Octogenarians digest food more slowly, too. Research suggests that 34 percent of women and 26 percent of men age 84 or older experience constipation.Bones and jointsBones become more brittle with age. The body starts to reabsorb the minerals that strengthen them, such as calcium and phosphate, in part because the intestines can’t absorb what is needed from food as effectively as they used to. For women, this degeneration is accelerated by the drop in estrogen after menopause, which reduces bone density.Decreased bone density puts older people at an increased risk for bone fractures and osteoporosis. In 2020, when Mr. Biden was the president-elect, he had a hairline fracture in his foot, requiring him to wear a walking boot as he healed. The bone injuries that doctors worry about most are hip fractures, which hospitalize more than 300,000 Americans over the age of 65 every year. “Hip fractures are one of the most common reasons for hospitalization among people 85 and over,” said Dr. Susan Wehry, a geriatrician at the University of New England. Recovery is often difficult because of complications such as infections, sometimes picked up at the hospital, and internal bleeding, or because conditions such as heart disease slow healing.Joints can also become more painful because the bones and cartilage that make up the joints start to wear down. According to the Centers for Disease Control and Prevention, nearly half of all Americans over 65 have been diagnosed with osteoarthritis, which causes joint pain and stiffness. President Biden has been diagnosed with osteoarthritis of the spine, which has stiffened his gait.SkinThe risk of skin cancer increases as people get older. The average age at which Americans are diagnosed with melanoma, a potentially deadly skin cancer, is 65. Men are at higher risk for melanoma than women. Dr. Holmes recommends that people in their 80s see a doctor or dermatologist once a year for a skin check.Non-melanoma forms of skin cancer, such as basal cell carcinoma and squamous cell carcinoma, affect more than three million Americans a year. These cancers grow slower than melanomas and are highly treatable when detected and removed early. In February, President Biden, who has said he spent a lot of time in the sun during his youth, had a basal cell carcinoma removed from his chest. He also had several other non-melanoma skin cancers removed before his presidency.Strength and balanceMost healthy people in their mid-80s can and should engage in physical activity, and many remain strong and agile, Dr. Holmes said. She encourages patients to participate in aerobic exercise and weight training a couple of days a week and to stretch at least once a week, but sometimes recommends modifications for patients with pain, orthopedic problems or cardiac issues.Adults “start to lose muscle mass and start to gain fat” as they get older, Dr. Morrison said. Between 42 and 62 percent of people in their mid-80s have sarcopenia, a disease characterized by loss of muscle mass and strength. Common symptoms include difficulty walking, ascending stairs and holding shopping bags.In addition, the spaces between the spinal vertebrae dry and compress, causing people to lean forward, which can affect their balance, Dr. Morrison said. People in their 80s tend to walk slowly and have a short gait, which also worsens balance, he added.In some older adults, the insulating layer that surrounds nerves and helps them communicate with one another, called myelin, starts to break down. This can slow reflexes and make people clumsy, Dr. Kaiser said.“One important consequence of these age-related changes to the brain and overall nervous system — along with changes to other systems and a broad range of other factors — is an increased risk of falls,” Dr. Kaiser said, which in turn can become more dangerous because bones are weaker and break more easily.Stress, stamina and sleepPeople in their mid-80s tend to have lower energy than younger people, so they fatigue more easily, Dr. Morrison said.Dr. Mody added that stress and changes to routine can be “harder to bounce back from” because older people’s tissues and organs take a longer time to recover after stresses or injuries. People may also take longer to recover from colds, Covid-19 and other infections, as the immune system becomes less responsive with age.Many older adults don’t sleep well, in part because they spend less time in deep slow-wave sleep, which makes them more prone to middle-of-the-night wake-ups. “Eighty-year-olds tend to sleep about an hour less than younger adults,” Dr. Morrison said.Still, it’s important to remember that everybody ages differently, and that age does not define a person’s health. Many people in their 80s are healthier than people 20 years younger, Dr. Mody said, and the choices they make late in life matter, too: Research suggests that adopting healthy behaviors even in the ninth decade can extend one’s life.Many octogenarians, Dr. Holmes said, are “quite resilient.” More