[Mrs Pony]

http://nz.news.yahoo.com/a/-/top-stories/5531808/qualified-nurse-refused-residency-obesity/

A British nurse who weighed 134kg has been refused New Zealand residency because of her morbid obesity, despite the need for skilled nursing staff.

The 51-year-old, who was offered a job in a home and hospital for the elderly in a provincial city, met the qualifications for immigration under the skilled migrant category.

But her body mass index of 55.2 was considered unacceptable by the immigration service who declined her application, despite nursing being on a long-term skill shortage list.

Now the Residence Review Board has dismissed her appeal.

For a New Zealand European, a BMI score of 25 is considered overweight, 30 obese and 40 morbidly obese.

The woman, whose waist measured 131cm, wanted to emigrate with her crane driver husband and daughter, who has a degree, after holidaying in New Zealand in 2007.

Medical assessors said that the woman would probably cost the country $25,000 over four years in health treatment.

She argued that she was physically fit, there was no history of cancer or chronic diseases in her family, and her weight did not stop her working more than 60 hours a week.

A medical assessor said that apart from her morbid obesity, she was an otherwise "well lady" and could be reconsidered for immigration if she reduced her BMI to under 40.

The appeal board said that the woman scored relatively highly in the skilled migrant category.

It concluded: "While the appellant is currently healthy, the severity of her obesity meant that two medical assessors found her to be of too great a potential risk to the New Zealand health system to determine that she had an acceptable standard of health."

Though the family would make a "sound" contribution to New Zealand , that did not weigh sufficiently for the board to decide that there were special circumstances in this case.

Just found this... I know there are some people on here that are struggling with the BMI issue and have stories like this... maybe they will try to change some things?

[ljrobin]

Not struggling with the BMI issue, but with the Nursing Council approving my qualifications, almost 6 months! I have over 20 years experience, with a Bachelors Degree and they are wanting the number of clinical hours completed in Nursing school which was 1983-1985!

[JandM]

This woman weighs 295 and a bit pounds (over 21 stone). Of course I'm sorry for her family's disappointment, but I DO understand NZIS's concern about her. Great that she has no health problems currently, but that size has to be putting a strain on her heart and other organs. It's not as if reducing her BMI to under 40 wouldn't be good for her. It's not as if NZIS have entirely closed the door on her. It's not as if this rule was introduced suddenly when the application was already in the works.

[JandM]

Not struggling with the BMI issue, but with the Nursing Council approving my qualifications, almost 6 months! I have over 20 years experience, with a Bachelors Degree and they are wanting the number of clinical hours completed in Nursing school which was 1983-1985!

Oh, good heavens... Do you have any hopes of tracking this down, or are you having to try and argue that they should accept an estimate?

[Flutterby]

If it was only slightly over i'd understand, but she is very big and the rules have been there a long time.

[James 1077]

This woman weighs 295 and a bit pounds (over 21 stone). Of course I'm sorry for her family's disappointment, but I DO understand NZIS's concern about her. Great that she has no health problems currently, but that size has to be putting a strain on her heart and other organs. It's not as if reducing her BMI to under 40 wouldn't be good for her. It's not as if NZIS have entirely closed the door on her. It's not as if this rule was introduced suddenly when the application was already in the works.

Just because she weighs a lot doesn't mean that she is fat though. BMI is a terrible way of measuring healthiness as it the formula totally screws up if you are tall or if you are muscular.

My personal opinion is that any doctor or medical practitioner who uses BMI is a quack who has no understanding of basic mathematics. The BMI formula uses height squared - whereas people generally live as three dimensional beings so as they get taller they expand in three dimensions - not two. A better formula is probably about height to the power of 2.3 or 2.4; or, better still, ignore BMI and look at body fat percentage.

[WANZLittles]

Just for Kicks, I found this.
BMI calculator (http://www.nhlbisupport.com/bmi/)

[JandM]

And just for kicks, I worked the maths backwards. The lady must be 1m 56 cm (just under 5 feet 1 1/2 ins). Her waist measurement is given as 131 cm, which is just over 51 1/2 ins (4 ft 3 1/2 ins) in Imperial. She's not tall. As I said above, that size can't be helping her vital organs.

We all know that the BMI features in the NZIS medicals. The NZ government are in the driving seat in this situation. They don't have to take any notice of what individuals think - if we don't like any aspect of the process, we can just *go away*.:uhoh

[WANZLittles]

And just for kicks, I worked the maths backwards.
I was going too :D

[BkyMonster]

While BMI is a bad measure I agree, it is quick and easy which is a boon when processing a lot of people. Body fat percentage measures (mine is pretty ok, but my BMI is still over) take skill or expensive equipment to measure correctly. Chances are if you are over BMI 35 you could stand to lose a bit of weight. This is from a person whose ideal body weight puts me at a BMI of 30+, with 35 being maybe 10kg overweight.

[dilanium]

I am very tall, as tall as my sister, that woman weighs WAY more than me (and I'm not a slender person), and my sister who weighs more than that, has a lower BMI anyway, so I don't think this is a problem with BMI calculation (also, it's much harder for women to put on that much excess muscle to throw a BMI off that much from working out, and if they have done it I would question how).

I'm sorry, but very large obese people ARE putting their life at risk and statistically will die younger and be a greater cost to the healthcare system. You may not agree with it, but that's why New Zealand denies these people.

(as for the other thread where the people are closer to a BMI of 35, I Do NOT understand why they're being kept out).

[cherieb]

I have to agree that when someone has a waist as round as they are tall (nearly) I would forsee future problems with diabetes and heart problems etc. which are a long term burden on the health system.
Good on everyone here who has worked hard to get their BMIs down to achieve their dreams.
On a different tack, has anyone had trouble getting into NZ with a BMI which is too LOW? That also can cause long term health problems.

[bobo]

Just because she weighs a lot doesn't mean that she is fat though. BMI is a terrible way of measuring healthiness as it the formula totally screws up if you are tall or if you are muscular.

My personal opinion is that any doctor or medical practitioner who uses BMI is a quack who has no understanding of basic mathematics. The BMI formula uses height squared - whereas people generally live as three dimensional beings so as they get taller they expand in three dimensions - not two. A better formula is probably about height to the power of 2.3 or 2.4; or, better still, ignore BMI and look at body fat percentage.

Yes but it is good at quicky putting people in to categories, OK, Not OK and need further info.

Now no matter which method you use someone with a BMI of 55.2 is never going to be placed in any group other than Not OK.

[IanW99]

Just like to add to this thread that NZIS are using international information provided by the "International Diabetes Federation" for their statistics on who will / wont be a burden on the health system.

Also, that AFAIK, if you are muscular and not fat with a high BMI then you can get tested to determine your true BMI and not just use the calculated one.

Ian

[dharder]

BMI is a terrible way of measuring healthiness as it the formula totally screws up if you are tall or if you are muscular.

As far as I understand this whole BMI thing, the muscle mass distortion is a bit of a red herring. You really have to be an athlete or a body builder with considerable muscle mass to actually make a big difference.

And quite frankly, I think at that stage, it will be fairly obvious to the person doing the medical exam that there may be a reason other than obesity causing the high BMI.

Daniela

[Kanga]

Ditto. BMI can be a bit crude around the 'over weight' measures but a BMI of 50+ with a waist nearly as high as your height is a ticking time bomb. Given that obesity is predicted to become the biggest drain on healthcare, I can't see that NZIS could have made any other decision and kept the whole 'medical' aspect of the application meaningful.

It's a tough one though because it arguable following this logic of burden on healthcare and lifestyle choices that perhaps NZIS should have a limit on the number of cigarettes you can smoke each day and get PR. Do they have this?

[James 1077]

My point isn't that the BMI limit shouldn't be relevant to her - but it is NZIS getting het up about BMI in the first place. Seeing that everyone pretty much has to have a medical it would make far more sense for them to look at "overall healthiness" rather than having an arbitrary BMI limit.

According to BMI I, for example, am obese. However I would personally say that I am just overweight rather than obese. Indeed my fat percentage scales tell me just that. The fact that I'm 6'6" tall is what pushes me into the obese camp (I actually have no tall friends who are , according to BMI, the correct weight - they are all overweight or obese). The mid-point for healthiness for someone of my size would look totally anorexic on my build and would be exceptionally unhealthy in my opinion.

It could be, and is probable, that in this person's case she is unhealthy and the risk of being a strain on the health service is too great. But if Brad Pitt, for example, wanted to move to New Zealand then he would fail the arbitrary limit as he too is classed as obese under BMI.

[Norwegian Blue]

Fat people are an easy target and because there is such a thing as BMI, they can draw a line. However, just because someone meets the benchmark at the time of checking does not mean that they will stay that way for ever! They do not discriminate against smokers or drinkers as it would be harder to quantify how much substance was OK. In any case, if you knew the max was x number of cigarettes or drinks, that's what you would put in the form, because how could they ever prove that you didn't meet the standard? And what about people who engage in extreme sports?

Also, there seems to be no link between income and the $25000. All tarred with the same brush whatever your contribution to the tax coffers.

But I haven't seen any sensible suggestions on how else they could lower their risk? Would any insurance company be willing to take a premium to cover the risk? Since they can't really tell who will and who won't cost the system, one way to do this fairly would be to have a mandatory group insurance scheme to which all new immigrants contribute and the risk is covered for whoever is unfortunate enough to need expensive medical treatment.

I'll climb off my soapbox now and do some work :laugh

[Kanga]

My point isn't that the BMI limit shouldn't be relevant to her - but it is NZIS getting het up about BMI in the first place. Seeing that everyone pretty much has to have a medical it would make far more sense for them to look at "overall healthiness" rather than having an arbitrary BMI limit.

But I think they do look at overall healthiness- BMI is just a part of that but the overwhelming evidence suggests that people with high BMIs are going to cost the health service- globally obesity is becoming a massive problem.

(I actually have no tall friends who are , according to BMI, the correct weight - they are all overweight or obese). The mid-point for healthiness for someone of my size would look totally anorexic on my build and would be exceptionally unhealthy in my opinion.

I'm a little confused here because although muscle mass has been reported to skew BMI (but not as often as people claim), height does not as height is factored into the calculation.

Just a consideration James and in no way am I meaning to intimate that this is the case with you, not at all- your post just reminded me of something my partner and I have discussed before; do you think that as the 'average' weight rises that our perceptions of what looks healthy alters, whereas what actually is does not? My partner is always referred to as slight and has a bit of poor self body image because he feels he's small or whatever, when in fact he is *exactly* right BMI wise, but most men are a good deal heftier than him. He's strong, atheletic and has muscles but very little fat or 'chunk'- in fairness his sense of being small is probably not helped by being married to me :o

[dilanium]

I'm a little confused here because although muscle mass has been reported to skew BMI (but not as often as people claim), height does not as height is factored into the calculation.

For people near the average height it's calculated for, but for people who are quite tall it is skewed.

For the record I'm 6'2" (188cm) and have a normal BMI, so it can be done for tall people (but I also work out 4-5 times a week for an hour or more).

[James 1077]

I'm a little confused here because although muscle mass has been reported to skew BMI (but not as often as people claim), height does not as height is factored into the calculation.


Height is factored into the equation but incorrectly.

The equation is weight / (height squared)

Theoretically it should be height cubed as people are three dimensional so, as they get bigger, they get bigger in three dimensions (height, width and depth).

However taller people generally have a slimmer build than shorter people (so aren't really scaled up equally in all three dimensions) so the exponent should really be somewhere between 2 and 3. Most studies put it at somewhere between 2.3 and 2.6 but 2 was originally used as it is easier to calculate. The difference isn't too big for most people but starts to get much larger when you get bigger (ie my BMI is 30 using normal calc but using 2.5 gets to around 22 and 2.3 around 25).

In addition short women are likely to have much higher BMIs than taller women even if they have a similar build - this is probably due to leg length and strength requirements.

On top of that BMI should also take age into account.

This picture (http://www.halls.md/body-mass-index/images/height.gif)shows how this all works (it shows the median BMI for males and females of different ages and heights - although it doesn't go up to the point where it all starts getting silly height-wise!)

Now that most people who are interested use BMI tables or online calculation tools it makes no sense to stick with the current formula if you need to keep some sort of quick and easy calc for healthiness. BMI was originally designed as something that was easy to work out with no more than a pencil and some paper but most people now have access to slightly more sophisticated tools than that! :)

[Kanga]

Very interesting post James- thanks, rep given :)