A NEW CLASSIFICATION OF OBESITY STANDARDS, BASED ON CALF MUSCLE DENSITY (Calf Hardness, cH) IN RELATION TO VARIOUS NON-COMMUNICABLE DISEASES.

V. M. Palaniappan, Ph.D.

Chief Consultant, Ecohealth Clinic, 16, Road SS 20/2, Damansara Utama, 47400 Petaling Jaya,

Tel: Office Tel: (603) 7728 3480.  Tel/Fax: (603) 7729 4694. Email palani@ppp.nasionet.net

ABSTRACT No.259: 5th ICPC+4thIHHC CONFERENCE, OSAKA, MAY 2001

PURPOSE:  To find an accurate method for the determination of disease-causing obesity, as opposed to the use of Body Mass Index.

METHOD: Some 1400 patients belonging to 3 ethnic races in Malaysia viz., Indians, Malays and the Chinese, who came to Ecoclinic for a treatment, were subjected to a survey that ran for 15 years.  Some 60 variables that included their features, lifestyle, diseases, and a measure of the hardness of their calf (cH) were recorded.  Pending the development of an instrument to measure, a subjective method was devised to assess the cH by pressing the dorsal side of the gastrocnemius and soleus muscles between the thumb and four fingers. Multiple correlation analyses of the data showed the inter-relationships between the diseases and the various cH measurements.  The raw data were then processed basing on the BMI of the same number of individuals, and a comparison on the efficacy between the two (cH and BMI) to help in the diagnosis of the 60 variables (lifestyles and diseases) were determined.

RESULTS: A total of 8 different categories of obesity stood out.  At one extreme, a rocky hard calf with cH 81–100% was categorised as of Obesity Type IV, and at this maximum obesity, any person would develop within next 12 months or so, one or more of the major non-communicable diseases.  If spongy, with cH “0”, no major diseases would occur.  At the other extreme, a toneless and tender calf, with cH –21 to –40, at “Minus-II” category, a person would be skeletal without any of the major diseases.

CONCLUSION:  The results show that the cH assessment alone can be used as a very useful tool in the preliminary diagnosis or futuristic prediction of the various serious ailments people may have, with greater accuracy, whereas the BMI assessment does not seem to have such potentials.

Introduction

At world level, all those directly or indirectly concerned with obesity have been using only the computed Body Mass Index (BMI) readings, otherwise called Quetelet Index for purposes of reference.  Now, it is no new knowledge that the BMI is obtained from the following formula:

Body Weight (kg)

Height (cm) x Height (cm)

The readings obtained through the BMI are often grouped together somewhat arbitrarily and genderwise, for young adults aged between 25 and 35, and it increases with age (Table 1).  

Table 1: The Body Mass Index (BMI) ranges, in relation to the obesity status

in males and females, as is being used in the conventional system, until now.

 

    Fig.  1.  The Body Mass Index (BMI) of the 90 female and 101 male patients are presented here.  As per this standard, 15.8% of the males and 19% of the females belong to the Overweight category, 4% of the males and 2.2% of the females are Obese, and about 1% of both sexes belong to Morbid Obesity.  All others viz., 79.2% males and 77.7% females are not supposed to be having any obesity-related problems.  In reality, this does not seem to be true.  A comparison of this with the cH measurements presented elsewhere in this paper would reveal a more realistic picture.

It is generally felt that the BMI is particularly useful when combined with the waist – hip ratio (WHR) in reflecting the regional distribution of fat mass.  It is based on the assumption that it is the fat mass that is causative to all the obesity related diseases.

This is often followed by the warning that most of those with a BMI of above 28 have the risk of developing one or more of the obesity-related diseases, and that these people should somehow lose their obesity to a lesser BMI level.  If they did so, the chances of escaping from the above diseases are great.

Again, how one loses the extra BMI does not matter to the weight watchers.  It could be achieved by any of the tedious physical exercises that would make a person profusely sweat.  This list often includes jogging, aerobics, and other gymnastic activities.

Alternative or supplementary to this, the obese people are strongly advised to reduce the quantity of food they eat, especially those containing more fats and oils.  Discouragement of children in Singapore schools from eating oil-fried food (Rajan, 1995) is a good example of this trend.

In all the above, the following questions appear to be prominently outstanding:

Why again those of the Gynoid Obesity[1] are not associated with cardiovascularcomplications and increased risk for cancer to the extent that has been described in abdominal obesity?  Why should some of those who belong to the non-obese category also get these diseases?

If BMI reduction is the answer, why should those achievers of the weight reduction program still get all these problems?  Do we not hear of health-conscious people who are regular joggers and sportsmen dying of heart attacks?  Even cardiologists who are regular joggers have become victims.

Among those who are obese with higher than 28 BMI readings, why is it that not every body is affected with the listed sicknesses?

All these appear to indicate that there could be something erroneous in the understanding of the phenomenon of obesity, and also its relationship to many of the diseases.

As a result of all these disparities, there is certainly a need to rightly determine and define obesity.  When measured properly the new method should clearly separate the ‘true obese’ susceptible to all the said diseases from those who are ‘pseudo-obese’, who are just big-sized but healthy.

Further, the newer method of determining obesity should also clearly bring out those who are in the danger zone, those in the process of developing the problems, and those who are going to get them after several years if they continued to lead the same life style.  Such recognition would facilitate prevention of the problems.

Mere deposition of adipose tissue in the chest area or on any part of the body does not pose as such any problem.  The methods of tracing true obesity are presented here.

New Basis for Obesity Index

All those who consume excessive food will become big-sized and heavy.  Nevertheless, not all big-sized and heavy people eat excessive food.  In fact, some giant-sized and excessively heavy people continue to increase in their size and weight in spite of severe starvation.  So, a measure of BMI would not all the time relate to the quantity of food consumed.

Some people while treating obesity, for want of proper explanation, attribute such obesities to differences in the metabolic rates.

In reality, (a) the metabolic rates of individuals do not seem to be related to real obesity, and (b) the metabolic rate itself is the result of obesity, rather than the other way around.  That is, when a person becomes obese, his/her metabolic rate changes.  The reason for this phenomenon has been explained in Palaniappan (1998).

In the first place, since some over-weighing people do not develop any disease at all, ‘excessive body weight’ as such should not be a subject for consideration. The literature on the subject appear to contain a variety of disparities and ironies.

 The Right Index

In this system, the hardness of the calf muscles[2] of people is measured.  This is called the “Calf Hardness” (“cH[3]), expressible in percentages, ranging from -60 to +100.

The cH readings among people differ enormously from one another, without any relationship to genetic inheritance.  Some have very tender, soft and toneless flesh.  This should be considered as one extreme.  At the other, people have very tough, well-built, strong, tight, ‘well-developed’ and toned muscles.  Between the above two extremes, there exist another six categories, making it a total of eight different types.

In other words, despite global and ethnic origin, and differences in age, sex, height, weight, quantity or quality of food eaten, physical or mental activity, financial status, geographic location, environmental differences, state of economic development of the dwelling country (whether that is underdeveloped, developing or well developed), all humans should fall within one or the other of these eight categories (or their intermediaries) of obesity only. The result of the correlations presented elsewhere in this paper confirms it.

 


 [1]Gynoid obesity is the most frequent fat distribution pattern in obese women, and at times is also encountered among men.  Here the fat deposits occur predominantly on the hips, buttocks, and thighs.  It is characterised by a low waist – hip ratio. This kind of obesity mainly increases the risk of orthopaedic (bone) problems of the weight-bearing joints, as well as psychological problems.  This is also called pear-type, gynecoid, peripheral, gluteofemoral, female or lower-body obesity.
 [2]The extent to which the fleshy muscular back part of the leg below the knee formed by the gastrocnemius and soleus muscles are hard, as measured on the dorsal side, is expressed as Calf Hardness, or cH.
 [3]The abbreviation “pH” is derived from the two words “potential of Hydrogen”.  Here, it could be taken to imply “the potentials of Hardness”, or simply the “cH”.

 

 Fig.2. Regressions drawn using the data for Calf Hardness (cH) and Obesity Type on one hand and Body Mass Index (BMI) on the other, show that (a) the distribution of all the 191 BMI points are clustered between –5 and +10 only.  This does not convey any useful information in terms of real obesity.  Whereas, the cH line covers a wide range of the BMI field from 14 to 40, indicating the distribution of the Skeletal, Thin, Perfect and others at various stages of obesity up to morbid state. The significance level of “r” for the “All Curves” regression line that has become reduced to 0.2219, from those of the other two (i.e. 0.5399 & 0.5886) indicates the inadequacy of the usage of BMI measures for our intended purposes.  Thus, the use of cH as well as the obesity types appears to be most appropriate for any application.  

These eight categories of obesity are measurable mechanically. Figures 2 and 3 offer clarifications for the validity of calf hardness (cH) and further grouping into eight types, especially in relation to the use of Body Mass Index (BMI) standards.

Obesity is recognised by assessing the hardness of the calf muscles(cH).  It can range anything from -60 to +100.  (Table 2)  (Palaniappan, V.M. 1998, 2000).  Therefore, correlations can either be conducted between obesity and all other parameters, or calf hardness and the rest.  Theoretically, both should give identical results.

Fig.3: The calf hardness (cH) of the 90 female and 101 male patients are presented here.  As per this standard, 13.45%) of the people (i.e., the mean of 8% males + 18.9% females) must have had one or more of the following: diabetes mellitus, lumps, cysts, fibroids, prostate enlargement, kidney spoilage, 

 

heart attack, or cancer (since they are of Withered stage); 21.95% are at the brink of getting any of these within a year or so; 9.8% are of 3rd stage obesity who would exhibit some of these symptoms only after 1 to 3 years.  Some 26.7% are in the process of becoming obese (viz., I and II), and they would suffer any of these only after 3 – 11 years.  Of the remaining, 5% are of Perfect stage and that they have no sicknesses of any kind; and 13.3% are Thin people, with minor health problems that are opposed to obesity; 4.8% belong to the Skeletal type, who would have duodenal ulcer, pre-menstrual tension, and the like (for more details, see Palaniappan, 2000 a, b).  When this is compared to what is presented in Fig.1, the BMI distribution appears to be altogether irrelevant.  

The Relationship Between Calf Hardness (cH) and the Body Mass Index (BMI)

A correlation performed between the obesity types and cH shows that these are extremely significantly related.  Therefore, it should be certainly acceptable to use either one of them for further correlations.

Obesity Type vs. Calf Hardness (cH)

(Male: r = 0.988, p = 0.001; Female: r = 0.961, p = 0.001)

Obesity Type vs. Body Mass Index (BMI)

(Male: r = 0.814, p = 0.001; Female: r = 0.728, p = 0.001)

These two are very highly correlated.  However, the following details should be borne in mind while considering the intensity of relationship between the above two:

The sampling method in this study was very subjective, and included only the sick people who came to me for the treatment of their health problems.  The healthy people did not form part of the sample.  That could be the major reason for such a high correlation between the two parameters.

The BMI does not offer an acceptable result if the sample includes healthy people as well.  The big, fat people who are just overeaters, with a cH of 10% (Perfect category), or 30% (Obesity Type I), and without any major disease, will also be categorised as Obese, if the BMI standards are used.

Hyperhidrosis is a closely associated feature with true obesity.  If its relationship is evaluated with the use of Obesity Type on one hand, and cH on the other, the usefulness of the two would become evident:

Obesity Type vs. Profuse Sweating

(Male: r = 0.694, p = 0.001;  Female: r = 0.333, p = 0.01)

Calf Hardness (cH) vs. Profuse Sweating

(Male: r = 0.717, p = 0.001;  Female: r = 0.333, p = 0.01)

Both the above contributions are almost identical to each other.  This confirms again that one of the two parameters could be used for general purposes.  However, the higher regression values obtained when cH is used show, the latter are more accurate for research purposes, or for exact diagnosis of the various diseases of a person.

Category

Calf Muscle, When Felt Between Fingers

Calf Hardness

CH %

Obesity Type

1 Rocky hard 81-100 IV
2 Very hard 61-100 III
3 Hard 41-60 II
4 A bit hard 21-40 I
5 Spongy (Ideal) 1-20 P (Perfect)
6 Soft -1 – -20 T (Thin)
7 Extremely soft -21 – -40 S (Skeletal)
8 a Mixed (V.hard–V.soft) +80 – -40 W1 to W7 (Withering)
8 b Very tender -41 – -60 W8 (Withered)

Table 2: The eight different types of obesity, based on the hardness in the calf muscles (cH).

A Subjective Method to Detect the Calf Hardness (cH)

With a 10-minutes’ training, any commoner or a nursing staff can be trained to assess the cH.  Pending the development of an instrument, the nature of the calf muscle at the left leg of a person sitting relaxed in a chair is felt between the thumb and four fingers[1].

If the entire calf muscle feels spongy textured, with cH 1 – 20% hardness, it will be the Perfect form (“P”).  One without any tone or texture is placed in the “W” or ‘Withered‘ category, and the cH  will be  between41 and60. The “Obesity Type IV” will be with cH between 81 and 100%, and they would look ‘giant-sized’ and extremely strong.  Table 2 has more illustrations.  Based on its occurrence in people, the cH scale has -60 at one end, and +100% at the other.

A person can lookbig-sized, but yet, he may have a spongy calf muscle.  Such a structure would give a measure of only 20% or so.  Another person may look mediocre-built, but may have a 90% hardness.  Therefore, the looks of a person should be cautiously considered in this classification, for a correct placement.

The recognition of the intermediate categories between W-1 and W-7 may confuse a diagnostician, for a diabetic patient having a spongy calf at W-5 stage could give an impression as he it belongs to the Perfect category, simply because the cH would be 1-20%, not withstanding the fact that he is in the process of “withering”.   Table 3 illustrates such details.

Fig.4 Regression drawn between the obesity types of males and females shows an extremely significant correlation. This means sex difference has no relevance to obesity status (or cH).  Whereas, sex difference has an important bearing in the determination of BMI assessments.

   Table 3 shows as how calf hardness (cH) measurements can be misleading.  A Withered (W) category measure can falsely represent one of the true Obesity stages, or vice versa.

The Development of Obesity Types

The presence or absence of calcium, or the degree of its accumulation, or concentration in the body of a person, with or without the aid of other substances (e.g. vitamin D), appears to be the determining factor for any one type of obesity.

These accumulations can occur all over the human body.  However, visible concentrations on the face, and measurable hardness at the calf appear to be significant for purposes of assessment.

The calf density could be the result of a combination of factors.  However, based on various evidences, I have come to the conclusion that it is calcium that goes into each cell and accumulates there in the presence of vitamin D, cements them up (Funk and Wagnalls, 1994) to contribute to the hardness.  It may be worthwhile analysing to determine if such accumulations have anything do with calcium oxalate crystals that are either consumed through vegetables and fruits, or liberated in the process of protein digestion (McCance et al, 1942). Elaborate details on the causes of calf hardening or obesity may be seen in Palaniappan (1998, 2000-a).

References

Davidson, Sir Stanley, Passmmore, R., Bock, J.F. and Truswell, A.S. (975).  Human nutrition and Dietetics.  The English Language Book Society and Churchill Livingstone. Pp.105, 121.

Funk and Wagnalls, Corp. (1994). Infopedia – Funk and Wagnalls Encyclopedia, A Nutrition, Human. p2

McCance, R.A. and Widdowson, E.M. (1942). J. Physiol. Lond. 101, 44, 304. Cited in Davidson et al, 1975.

Palaniappan, V.M. (1998).  Ecological Healing System: Thesis and Hypothesis I. Obesity: Causes,    Cure and Prevention.  Ecohealth Sdn. Bhd., Kuala Lumpur.  471pp.

Palaniappan, V.M. (2000 a).  Ecological Healing System: Thesis and Hypothesis II. Health Problems: Diagnose Yourself.  Ecohealth Sdn. Bhd., Kuala Lumpur.  148pp.

Palaniappan, V.M. (2000 b).  Ecological Healing System: Thesis and Hypothesis III. Yours Sex Potentials.  Ecohealth Sdn. Bhd., 181pp.

Rajan (1995).  Management of Childhood Obesity: Singaporean Perspective.  Malaysian Society for the Study of Obesity: First Scientific Meeting on Obesity.  131-137.


 [1]An alternative and perhaps more accurate measure could be obtained from the calf of a raised leg of a person.  But that could be a cumbersome task, and not all sick people will be able to raise their legs on their won.  The current method facilitates cH assessment even in a public park.