One of the best predictors of illness is visceral fat, and standard labs usually miss it. Here is how we measure what’s actually happening inside your body.
I mean, yeah, I get it. But I’m nearing 60, have early onset dementia, and I’m otherwise healthy. Not overweight. Not thin. Maybe I’m a little depressed. I don’t know. Just pass me my brandy.
I vote to enjoy the brandy. I don't think the visceral fat will do much for mood but the brandy might be a wonderful way to unwind. As for future health, it's different for each person. There are 7 stages of dementia and each has evidence-based ways of intervening to prevent it from progressing, both according to the recent Lancet paper and the wonderful book by the duo team of neurologists: https://www.goodreads.com/book/show/33991763-the-alzheimer-s-solution
Really solid framing, Dr. Ashori, and I like that you’re treating BMI as what it is: a coarse proxy, not a physiologic truth. The emphasis on visceral fat as the clinically relevant signal (vs total weight) is exactly where preventive medicine is heading. 
Your “ladder” from accessible → precise is also practical:
1. Waist-to-height ratio as the best bedside screen (fast, free, behaviorally sticky). 
/. DEXA as an affordable next step that adds meaningful body comp context beyond the scale. 
3. MRI as the gold-standard-ish look at visceral + liver fat (PDFF), when someone needs true phenotyping. 
Two “yes, ands” that might strengthen this even further for readers:
1. If someone wants a cardiometabolic “tie-breaker” alongside body comp, pairing this with ApoB (or non-HDL-C), A1c/fasting insulin or OGTT/CGM, and BP often clarifies risk when body composition looks “fine” but physiology isn’t.
2. The “mirror test” is psychologically useful for some, but I’d keep emphasizing your core message: we’re not chasing aesthetics; we’re tracking risk and choosing the least invasive tool that answers the question.
I mean, yeah, I get it. But I’m nearing 60, have early onset dementia, and I’m otherwise healthy. Not overweight. Not thin. Maybe I’m a little depressed. I don’t know. Just pass me my brandy.
I vote to enjoy the brandy. I don't think the visceral fat will do much for mood but the brandy might be a wonderful way to unwind. As for future health, it's different for each person. There are 7 stages of dementia and each has evidence-based ways of intervening to prevent it from progressing, both according to the recent Lancet paper and the wonderful book by the duo team of neurologists: https://www.goodreads.com/book/show/33991763-the-alzheimer-s-solution
Really solid framing, Dr. Ashori, and I like that you’re treating BMI as what it is: a coarse proxy, not a physiologic truth. The emphasis on visceral fat as the clinically relevant signal (vs total weight) is exactly where preventive medicine is heading. 
Your “ladder” from accessible → precise is also practical:
1. Waist-to-height ratio as the best bedside screen (fast, free, behaviorally sticky). 
/. DEXA as an affordable next step that adds meaningful body comp context beyond the scale. 
3. MRI as the gold-standard-ish look at visceral + liver fat (PDFF), when someone needs true phenotyping. 
Two “yes, ands” that might strengthen this even further for readers:
1. If someone wants a cardiometabolic “tie-breaker” alongside body comp, pairing this with ApoB (or non-HDL-C), A1c/fasting insulin or OGTT/CGM, and BP often clarifies risk when body composition looks “fine” but physiology isn’t.
2. The “mirror test” is psychologically useful for some, but I’d keep emphasizing your core message: we’re not chasing aesthetics; we’re tracking risk and choosing the least invasive tool that answers the question.