We all know the drill…go to a doctor’s appointment and the first thing is to get your temperature, blood pressure and weight. Now, I don’t know about you, but I have always wondered why we get weighed at this particular point in time. Especially if I might have just eaten a large meal, and am wearing heavy winter boots and a bulky sweater. On occasion I am able to take my shoes off…but not always.
I only point these things out because if the accuracy of my weight is SO freaking important, then why not get a truly accurate number? Especially since this number is then used to place us in a category on the BMI chart.
Yes, this “all-important” BMI category. This chart that takes our height and weight and puts us in a category that honestly does nothing but label us and, at worst, wreak havoc on our self esteem and ultimately, our health.
I cannot tell you how many of my patients over the years actually refuse–yes REFUSE–to step foot into any medical doctor’s office simply because they:
A) Do not want to get weighed, and/or
B) “Know” that even if they are going in for, let’s say a cold or a wart on their finger, they will always have the focus be on their weight and get the lecture: “If you just lost some weight by eating less and exercising more, then maybe you would be in better health”.
They tell me that no matter what is going on with them, it is always blamed on their weight. They just can’t have a cough because they have a cough….their weight must somehow be a cause of it. At least that is how they feel walking out of their appointments most of the time. So to avoid judgement and walking out feeling bad about themselves, they would rather suffer with whatever ailment they have than actually go in for help.
They also tell me that they are usually advised to alter their diet and increase their exercise. This is usually quite upsetting and triggering to most of my patients, as they have not only tried so many diets in their lifetime that they have lost count…but they may actually be eating very little and exercising more than even the doctor encouraged them to and still struggling with their weight. Patients either completely shut down at this point or, if they do try to be honest with their doctor about their struggles with food and weight, it is often met with disbelief and a comment such as “well, maybe just try to watch things and be more active, ok?”
I know this may be one of the most difficult things for anyone to wrap their mind around….but you cannot look at anyone and know if they have an eating disorder or not. You cannot look at anyone and know how little or how much they are eating and/or exercising.
If someone has been dieting for many years of their life, they may very well be in the “overweight” or “obese” BMI category or objectively appear “overweight” even if they eat very little and exercise frequently. Their metabolism is not the same as it was before the dieting and their body has become accustomed to exiting on very few calories. The erroneous assumption is that if someone is “overweight” then they must be eating “too much” and “not exercising”.
To me, this is all so sad. Patients would rather avoid seeking healthcare because of how they are treated and judged based on their weight.
I believe preventative health care is important. So, if my patients are doing such things as avoiding going in when they really are sick AND avoiding preventive care such as mammograms, pap smears, etc… something is very wrong. Health care is supposed to help patients get healthy and stay healthy…not serve as a barrier to their health.
I can tell you this much, patients who are not objectively “overweight” do not get this “lecture” or told any of this. Yet, for the most part, the assumption still remains that if someone is objectively overweight, then their health must be compromised. They must be unhealthy. So, it must be addressed somehow. The BMI category is right there to justify and explain all of this, right?
Ummm..let me tell you something. I know this may shock people, but some (most, actually) of my most healthy patients (normal labs, lack of physical disease or illness, no sign or trace of diabetes, etc..) are, according to societal “standards”, objectively “overweight”. No number on the scale nor category on the BMI chart will say any different.
Yet, because they “look” overweight, when they go into see a doctor, they are the ones that get the lecture on healthy eating, exercise and get sent for labs. Certainly “something” is going to show up as abnormal, right? Nobody can be in an overweight BMI category or above and actually be “healthy”. My goodness, not possible, right?
Likewise, some of my most sick, unhealthy patients objectively appear “healthy” or “thin” according to societal standards. They are given a BMI that places them in a category where the medical doctor praises them and tells them to “keep up the good work”.
Again…WHAT? If a patient who has anorexia nervosa or bulimia nervosa is engaging in very dangerous behaviors that might kill him/her in order to maintain the weight they are at, that means that their bodies are NOT meant to be at that weight when they are healthy. They are fighting against where their body wants them to be in order to be at that weight.
And yet, they, the ones who NEED to be sent in for labs and have a long discussion about what they are eating and how much they are exercising never get those things. They walk out feeling justified in their disordered behaviors and come back to me telling me “see, I am just fine. Healthy, in fact. I was told so. I don’t need to change a thing”.
I cannot tell you the damage this does in being able to treat someone with an eating disorder when there is another provider telling them that they are “healthy” based on the BMI number. The scariest thing of all is that a patient hearing this can, and oftentimes does, prolong their illness and can lead to devastating complications and even death!
As another example, some of my non-eating disorder patients have gone into see their doctor for a routine check up and because they were in the “healthy” BMI range, they were not given much time or attention in the office. However, they had asked to have their basic labs checked (cholesterol, fasting glucose, etc..).
I cannot tell you how many times patients have come back to me in shock because their lab results indicated an illness such as Type 2 diabetes (with no family predisposition, mind you).
I imagine there are so many people out there with a false sense of “health” because they are not overweight based on the BMI that they either never go to the doctor to get a check up or, if they do go in, the assumption is that they are “healthy” and are not sent for any.
The BMI seems to be doing more harm than good, so why are we keeping it around?
Yes, I am passionate about abolishing this bogus, bs measure. I will continue to write, scream..do whatever it takes to get someone..anyone to listen. To FINALLY get it. I am ALL for having people live happier, healthier lives. That IS why I became a doctor. And I truly believe that all of my colleagues want the same for all of their patients. So, why on earth wouldn’t we get rid of something that is hurting people with labels and not actually a valid measure of health?
You know, most of my “overweight” or “obese” patients will say “you know doc, I don’t need a number on a scale or to see a BMI chart to know I am overweight. I know that I am. I certainly don’t need the nurse or doctor telling me I am. Do they not think I know that already?”
To the point here: the BMI is not like any other measure we use. It is stigmatizing and serves no purpose other than to categorize people in such as way that they are then labeled . This label is then internalized and has a nasty, horrible effect on someone’s self-esteem. Or, like I said–can validate someone’s denial about having an eating disorder and keep them sick, ultimately killing them.
Where, I ask you, is there any value in this? Please, please tell me. I would love to know. We are all smart, educated caring providers who want the best for our patients. Let’s ditch the BMI and find a way to find out if our patients are healthy or not. Because it is NOT based on what they weigh. You just cannot look at someone and tell if they are “healthy” or not. You just can’t.
I hate to be the bearer of bad news here, but weight and health are not linked. I know, everyone is up in arms these days about the “obesity epidemic” and how it is killing people. “Something MUST be done”. And this is based on the BMI? Does anyone actually know how the BMI was derived? If it actually is a measure of health at all?
We are all so blindly accepting of it..beholden to this number. Yet, I bet so very, very few of you have actually ever questioned where is came from and if it is even a valid measure of health.
It is NOT. Here is the background of the BMI and how it somehow came to be such a powerful, yet completely bogus measure and standard by which we are all labeled. I think once you read and understand this, you, like me and many of my colleagues, will also wonder why on earth this antiquated chart has not been kicked to the curb decades ago:
The BMI was introduced in 1832 Belgian mathematician, astronomer and statistician, Lambert Adolphe Jacques Quetelet. He was not a physician. He produced the formula to give a quick and easy way to measure the degree of obesity of the general population to assist the government in allocating resources.
In my opinion, the BMI should have stayed allocating resources for the government. First off, it makes no allowance for the relative proportions of bone, muscle and fat in the body. Bone is denser than muscle and twice as dense as fat, so a person with strong bones, good muscle tone and low fat will have a high BMI. So, many professional athletes, ironically, tend to find themselves classified as overweight or even obese…categories associated with having a higher risk for poor health.
What? Who could possibly be healthier than a professional athlete? Their entire profession and life revolves around their health and well-being. Yet because of the BMI, many of them are categorized such that they are deemed “unhealthy”. Need I say more?
I have to say, I am a bit of a research nerd and love perusing through the internet to try and find something useful to inform my practice. And..I was nothing short of thrilled to find a study done at UCLA on the BMI. It actually validated what my patients had been telling me for years!
I will save you all the boring details and give you the highlights:
The study done at UCLA found that:
A) Close to half of Americans (47.4% or 34.4 million people) who are considered “overweight” by the BMI are healthy.
B) 19.8 million of Americans who are considered “obese” by the BMI are also healthy.
C) ~20.7 million people (more than 30% of those with BMIs in the “normal” range) are actually unhealthy based on their other health data.
D) ~15% of Americans ( 2 million+) are considered “very obese” (BMI of 35+) and are actually healthy.
The director of UCLA’s Dieting, Stress and Health laboratory (DiSH) also found in previous research that there was no clear connection between weight loss and health improvements related to: hypertension, diabetes, cholesterol and blood glucose levels.(1)
So, just in case it was not clear enough to anyone: I am all in favor of getting rid of the BMI now and forever. We are so much more than a number on a scale…our health and well-being cannot be measured by the number on the scale.
When I ask people what “healthy” is, I do often hear “eating healthy food and exercising”. I challenge you to consider that it is WAY more than that. Just like our health cannot be determined by the BMI, it cannot just be determined by what we eat and how much we exercise.
There are so many dimensions to our lives. 8, in fact. The goal is to try and balance each of those areas so that we can achieve overall balanced wellness. The more balanced, or “well” we are, the more healthy we are.
Here’s to your health!
(1) University of California — Los Angeles. “Don’t use body mass index to determine whether people are healthy: BMI incorrectly categorizes millions of ‘obese’ people as unhealthy, according to research.” ScienceDaily. ScienceDaily, 4 February 2016. <www.sciencedaily.com/releases/2016/02/160204042240.htm>