Today I wanted to talk about BMI, and in particular my experience of the use of BMI charts in ED treatment. This is something we are becoming increasingly vocal about in the recovery community, as it is a flawed measure which through it’s failure to account for so many factors, is essentially useless. Before I really get going though, I thought it may be beneficial to outline just some of the reasons that BMI is nonsense in order for you to understand the need to stop using it.
BMI was invented in the 1830’s by a mathematician (not a health professional!) and it was intended to help the government allocate resources to the population, NOT determine an individual's health status.
It’s creator (who was male) used a sample which consisted of 19th century men whose lifestyles were vastly different from most people’s nowadays.
It also failed to account for differences between men and women such as fertility, hormones and metabolism.
It uses the formula of weight/ height squared and so ignores factors such as fat percentage, bone structure, body type and muscle.
It categorises individuals as Underweight, Normal, Overweight, or Obese, and this creates stigma based on flawed logic.
Studies have shown that nearly half the people categorised as “obese” are perfectly metabolically healthy, and yet society and doctors often associate obesity with poor health and use it insultingly. (https://www.nature.com/articles/ijo201617)
It negatively impacts diagnosis and acceptance of eating disorders as very often individuals will not be classified as underweight but will be dangerously malnourished and suffering mentally. This prevents people from accessing the help they need.
The above evidences the need for BMI to be abolished as a scale universally as it’s inaccuracy but continued use creates stigma around different weights and body types both in society and medicine. This is because we have applied it to individuals when it was intended only to look at wider populations. The consequence of this is that a mathematical model is being incorrectly used to categorise people and this results in poor healthcare practice, for example illness being wrongly linked to obesity and dismissed as a result.
Further from this, the model continues to be used in the treatment of eating disorders which given what I’ve just discussed makes zero sense. It acts as a barrier for individuals seeking help, as it feeds the stereotype that all sufferers must be underweight and so isolates the large percentage of people who do not fit this category. This is not only invalidating, but also dangerous as you can be malnourished and mentally unwell at any weight and so are just as worthy of help. Beyond this, the implication that someone would be healthy at a “normal” weight completely ignores individual differences. I mean think about it… why on earth would such a diverse population be measured on a single scale based on a specific sample?
The use of BMI charts is also unhelpful when weight gain is an aspect of treatment, as often individuals are told to aim for a certain BMI, usually 19. This again is problematic, as whilst it may just about achieve the category of “normal”, it is impossible that this would be the set point (natural, unrestricted weight) of every individual. I have personally experienced this in treatment, as my therapist has suggested that once I get to this number I can switch up my meal plan in order to maintain this weight. This is something I will not be adhering to as I have no desire to recover to a certain extent but then continue engaging in disordered behaviours in order to stay at a nonsense value on a nonsense chart. I don’t want to spend my life having to monitor my intake and miss out on countless experiences, and moreover I don’t want to be told by a professional that I should! I am by no means blaming my therapist herself as it is the system which is flawed, but I take issue with the fat phobic attitudes it pushes. Eating disorders have exceptionally high rel apse rates and honestly it isn’t surprising given that patients are told to “eat, eat, eat… but not too much”. It is ironic that in our efforts to build a healthier relationship with our bodies and food we are set limits imposed by society's beauty standards as to the extent we can do this.
I hope this post has helped educate you as to why BMI should not be used as a measure of health nor in the treatment of eating disorders.
I’d love to know what you think, or if anything you’ve read has altered your beliefs?
More from me soon,
Mais// The Recovery Bean <3