“Here, take these,” he said. “We give them to everyone.”
I stared at the nurse and reached for the papers he was holding. I had been to this clinic several times before, and my appointments had never ended like this.
His tone remained relatively normal, although he seemed uncomfortable. He smiled and leaned toward me to show me what he was holding. The first paper was titled, “Tips for Losing Weight.” It listed my weight and BMI, and noted that my BMI fell within the overweight range. It then listed health issues associated with being overweight and tips for changing my diet and exercise routine. Below this sheet was a packet devoted to similar pointers.
I felt sick. I didn’t know what to do, so I took them. I scanned the top sheet. The “tips” were things like “Park further [sic] away in the parking lot,” and “March in place.” I stopped reading and stood up to go back to the lobby.
Thoughts flickered through my brain. They see you and they think you’re fat. It’s good that I didn’t have breakfast this morning. I shouldn’t eat for the rest of the day. My hands twitched to download the calorie-counting app I promised myself I would never use again. I tried not to cry.
Maybe my reaction would have been different if I had been prepared for this interaction. Maybe not. In any case, I had come to talk about birth control options, not my weight. Talking about my weight made me lightheaded and shaky.
My eating disorder began to develop seven years before this trip to the doctor’s office. Growing up, I had learned to be unhappy with my body. I flirted on and off with dieting, but, for the most part, it didn’t make sense to me. I was a figure skater, and I needed the energy from food to succeed. My love for the sport overrode everything else in my life, and that included my relationship with food.
And then my life started to fall apart. I dropped out of high school and quit figure skating and suddenly everything felt out of control. So when I discovered a website that would help me keep track of every calorie I consumed, I was hooked.
It didn’t take long for counting calories to become an obsession. I began counting the calories in gum and crying when I ate too many calories of rice. But it wasn’t enough. I started running, and soon I was running miles every day. The number on the scale haunted me, and I always knew what it was, up to the tenth of a pound. When things got really bad, I would binge eat until my stomach burned and occasionally throw it all back up. My period stopped, and I started to develop severe health issues. I was in trouble and there was no end in sight.
Until there was. With love and support from my community, I started to recover. I stopped counting and started learning how to eat again. I gained the weight back, reached the weight I am now, and then stopped. My period started again, and my health issues disappeared. It was like my body was breathing a sigh of relief.
So this is why this incident at the doctor’s office startled and upset me. Not only was I not there to talk about my weight, but my relationship with food was fragile at best. Handing me these papers threw me into a tailspin.
It could be argued that what this nurse did was based on concern for my health, and that it was medically necessary to point out that my BMI made me overweight. Except, BMI is not a medically relevant scale. In fact, BMI doesn’t even provide an accurate depiction of your overall health. All BMI does is divide weight by height and produce a fairly arbitrary number.
And this number can have consequences. A study published in the International Journal of Obesity reports that “nearly 75 million adults in the US are misclassified as either healthy or unhealthy when BMI is used as the sole health indicator.” Essentially, when more precise cardiometabolic tests are used, they indicate the medical irrelevance of BMI.
So why do doctors still rely on BMI? Many people agree that it’s because BMI is cheap and easy. All a doctor needs to calculate it is their patient’s height and weight. But, while BMI is accurate in this calculation (i.e. dividing that weight by that height and producing a number), the number it produces is arbitrary and an inaccurate representation of that person’s health. Inaccuracy shouldn’t have a place in any medical discipline.
And my BMI certainly shouldn’t have a place in a conversation about birth control. I understand the medical necessity of monitoring my overall health when prescribing something new or changing the way my reproductive system runs. However, my BMI is not a helpful measure of this by any stretch of the imagination–And this isn’t true for only me. There have been many, many cases of healthy women falling into categories describing them as overweight or obese and unhealthy, and vice versa. But as my BMI went up during my recovery, my overall health stabilized. I started taking better care of myself and, as a result, I gained weight. My experience is just one example that health and weight are not, as we have been led to believe, inextricably linked. In fact, they are two totally different things.
So I’m going to continue doing what I need to do to feel good and be a healthy human being. It would be nice if I didn’t have to do so while avoiding triggering-and-definitely-unhelpful information at my doctor’s office. And, regardless of any of this, BMI is still bullshit as a measure of health. Dividing someone’s weight by their height cannot possibly encompass all of who they are and all the factors of their health. BMI strives to boil health down to a simple number, and it fails miserably. So let’s go ahead and retire it already.