I’m Pissed
Recently I listened to two episodes of the podcast “Maintenance Phase” by Aubrey Gordon (the link here). In a word, I love this podcast. Aubrey and her cohort, Michael Hobbes, discuss the fallacies of diet culture. They even go into the origins of words that show up in diet culture like “snake oil.” Their last two episodes covered the obesity epidemic and body mass index (BMI). Listening to these podcasts, I feel pissed off. I mean really angry. I’m not angry with Aubrey or Michael. They did a wonderful job speaking to the specifics of these two areas. No, I’m pissed at diet culture (no surprise) and how it impacts the medical industry.
In BMI they talked about the origins of the term. I’ve touched on BMI in other blog posts, but here’s the deal: BMI is arbitrary. It’s a set of numbers that was established by a Belgian over 200 years ago to determine what the characteristics were for the average man. He wasn’t a doctor. He studied sociology. He used BMI to look at a total population, not a single person. BMI is a score based on your height-to-weight ratio. Doctor’s have adopted this score to determine the obesity levels of individual bodies and use the number to determine “healthiness.” But a body’s health can be measured by so much more than its size. Why do they bother using BMI? Studies funded by the diet industry and diet pill manufacturers indicated that there is a correlation between BMI and death rates. Remember that I said “correlation,” not “causation.” There’s a correlation between the number of divorces in Maine and the US consumption of margarine. I don’t think whether or not you slather your toast makes any difference for Marge and Al of Kennebunkport dissolving their nuptials. However, the world got in in an uproar when they heard this correlation between BMI and death. At that point, the WHO and United States CDC started saying that we should track BMI to make sure that people stay in the “healthy” 20-25 range in order to live longer. Obesity got labeled a “disease” and an “epidemic.” But really those numbers can be super arbitrary. Why? Well for one thing, our health is much more than the data point of a number on the scale or how it measures up against the BMI scale. Secondly, one day in July 1998, the National Institutes of Health (NIH) changed the BMI number for being overweight from 28 to 26. So overnight, without even eating a morsel, a new set of people became “overweight.” On the surface you might think, “So what? Who cares. BMI is a crock of shit anyway.” You’re right. But you’ve just labeled someone “overweight.” And in our society, where the words “overweight” and “obese” are used as insults, someone’s life just got a whole lot crappier. The healthcare that practitioners will provide them just got diminished.
The fact that BMI is used to judge if someone is inferior gets worse. People point out the problems with BMI and how some folks have higher BMIs but they aren’t “fat.” They say, “Look at ‘The Rock.’ His BMI is 34.3. That would classify him as ‘obese.’” Well, that’s true. But that isn’t what makes the BMI scale flawed. Other folks have BMIs over 34 and they don’t look as buff as “The Rock.” They are still healthy. Women have more fat on their bodies than men. That’s just the way we were made. Black people often carry more fat. It’s just a given genetic predisposition. Some Pacific Islanders carry more fat. It’s genetic. So we need to stop using BMI as the measure of all things that make a body unhealthy.
Here’s what gets me really pissed. During the podcast, Aubrey and Michael talked about how it isn’t until BMI is over 35 or even 40 that the correlation with mortality was really strong. So we’re using BMI to measure people’s “health” and chastising those from 26-34 who aren’t even in the correlation range? Really we shouldn’t be chastising anyone over the 25 BMI measurement, but here the judgement is completely baseless.
So when people are in the 26-34 range, they are often told to diet. In fact, when they go to the doctor with health issues, folks with a BMI over 25 are often told to lose weight when they need help for issues unrelated to body size.
For example, when I was struggling with a herniated disc that brought me so much pain I couldn’t even sit up, my doctor said, “Maybe you should lose weight. Maybe all that pressure on your back will let up if you lose weight.” Huh? A herniated disc is a disc in my back that has been pushed out of place. It could have happened when I sneezed. It was actually rubbing against another bone on my back, creating shreds that looked like crabmeat on the disc. I found this information out from the surgeon who went ahead and performed surgery on my back. He told me that he had to surgically move the disc to release the pressure and pain. No weight loss was going to magically put hands inside my back and move that disc. The surgeon told me that had he been able to provide the surgery sooner I wouldn’t have been creating “crabmeat” in my back. Yet my GP wanted me to lose weight, and I had to wait months before I was taken seriously enough to have surgery.
Other friends have told me they needed knee replacement surgery, but the doctor told them they had to lose weight first because the surgery was too “risky” due to their BMI. I call bullshit and I will tell you why:
Remember back up at the top when I talked about the studies that correlated BMI with death? The studies were done by the diet industry and the pharmaceutical companies that promote weight loss. Do you know what one of their favorite ways to get you to lose weight is? Weight loss surgery! That’s right, the same folks who say, surgery is “too risky” promote surgery! These surgeries are the ones known to cause severe life changing challenges and even death. Who wants that?
There’s also the challenge of getting medication when you are over the 25 BMI threshold. I’ve had friends who’ve told me stories of going to the doctor for knee pain or back pain and being told, “Lose weight. Then we will see how your knee feels.” Really? Would you say that to a thin patient with knee pain or back pain? Is there a reason these folks can’t have pain killers or surgery? Maybe there’s bone cancer or a tumor in there! Can you check that out instead of waving a diet pamphlet at them?
On the flip side, a friend recently told me the story of visiting her cardiologist. The cardiologist was concerned with the condition of her heart and recommended that she visit a dietician for some meal planning advice. I passively listened, hoping that the dietician would recommend foods to add to her diet and not suggest she remove food from her diet. When she went to visit the dietician, she was first met by a nurse practitioner. The NP did not cover any information about nutrition. Instead, she asked my friend to fill out a questionnaire describing her eating habits and asked questions about binging and overeating. When my friend completed the questionnaire, the NP prescribed pills to stop my friend from eating in the evening. The NP recommended she take the pills after 7 PM because, “These pills might make you feel loopy and you don’t want to feel that way during the day when you might be driving and performing tasks.” What? Take some pills to stop you from eating but they will take your brain function away? Really? That’s how we want to take care of someone’s health? What would you do for the thin person here? Would they have to take special pills? Or would you just give them nutrition recommendations? Treat my friend the same way you would another patient!
This discrimination has got to stop. No wonder fat people are getting sick. Who wants to pay for a doctor visit when the doctor doesn’t acknowledge that you have health issues? This reality keeps many fat people from even visiting the doctor. If you hear your doctor or hear about your friend’s doctor prescribing something for weight loss rather than listening to the true health conditions, speak up. As I’ve said before, I can’t fight the $72 billion industry alone. So let’s all take our sling shots out and fight back at this Goliath.
