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The LA Times has published another awesome article, this time taking aim at BMI. The article headline states “For nearly 1 in 5 Americans, BMI may tell the wrong story”. Although one of the main studies actually places the misdiagnosis statistic closer to 2 in 5 Americans, I have to give the LA Times credit for posting this story which goes on to detail something that many of us in the HAES (R) universe already know: BMI is not a good predictor of individual health. In short:
Having a high BMI does not mean you have poor metabolic health. Having a low BMI does not mean you have good metabolic health.
So why is this important? Well for a lot of reasons. First off, if your doctor is using BMI to determine whether or not you should get further screenings or tests, he or she is using an extremely unreliable metric to make this determination. This means as a fat person you may be exposed to a lot of tests you really don’t need. This means as a thin person, your doctor may miss some stuff that is really important or even life-threatening. I often wonder if a significant proportion of the medical costs associated with fat people are because we have so many more tests done. Or even if higher percentages of certain diagnoses among fat people are in part because we look so much harder for these diagnoses among fat people.
Another reason that BMI bias is such a big problem is that the workplace wellness gurus are using it to coerce or even force us into interventions that may be entirely inappropriate for us. For example, I’ve been talking a lot about this Michigan “walking program” for fatties. BMI was used as the sole determinant as to who had to participate. Those with higher BMIs were told they either had to wear a pedometer that reported their steps to the “home office” or they had to go to Weight Watchers. There was no initial fitness assessment done. There was no assessment of eating behaviors. The program simply assumes that people with higher BMIs don’t engage in fitness and eat very poorly. It’s entirely possible that people in the program had to reduce other, more strenuous and more enjoyable exercise programs in order to comply with the stupid walking rules. It’s entirely possible that people in the program with well-balanced healthy eating habits were encouraged towards more disordered eating habits after their new stint with Weight Watchers. It’s almost certain that people with low BMIs who are also sedentary and eat nothing but junk food were patted on the head and told to “keep up the good work”.
But we’ll never know because they never tested this stuff.
You know what? When company money and government money and my money gets spent on stupid health programs that are just as likely to make people less healthy than before, and nobody bothers to test the hypotheses because “fatties” I get pretty annoyed. In fact I’m crossing right over the line towards enraged.
It’s not like this research is all new. It’s not like the problems inherent in the BMI as a measurement of individual health haven’t been known for decades. But as long as entire industries are set on putting their fingers in their ears and chanting, “La, la, la, I can’t HEAR you!” I’m just gonna have to keep on saying the same things over and over and over. As long as people walk around with misdiagnosed brain injuries because doctors simply think they need to lose weight, as long as thin people miss out on important medical screenings because they are assumed well, and as long as some insurance programs think it’s okay to strap a piece of hardware to my a@@ to track whether I’m moving enough just because of my dress size, I’m gonna keep on talking.
You hear that universe? I’ll keep shaking my chubby fist and you and shouting that your BS. Measuring. Instrument. is not a valid way to understand anything about who I am.
The Fat Chick
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