Trigger warning: This topic discusses eating disorders and may be sensitive to some readers.
I remember when I first walked into the GP’s office of my university’s medical practice. I don’t recall what made me do it, just that I felt the sudden desperation to be noticed or heard, all the while doing everything I could to hide from the world.
I’d been living in this paradoxical state for a while. It was the first year of my undergraduate degree, you see, and I’d been experiencing symptoms of an eating disorder for around 5 months – though at the time I didn’t want to admit it to myself.
I sat in the waiting room twiddling my thumbs and nervously looking down at the floor, wondering what a big mistake I may have made by coming here. But in that moment of hesitation and panic, I heard my name being called, and timidly made my way to the doctor’s office.
“I don’t know what’s going on,” I told her, “But I’ve been feeling really unwell mentally and physically. I think I’m scared of … (I remember being too embarrassed to use the word ‘eating’ or ‘food’ here). My friends tell me I lost weight.”
Subconsciously, I knew exactly what I was struggling with – I just couldn’t see it with my own eyes at the time. In the last several months, I developed such a serious fear of food, that just walking past the grocery isle in a supermarket made me hold my breath in, because I was afraid that the sheer smell of food would make me gain weight. Of everything I knew about myself, and of all the illnesses I could have possibly suffered in my lifetime, I never imagined that anorexia would be one of them. It twisted my mind like nothing I’d ever experienced before. But all that was about to be invalidated.
I popped on the scale, so ashamed weighing myself in front of another person that I needed to look away. All I could hear in my head was “FAT FAT FAT.”
“Well, your BMI is normal. It’s at the lower end of the scale but it’s completely normal” – she tilted her head as she looked at me empathetically, “Be strong. Don’t let this feeling beat you.”
A few minutes later I left the office, part confused, partly feeling the tears welling up in my eyes. I couldn’t for the life of me understand why the appointment concluded so soon, or why no health checks or support were offered. It was already so hard to speak up about my problem in the first place. But I learned one toxic truth that day – I ‘wasn’t sick enough’ to get help.
What the GP said was possibly one of the most triggering things I could have heard, and to understand this, one must get inside the mind of somebody with an eating disorder for a few moments.
Just as a disclaimer, I am by no means speaking on behalf of everyone with anorexia here.
On a somewhat subconscious level, many anorexia sufferers feel the need to ‘disappear’ or hide from the world – we see decreasing numbers on the scale not just as a form of punishment, but as something we can actively ‘control’ when other things in life seem out of hand. We reduce ourselves to a fragile state in what seems like a never-ending roller coaster of painful struggles. And yet despite actively reducing ourselves to this physical nothingness, we often long for someone to notice our suffering and acknowledge our feelings, even just for a little bit. Being so ensnarled in self-hatred, we often seek for validity from other people. Our disordered side is in a constant battle with numbers, and with ourselves. For someone to then turn to us and dismiss all that with something as trivial as a BMI (when we are already unhealthily obsessed with numbers), is a horrible feeling. It confirms our worst anxieties and reinforces our disordered thinking. In my case, the thinking was “I am not visibly sick enough, therefore I am okay. I can keep going.”
“I guess I will just go away and lose more weight until I am deemed ‘sick enough,” I thought to myself as I left the GP’s office.
Some weeks passed, and I remember getting in the shower one evening. I was just thinking about my next submission deadline, as a churning feeling of acid and hollowness passed my stomach, a sensation I was oddly addicted to by this point. I felt fatigue washing over me just as I placed a dollop of shampoo into my hand, running my fingers through my hair.
I realised something was off seconds later, because I began pulling clumps of hair from my head. My hands were barely touching it, and yet the water poured through it like a violent waterfall, taking hundreds of strands away with it. I stood there in shock. I didn’t realise how bad things had gotten until the drain had stopped letting through any water. The long hair I’d had all my life was suddenly disappearing in front of me, like hundreds of leaves floating down to the ground in autumn. I remember tearing up as panic washed over me. “But I can’t be that sick,” I kept telling myself. I thought of what the GP told me, “Your BMI is fine.”
Over the course of those 3 horrible years, I was frequently rejected by hospitals and dismissed by doctors, simply because I didn’t have a critically-low BMI. They were even hesitant to put ‘anorexia nervosa’ on my record, because I was never thin enough. I was severely malnourished and experienced frequent fainting episodes, delusions, and panic attacks. None of that was ever enough to have me admitted to a hospital or receive grounded mental support – because the doctor’s visits ended as soon as I stepped off those scales, which somehow defined the severity of my condition, and the criteria for getting help.
And so, I continued losing weight for another year and a half, until one day, aged 20, things eventually took a turn for the worse.
I developed neutropenia and lost my periods for 3 years. With the little student savings I had left, and with desperate encouragement from my family, I resorted to a couple of private visits, and was put on hormone replacement therapy by a gynaecologist. When she initially assessed me, she told me my internal female organs looked severely underdeveloped – as if I were 8 years younger. Blood tests revealed I had virtually no oestrogen in my body. I stopped feeling like a woman.
The fact that in the 21st century, at such a progressive age, the severity of an eating disorder is still getting defined through a flawed system designed to (inaccurately) measure physical body fatness, is beyond me.
Let’s go back a few steps to the origins of BMI. The concept was first introduced by a Belgian mathematician by the name of Lambert Adolphe Jacques Quetelet in the 19th century – a time when we hardly knew anything about the human body. Quetelet was obsessed with the idea of human perfection, what he called “l’homme moyen,” or the “average man,” and in his book A Treatise on Man and the Development of His Faculties he stated that “everything differing from his proportion or condition, would constitute deformity or disease… or monstrosity.” Thus, the Quetelet Index was born; a calculation based on nothing more than the weight and height of an individual. Insurance companies soon incorporated this standard into their own practice, as they would associate overweight individuals with decreased life expectancy (Psychology Today; 18th March 2016).
Wait, you mean to tell me that BMI wasn’t invented by a health expert or physician, but a mathematician? Yep.
Let’s also not forget that BMI standards vary from country to country. A perfectly healthy individual considered slim by Western standards may be classed as overweight in countries like Japan, purely because the average weight of the general population there is much lower. The BMI was never designed to measure individual people, but to screen the general population – something Quetelet himself admitted.
BMI doesn’t take into account things like age, sex, muscularity, bone density, fat percentage, nor fat distribution in an individual. As a writer by the username of Your Fat Friend points out: “Weight wasn’t considered a primary indicator of health until the early 20th century, when U.S. life insurance companies began to compile tables of height and weight for the purposes of determining what to charge prospective policyholders.” Not to mention that the entire measurement method was primarily designed around white people – Quetelet’s research sampled mostly white, male individuals, marginalising not only his study, but effectively a large part of modern medicine today.
To add to that, we have yet another area in which females fall victim to medical sexism, since most of the medical research on BMI has been conducted on males, putting women at a potentially serious risk of misdiagnoses. Are you just going to tell someone they are overweight, or might they actually be suffering from PCOS? The list can be long. Weight may vary for both healthy and unhealthy reasons.
Let’s take another example. If one excluded a large part of the demographic in a crucial scientific study which tested the effects of a certain medication, would you take that medication? Would you take it as a young black female, knowing that most studies were conducted on white, middle-aged, European men? We seem so quick to point out flaws and express our mistrust in science these days (the recent scepticism around the Covid vaccine being a good example), and yet many seem to have trusted a fundamentally racist and sexist concept like BMI for decades. Even worse, we have often used it to define our own self-worth.
Some may argue the BMI to be a good general indicator of health. But it is fundamentally flawed in its science, and rarely works for most individuals. On the one hand, you may find thin people with a low BMI, a high body fat percentage and a sedentary lifestyle, and on the other side you will find muscular athletes whose BMI sit in the ‘very overweight’ category. Which is healthier? And what about horrible conditions like bulimia, whose sufferers often fall in the ‘normal’ BMI category, all the while destroying themselves from the inside?
Looks can be incredibly deceiving. At the end of the day, everyone has their own story, their own life journey. Everyone also has their own ideal weight, because every body is different. BMI strips all that logic and takes a completely black and white approach. Arguably, it is just another catalyst for body shaming.
You can take two completely different people, and a BMI measurement will tell them that they’re both healthy – and it will always stop at that. Unfortunately, many medical professionals also stop at that. And yet, there are so many other factors to consider. How could you possibly know what goes on in someone else’s body just by looking at a number on their scale and dividing it by their square height? We have far more sophisticated technology today to assess one’s physical health, and yet those methods are unfortunately more expensive, so BMI remains a fast and convenient solution.
Whoever you are, I urge you not to let numbers dominate your life. Though we shouldn’t endorse unhealthy lifestyles, we certainly don’t need BMI measurements to tell us who we are. The best way to stay healthy? Take care of your body, be kind to it. Eat healthily and exercise in a way that works for YOU, without striving to be perfect. The perfect body does not exist. Do what works for YOU, because you know your body best.
Jackson-Gibson, A., 2021. The Racist and Problematic Origins of the Body Mass Index. [online] Good Housekeeping. Available at: <https://www.goodhousekeeping.com/health/diet-nutrition/a35047103/bmi-racist-history/>
Karasu, S., 2016. Adolphe Quetelet and the Evolution of Body Mass Index (BMI). [online] Psychology Today. Available at: <https://www.psychologytoday.com/gb/blog/the-gravity-weight/201603/adolphe-quetelet-and-the-evolution-body-mass-index-bmi>
Medium. 2019. The Bizarre and Racist History of the BMI. [online] Available at: <https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb>
Nytimes.com. 2021. Trapped in the House With an Eating Disorder. [online] Available at: <https://www.nytimes.com/2021/03/31/well/mind/covid-eating-disorders.html>
Rejuvage. 2021. Can Body Positivity and The Fitness Industry Co-Exist? – Rejuvage. [online] Available at: <https://rejuvage.com/can-body-positivity-and-the-fitness-industry-co-exist/>
Teich, J., 2021. The Unbearable Weight of Diet Culture. [online] Good Housekeeping. Available at: <https://www.goodhousekeeping.com/health/diet-nutrition/a35036808/what-is-diet-culture/>
Women’s Running. 2021. How to boost your body positivity | Women’s Running. [online] Available at: <https://www.womensrunning.co.uk/motivation/how-to-boost-your-body-positivity/>