Thank you, Dr. Kara Pepper, for your recent article “Why you should not use BMI for your New Year’s resolution.”
Our weight-obsessed, BMI-focused culture has been a thorn in my side for much of my life. And since eating disorders thrive in secrecy, let’s get talking. In sharing my story, I hope to encourage revision of the way we speak to patients and utilize (or do not utilize) weight/BMI as correlates for health.
During adolescence, I developed anorexia. The mental and behavioral signs and symptoms were all there. However, as my natural physical build is muscular and falls on the higher end of the BMI scale, the behaviors were seen as “healthy” ways to get my bodyweight down to fit societal standards. The combination of the stereotype of what anorexia “should” look like and the presence of weight-based criteria for diagnosis resulted in delayed diagnosis, access to treatment, and invalidation of my struggle.
For several months of living with anorexia in my brain, I would get to the BMI and officially obtain the diagnosis. However, I did not suddenly develop anorexia when my weight reached that BMI. I followed the rules from anorexia to get there. And by then, I couldn’t stop.
As anorexia took over my brain, I used the BMI index to validate my worth. Like many that live with anorexia, I was a perfectionist (now recovering perfectionist), which translated into how well I needed to fit the anorexia diagnostic guidelines. If I was not at or below the BMI associated with the disorder that had then become my identity, then I was not “anorexic” enough to receive help (in my mind). My brain told me I wasn’t even sick. Thank you, Dr. Jennifer Guadini for speaking on this concept in your book, Sick Enough.
To make matters worse: I found diagnostic guidelines using BMI’s for mild, moderate, severe anorexia. These numbers fed deeply into my disordered brain and became objective measurements of “success” in my achievement as a person with anorexia and became the basis of which I would determine my worthiness for help. As I look back now, it’s easy for me to see how bogus it is to use BMI indicators to determine the severity of health, especially mental health. But the intellectualization, alone, has not provided defense from the reign that BMI took over my thoughts.
I was diagnosed over 20 years ago, and looking back, I feel privileged that I did meet the stereotype for anorexia and be forced into treatment. However, along the way, I have gained insight that people of all bodies share my struggles. And the use of weight/BMI to determine whether someone is struggling and should have access to treatment results in delayed diagnoses, limitations in access to care, prolonged suffering, invalidation, and shame.
Worse, eating disorder behaviors in people with higher BMIs may be celebrated as the goal of “weight loss” is held to a higher standard than their mental health and physical consequences of their behaviors. I am appalled.
Thus, continued use of BMI is not only frivolous but has the potential to cause serious harm. While I am glad the diagnostic criteria for anorexia have changed, how has BMI continued to survive in our health care system where we pledge to “Primum non nocere”?
You are right, Dr. Kara Pepper: “It’s time to find a better measurement of health.”
Jillian Rigert is an oral medicine specialist and radiation oncology research fellow.
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