21. Should I care about my BMI?

The BMI scale has been used for a long time to determine health by many medical professionals. It categorises people into weight categories and suggests whether you will be healthy or not based on that. This week I explain why the BMI scale is problematic, what it was originally created for, and why it's not an appropriate measurement of health. 

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Please note, this podcast is intended to be general information for entertainment purposes only. Any figures quoted are correct at the time of recording. As always, please seek the support of a registered professional before making changes to your diet or lifestyle⁠, or if you feel that you are affected by any of the topics discussed.

Related Topics:

Intuitive Eating, HAES, Health At Every Size, Body Positivity, Body Confidence, Body Positive, Anti Diet, Non Diet, Diet Culture, Food Freedom, Fat Acceptance, Fat Liberation, Self Care, Weight Loss, Eating Disorder, Eating Disorder Recovery, Disordered Eating, Nutritional Therapy, Slimming World, Weight Watchers, Cambridge Diet, Cambridge Plan, 121 Diet, Lighter Life, Noom, Coaching, Healing, Health, Wellness, Calorie Counting, Macros

Transcript

Welcome to the Intuitive Eating and Body Positivity podcast. I'm Terri, and I'll be talking about all things Intuitive Eating, body positivity and health at every size and shaking off weight stigma, diet culture and food rules so that we can all have a better relationship with food and our bodies.

Hello. Hello. How are you? Hope you've had a great week. Hope you had an absolute corker of a week. I also hope you're answering me back when I ask you these questions.

Yeah. How's your week been? I've had a great week. I've had such a good week this week. So firstly, it was my birthday. Well I went to work on my birthday. Now, I know a lot of people go to work on their birthdays, but I never do. This is the first time in my entire life that I have worked on my birthday. I always book it off work always. And this year, for some reason I completely forgot.

But anyway, it was nice. It was a nice day. I had a nice chat and some nice food with the guys at work and then in the evening I went to a local country pub, had a nice food there. Now people around here rave about this place. I haven't been for years but decided to go out there. They've got a really nice menu, and also, the thing we struggle with is that my son is vegetarian, and I wanted to find somewhere that had a nice menu for him as well.

So many places have vegetarian and vegan options as a second thought and it's really difficult to find somewhere that's got a really nice selection for him to choose from as well. I don't think that we should go out for a meal and he'd be able to eat what is on the menu just because it's available. I think he should be able to go out and just like we would choose what we want to eat. So anyway, the Bell at Tillington, Bloomin fantastic. Had a really nice selection of things that my son could eat and we all had the best best best meals.

I had brie wedges to start. Breaded brie wedges. And they came on a salad base with some chutney and a balsamic drizzle. I don't know, there's probably a catering term for that, but that's always going to be a winner for me. So I was not disappointed by that.

Three of us have that on the table. That's how much our family likes brie. My son had garlic bread, which was really good. I mean, you can't go far wrong with garlic bread, but still it was really good.

Then for mains, I had the most amazing bit of roast pork belly. Now the meat just fell apart and it really wasn't that fatty, and I know that sometimes it is an issue with pork belly. And the top on it was crackled, you know, like crackling, like you would expect, but not to break your teeth hard. It was so good, so good. And it came with a new potato smash. And I was even sat there at one point saying, this is the best broccoli I've ever had because it was perfectly cooked.

Honestly, I don't think you have heard me saying that a few years ago. In fact, you wouldn't have had me eating one of those meals off a menu anyway. I'd have always gone for the kind of more what they call junk food option. You know, the fast food option, burgers, things like that. But that is what I wanted.

I really wanted this roast pork belly dish. It was lovely, really, really good. And everybody else on the table had equally good meals. Really, really good quality.

And then I heard Mars bar cheesecake. Oh, my goodness. Oh, my goodness. What a pudding. That was so that was awesome. And then when I got home, I was surprised with a birthday cake. I love a birthday.

Then what else do we do this week? This week also, I booked a holiday. Now I didn't realise how desperate I was for a holiday until I booked this holiday, and now I am so ready to go.

We've done something a little bit different in that we're not booking the usual hotel and holiday complex. We are booking a villa. Je vais en France. I'm going to France, so I'm digging out my conversational French from many moons ago. It's all in there. It just needs dragging back out.

But I keep trying to come in other people in the house to speak French with me. They're not having it. The kids didn't learn it at school. They learned Spanish, and my husband's not keen to play that game. So I'm just spouting random French things at the cat every now and again.

But I can't wait. I'm so excited. We're not going into June, but this gives you plenty of time to prepare, and here's how food driven I am. What I'm really looking forward to is going to the little French bakeries and ordering some proper French bread and croissants and finding cute little French patisseries and having some of their pastries. Ahh it's gonna be amazing.

I'm so looking forward to it. I'm also just looking forward to the down time and some sun and some lying around by the pool and the other things that come with the holiday. It's going to be amazing. Initially, this would have triggered, well and actually has to a degree, triggered those thoughts that you get when you book a holiday. I am going to have to wear a swimming costume if I am going to get in that pool.

And automatically previously I would have been dieting ready for that holiday. I'd have been thinking along the lines of I have got nine months there or thereabouts to get myself into tip top shape so that I look amazing at the pool. Now I knew I was never going to look amazing as in my mind, but I wanted to lose weight and feel happier, and it's like I was talking about last week in last week's podcast that wasn't for me.

That was so that I could reduce the negative thoughts that other people might be thinking. But as a good friend pointed out to me when I was having this conversation with her a couple of days ago, what I actually have is nine months to work on my mindset, to be in that place where I am happy to just put on that swimming costume, to just be confident when I am at that pool side, to just have a good time without worrying about it.

So that is what I have. I have all this time now to really work on my mindset, and that is much better, much, much better, than nine months of working on a diet. Nine months of starving myself, restricting, being miserable, being mentally and physically drained by the whole prospect of whether I am thin enough to go by that pool on holiday.

So yes, I'm really looking forward to that. It's going to be amazing.

This week in the office, one of the guys had to go and have a medical and he came back and he was like, "well, we're were pleased to know I'm in this BMI bracket", and that prompted a bit of conversation in the office. So I thought that would make a good topic for conversation this week on the podcast.

BMI. So for anybody who doesn't know what that is, it is the body mass index, and it is basically your weight compared to your height. It is the kilogrammes of body weight per metre of your height squared.

So you don't have to do the maths. Don't do the maths, it's pointless, but that's all it is. It's your weight and your height combined or rather compared, and it's used by a lot of medical staff to work out with your "healthy" or not, or whether you're at risk of certain things. A lot of medical professionals have weight as their targets. Everything is weight driven.

Risk is weight orientated. How healthy you are is weight orientated. And this tool that they use is the BMI scale, and it is a scale that ranges in categories from "underweight" through to "morbidly obese". Now the category names are problematic and quite frankly horrific to start with without even delving into the actual calculation itself.

So basically your height and your weight are compared and then you'll be put in this box according to where you sit on this BMI scale, and that gets recorded on your medical records.

It gets used to determine your supposed risk of things, etc. Etc. But the problem is, this tool was never created originally as a tool for measuring health. It was created by a Belgian astronomer and statistician, and he developed this scale, which was the weight in relation to their height, but it was a population tool.

It was categorising a population of humans so as to figure out what the characteristics of a normal man would be. There was no intention there of using it to measure any kind of health or to criticise people for their weight. He was just looking at the population and there was nothing medical attached to that. And also he only actually ever looked at white European males. He didn't take into account anybody else in the world.

He didn't take into account different ethnicities and races, and he didn't take into account of the genders and body types shape wise, composition wise. It was just a very, very crude basic tool. But then in the 1900s, what happened was US insurance companies, life insurance companies, saw that there was a higher death rate for people who were overweight using a ratio of weight and height. And so they developed this into weight tables.

Now, just to add in a little side note here, later studies showed that that reference to weight and death rate actually didn't really apply because there was a lower mortality rate in people who were overweight. So don't listen to that first fact and freak out about that. It was later kind of debunked.

Anywho, later on in the 70s, our good friend Ansel Keys (remember I've talked about him before? He did the Minnesota Starvation study) then put this BMI scale over the top of the weight tables that the US insurance companies have come up with and decided that it would now be called the Body Mass Index, and that would be used to study and link health and disease and this obesity.

And that is how the two came to be merged. So it was never originally intended to be a scale on which any kind of health could be determined against somebody's weight. That's really, really important. It was never, ever, ever meant to be a tool for assessing risk to anybody's health based on their weight, and yet we still use that. We still use that now to do exactly that.

So my next issue with the BMI scale is that in the 70s people's body compositions were different to how they are now. A couple of podcasts ago, I talked about the body trends across the years and how body types have changed over the years and what was deemed to be attractive in a female, and just looking at that you can see that overtime bodies changed drastically.

So if bodies have changed so much over time, how can this one scale that's been around for a gazillion years, that was never intended to be used for health monitoring, how can that be an appropriate tool to use on bodies today? The categories are underweight, normal, overweight, obese, morbidly obese, and those numbers have stayed the same over time. They've not changed yet body types have.

And if body types are changing and maybe we are genetically changing and evolving and we are naturally not the same as we were in the 70s and before, how can we be using a scale that is based on thousands of years ago? That "normal" category that were aiming for, or that we're supposed to be aiming for, if you ask a medical professional, that "normal" category isn't normal at all for the large majority of the population. For me to get into that "normal" bracket on the scale, I will look emaciated because my body is not designed to be that small.

Even at my lightest, in the depths of my slimming obsession, even then I was still above the top end of the normal category. If I'd wanted to get down into that "normal" category for my height, I would have had to have made myself incredibly ill. And so any scale that encourages eating disorders and disordered eating in order to achieve what is an antiquated category is, in my eyes, just ridiculous. And these categories, by the way, are not based on anything scientific. They were defined by a handful of people with some kind of ideas around what a "normal" weight should be.

And imagine this. If you are top end of the normal category, say you're very, very, very top end, you're just squeezing into it, and then because of natural body fluctuations you get up the next day and you are a couple of pounds or a couple of kilos heavier than you were yesterday, you're suddenly in the next category up. Have you gone from normal to overweight overnight in your sleep?

How bonkers does that sound when you put it into that context? You don't go to bed one day normal weight and then get up the next day overweight. Yet if you recorded where you sat on the BMI scale in those two days, you could easily think so.

Actually, I will apologise. There was a shift in the BMI tables not so long back. The "normal" category was lowered. There was a response to a report that was funded by some pharmaceutical companies that were involved in making weight loss drugs and so very quickly, as you can imagine, lots of people that were in that "normal" bracket all of a sudden woke up overweight. Now their bodies hadn't changed one little bit, but the categories had shifted and therefore they were now deemed to be "overweight". Well, how can you be "normal" body size and then "overweight" without your body even changing? weight-basedDoesn't it sound crazy?

So my next issue with BMI is that the scale takes no account for somebody's health in any context other than their weight and their height. So what it doesn't take account for is the amount of exercise that the person does or their muscle mass. Someone could do lots of cardiovascular exercise, do lots of weight based exercise, eat a very, very, very good balanced diet and be physically fit and well, if you did all the biological health markers.

If you did cholesterol, and you did blood pressure, and you did cardiovascular health, and you did all these things that showed how fit and health a person's body was, they could still be "overweight" or above on these BMI scales. Muscle weighs very heavy. So if you've got somebody who's very muscular, they may show up as heavier on the scales and therefore tipping these categories up a notch or two. If you stood a bodybuilder at the top of their game next to somebody who had very little lean muscle mass and lots of fat mass, their weight may be the same on the scales, but their body composition is very, very different.

The one person with lots of fat mass will be in the same category as the person with lots of lean muscle mass. And yet one person has a very different composition to the other. And regardless of whether they are physically fit and active and healthy, the people with a BMI of 30 to 34.9, so in that "obese" range, actually have the same risk of death as those people in the "normal" BMI range.

So it's not even a marker of health anyway. The category with the most risk actually is the "underweight" category. And being in the "normal" category doesn't even guarantee that you're going to be healthy anyway. Lots of people who would fit into that "normal" category would still be deemed as unhealthy. They would still have health issues and health markers that say that they are at risk of different things.

Another lovely little fact for you is that people living with type two diabetes, high blood pressure, cardiovascular disease, and kidney disease, if they are in the "obese" BMI category, they actually live longer than the people in the categories below their category.

And then when you add on top of this all of the weight stigma and the poor health care and the discrimination that comes with being in a bigger body, that is adding extra pressure on, and that alone leads to poorer health outcomes.

So if we could just remove those categories, remove the pressure of categorising people into these horrible weight brackets, that would relieve some of this pressure and lead to better health outcomes.

There was a very large scale study done not very long ago at all. There were 40,000 people in this study, and it found that nearly half of the people in the "overweight" category in this study, and the third of the people in the "obese" category in this study were actually healthy. Their blood pressure, their blood sugar levels, their cholesterol, all actually really good.

And nearly one third of the people in the study that were in the "normal" BMI category were actually found to be unhealthy against those markers. And it just goes to show that you cannot determine somebody's risk of health or actual health by their weight, by their weight, their height, their category on the BMI scale.

And finally, the terminology that shows in those charts, the wording used for the categories on the BMI scale, I think that's problematic.

Anyway, before you even started to put people in those boxes, "overweight" suggests that there is a normal. It suggests that there is some actual right weight that you should be in order to have a "normal" body. If you were to look at a selection of people in that category, or that fitted that definition of "normal", they could still have totally different body shapes and sizes. So whereas their weight and their height might be similar, that could be the only thing the same about them. So why does that then have to be the picture of "normal"?

Which one of those people in that category is the ideal? That can't be defined. So then overweight then assumes that you are over this ""normal weight? Well, you might be heavier than somebody in the bracket below you, but that doesn't make you not normal. It doesn't make you wrong. It doesn't make you unhealthy.

It just means that your weight against your height is different to that in a category below you.

And then we come to words like "obese". "Obese" is a horrible word anyway, it's a really horrible word. "Obese" and "obesity" come from old Latin terms which mean over eaten or eaten until fat.

It has, horrible, horrible connotations. It tells you that your body is wrong and that the amount of food that you eat is wrong. Those things have no bearing on your health. Your body shape and size and weight Haes no impact on your health. The amount of food that you eat has no impact on your health.

And all this category does is say that if you are bigger than people in the category below, then you are going to be more unwell, more and healthy. And it is simply not true. Putting people into those categories does a lot of damage. It causes lots of problems like shame and worry and fear, and it actually starts alienating people from getting the help that they need.

If they do have something wrong, it stops people going to see their doctor for fear that they will be told that they are in the "obese" category or above, and that that is why they are unwell. It stops people getting the treatment that they actually need when they might have an illness. That is just, just one of those things. It's just a coincidence that they have become unwell. It doesn't have to be born out of their weight.

It's all very, very problematic. I don't know about you, but my worth, my health, my abilities, they can't be determined by a number on a crappy scale that was created a million years ago. I am able to live a healthy life at whatever weight I am because I have control over whether I exercise, whether I eat well, whether I look after my mental health. None of those things have any bearing on the BMI scale, and the BMI scale does not have any bearing on those things.

This person that prompted the start of this conversation earlier in the week had gone to have a medical at the doctors. They had their BMI calculated as part of an overall medical, and this medical was done to determine whether these people could be foster carers or not. I absolutely agree with making sure that somebody is fit and well and able to look after a child. However, I don't think I'll be the only person in the world to agree that you do not need to be in a certain BMI bracket in order to care for a child in order to give them a loving home in order to take them away from a home that is unsuitable or give some respite to a parent who is struggling to cope.

And so I really struggle with the BMI scale. This is just one example of situations where it is used, and it's used with no appropriate context. I guess what I'm trying to say here is BMI is an old old old tool and it's something to be taken with a pinch of salt. The doctors hang so much on it, but you do not have to. If you go to the doctors and you're not in a place yet where you are comfortable or happy to ask to not be weighed, you can still ask to not see the numbers. You can ask to be not told your BMI.

But if you do end up finding out what your BMI is or you calculate it out of curiosity (I don't advise that, but it's real human life, isn't it? We get curious about stuff), if you find out what your BMI is for any reason, take it with a pinch of salt. It means nothing.

Better markers are your physical health, your wellbeing, your mental health, your overall diet, activity level. You getting some good movement in because you enjoy it. Not because you're trying to get down into the next weight bracket. These things are way more important than any BMI scale bunkum. That's what it is BMI bunkum.

So I hope it gives you an insight into the BMI scale and what it means and what it's actually used for, and why people kick back against it. If you follow people on social media in this field of intuitive eating and health at every size, you will see that nobody has got a good word to say about BMI. And quite rightly so. So if you're seeing some of these messages and you've wondered why, I hope that's put some context to it for you.

Okay. I am off to have some food with the girls this evening. I am off to play some pool and have some food and drinks to celebrate my birthday with the girls on the pool team, so that will be lovely. Be nice to catch up with them.

I hope whatever you've got planned, it's fabulous. I don't know when you're listening to this, so if it's the weekend, enjoy your weekend. If it's in the week, I hope you're having a good week. Whatever you are doing, whatever time of the week this is. I hope you're having a lovely week and I will speak to you next week.

Bye bye.