[Listen to an audio version of this blog here.]
My annual physical is normally short and to the point. Height, weight, blood pressure, throat check, a small conversation about safe sex, double checking that my pap smear is scheduled, double checking that my therapy is going well, and my doctor peels off her white gloves that she didn't even use. I'm normally in and out of the doctor's office in under 30 minutes. But this year, my doctor furrowed her brow and said, "It looks like you're overweight." I haven't gained weight in at least 5 years, so I laughed and kicked my shoes like a small child on a park bench watching a balloon artist. Normally, my chart would show that I have a history of an eating disorder, along with the treatment my hospital provided. Because I stopped seeking treatment awhile ago, I figured that bit of pertinent information had disappeared from my chart. I also figured that it doesn't really matter. At some point, that piece of information should disappear from my health chart if I've successfully moved past it.
So, I wasn't upset that my doctor told me that I'm overweight, but I was amused. She cocked her head, "Why is that funny?" she asked.
"Because I'm not." I answered. I then attempted to explain that I'm an athlete, and have been for most of my life. My bones are dense, my muscles are dense, and by every single health measure outside of weight, I'm off the charts healthy. Resting heart rate of 40 beats per minute healthy. Blood pressure of 120/80 healthy. Low cholesterol, low blood sugar, hydrated, well-rested, eating-my-greens healthy. A Dexa scan from a few months back showed only 20% body fat, off the chart bone mineral content (BMC), and absolutely nothing to worry about.
I don't know why my doctor was so hung up on the BMI scale. Most doctors I've interacted with look me over, pinch and prod me, say something like, "Keep it up, kid. Come back in a year." The fact that I'm muscular and athletic is not hard to see, especially when I'm draped in a shabby hospital robe. Most of my doctors get the gist, and leave me alone. But she was different. She handed me a pamphlet about healthy eating entitled, "Dietary Guidelines For Good Health," which included a rudimentary food pyramid-turned-plate, half-boiled tips for healthy eating, and stock photos of men and women walking, eating, and smiling broadly.
My I was in the thick of my eating disorder, it influenced everything I did, ate, or thought about. Now that I've put it to rest, here was a doctor with tired eyes and bright lipstick telling me that a good way to reach my ideal weight would be to wake my eating disorder back up again. Count calories, the pamphlet said, to gauge your starting point. Eliminate processed foods. Take walks on your lunch break. Eat fruit. Drink water. No shit.
The BMI scale was devised in the 1830's by Lambert Adolphe Jacques Quetelet, a Belgian astronomer, mathematician, statistician, and sociologist. He created it as a tool to estimate whether a person has a healthy weight by dividing their weight in kilograms (kg) by their height in meters squared.
Researchers from the Perelman School of Medicine at the University of Pennsylvania found that BMI does not take into account muscle mass, bone density, or overall body composition. A cubic inch of muscle weighs more than a cubic inch of fat, which is why the BMI scale inevitably categorizes muscly, athletic people as overweight. Experts largely agree that the BMI scale is sort of moot for athletes. However, the Centers for Disease Control (CDC) and National Institutes of Health (NIH) both support the BMI scale as a good measurement of health for most people, which is why many doctors and health systems still use it.
So, if the BMI scale isn't useful for muscular athletes, what is? Waist circumference is a good tool; Harvard Health Publishing states that a healthy waist circumference is less than 35 inches for women and less than 40 inches for men. But the best measure is body composition, because this measures fat, not just weight. It can also measures bone density, which is normally high for athletes. According to Livestrong, desirable athletic ranges of body fat are 5 to 13 percent for men, and 12 to 22 percent for women. Optimal fitness values are 12 to 18 percent for men and 16 to 25 percent for women.
There was a time in the not-too-distant past when my doctors comments would have really bothered me. When I left the office that morning though, I felt nothing because I knew she was wrong. And, I know that I'm stronger and healthier than I've ever been. The only point of me writing this is to amplify the many voices already protesting the BMI scale.