Why we should NOT use BMI to diagnose eating disorders

Today’s post is a bit different from my usual content but I saw a story on BBC news yesterday which really stirred up emotion in me and inspired me to write. It was a young woman sharing her experience with disordered eating and being told by doctors that her BMI “wasn’t low enough to be anorexic” when she went to seek help. Here is the short video clip:

For those of you who haven’t read my previous posts about my struggles with disordered eating, I had an undiagnosed eating disorder throughout my teens and early twenties and lost my period for nearly 10 years due to being underweight for my body type. During this time I too was told by doctors that I was healthy because my weight was within the normal range and was led down the road of more and more tests to figure out why I wasn’t menstruating. This definitely prevented me from getting the help I needed and delayed my recovery by several years as I was able to keep kidding myself that I was healthy and continue with my unhealthy behaviours around food and exercise.

I still have anger inside me towards the medical system for failing to help me and I think it’s so important to share stories like these in the hope that they can help someone else who might be going through something similar. Disordered eating is something that so many women go through at some point during their life and often it is brushed under the carpet because obsession over our bodies, chronic dieting and exercising to lose weight is seen as just part of being a woman in today’s world. Using the BMI scale as a measure of disordered eating is so outdated and only continues this issue. Women and girls, like me in the past, who do become aware that perhaps they have a problem around food are often made to believe we “aren’t sick enough” to seek or receive support.

The BMI scale was developed around 200 years ago by a mathematician as a quick way of determining whether an individual is at a healthy weight for their height. It is usually seen as a chart of height vs. weight like the one below with marked ranges for underweight, normal weight, overweight and obese. However, it was never intended to be used as a formal diagnosis of health. It wasn’t developed by doctors but for some reason it has been adopted by the medical system and is still used, often without question, to this day.

According to most doctors, a BMI within the range 18.5-25 is considered “normal” but there are several major problems with using the BMI scale. The main one I want to highlight is that it doesn’t take into account the percentage of lean mass which consists of bones, organs and muscle tissue. So someone with a larger bone structure or more muscle mass can quite easily be considered overweight or even obese. Think football players or figure skaters who are often lean but extremely athletic and muscular, according to the the BMI scale many would probably need to lose weight to be considered healthy.. really?! How can a basic mathematical formula know what it healthy for your body type. All it is is statistics. On average, humans have less than 2 arms but does that mean that the typical human has less than 2 arms? Of course not!

What is healthy for our bodies depends on so many factors, including our genetics, the environment we are currently living in and what stressors we have in our lives. At certain times it’s healthier for us to hold more fat and at others it might be more advantageous to be leaner. Our bodies are smarter than we give them credit for. I look at photos of myself at my lowest weight when I was around a BMI of 18.5 and I wonder how any doctor could have thought I looked healthy. I was 20 years old but I looked like a child. There was nothing womanly or fertile about how my body looked at that time. I had hardly a scrap fat on my body, no breasts at all without a padded bra and my knees stood out a mile on my stick legs.

Of course, I didn’t look like the completely skeletal anorexic figures that you see, but I was clearly not at a healthy weight for my frame. It’s obvious to me now why I didn’t have my period. As women we need fat on our bodies to support a healthy pregnancy and to nourish a growing baby. I definitely was not eating enough to support my activity level and I was restricting food groups and specific “unhealthy” foods. I had a high level of cognitive dietary restraint meaning that I thought a lot about food and I was constantly controlling and denying my cravings. My body was sending me all the signals that it wanted to be at a higher weight, I would have crazy binge eating episodes because my body was starving for calories but I saw this as a lack of motivation or as emotional eating. I wasn’t underweight for my height so I didn’t see the problem.

This is the issue with the BMI scale, it lumps everyone in the same category and doesn’t account well enough for our bio-individuality or our bodies’ natural intelligence. Personally, I had to workout excessively and restrict my diet in order to maintain this weight which should have been a major red flag that it wasn’t my natural set point. Perhaps another woman could maintain this same weight naturally with little effort and could be healthy but that is not how my body was designed to be. But because I was so attached to the BMI scale and trusted doctors when they told me I was healthy, I carried on this delusion for too long. I’m sure there are so many other women (and men) stuck in this same false narrative, believing that their behaviours around food are healthy when in reality it is causing more harm than good.

When it comes to eating disorder diagnosis, I think using the BMI scale can be extremely dangerous. Especially today as the trend online is not just to be skinny but also to be fit and lean. There must be so many girls and women out there who are suffering in order to achieve a “perfect body” either by being overly rigid and restrictive around food or by over-exercising but they are at a normal BMI so they must be healthy, right? Wrong. Eating disorders are about so much more than physical appearance, they are mental disorders. Diagnosis should be based on thought patterns and behaviours and not on weight alone. If someone is focused on food to the point it is affecting their life, if they are afraid of certain foods or obsessed with losing weight, it doesn’t matter what BMI they are, they deserve help.

I understand that the NHS has limited resources and that they have to prioritise those who are at the highest risk. Being dangerously underweight can cause so much damage to the body and of course these people need to be under medical care, but for those who fall into the grey area of not being sick enough to receive support this can be a real problem. Disordered eating develops over time and generally the earlier it is diagnosed, the easier it is to recover. Eating disorder thoughts are like a fungus that enters your brain, sets down roots and spreads a network across your psyche. Rooting out all of the false beliefs, stories around food and your body and replacing them with healthy, helpful thoughts takes a lot of time and effort.

Putting off treatment because your weight isn’t low enough yet means falling further down a slippery slope and it can become harder if not impossible to achieve a full recovery. Eating disorders are already such a secretive disorder, drenched in shame and denial. Even when part of your mind realises there is a problem and wants to seek help, the disordered part wants things to stay as they are and will hold tightly onto any excuse to stay stuck. A healthy BMI is exactly that, a lifeline of denial for the eating disorder voice. I still have to deal with these thoughts today, even though I can recognise them and not act on them. I think this is partly because of my disordered eating being hidden and allowed free reign of my sub-conscious mind for so long.

I do believe that full physical and mental recovery is possible but it’s much more likely when these things are caught early and don’t go as deep. I definitely consider myself fully recovered now and have for many years but I don’t think that quiet voice will ever completely go away. As a nutritionist and yoga teacher, healthy and wellness is still a big part of my life but I am fully aware that I have to stay vigilant as it can be a fine line between looking after your health and obsessing over your health. It’s not like recovering from alcohol or drugs where you can completely abstain, you can’t recover from obsession with healthy eating by avoiding healthy foods.. that’s a recipe for disaster! However, my motto now is be healthy to live, don’t live to be healthy. Eat vegetables but also eat chocolate cake. Move your body but know when to rest. It might be cliche but balance is the way!

Over to you

Please like and share this post and help to spread awareness of this issue. Follow my blog for more posts on balanced health, yoga and nutrition for healthy hormones.

If you feel like you or someone you know is suffering with disordered eating, please please reach out for support. Don’t let having a healthy BMI get in the way of getting the help you need.

YOU DESERVE TO HAVE A HEALTHY, ACCEPTING RELATIONSHIP TO FOOD AND YOUR BODY NO MATTER WHAT!

BEAT: https://www.beateatingdisorders.org.uk/support-services/helplines

NHS: https://www.nhs.uk/conditions/eating-disorders/

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the problem with fitspo

Real health #16 The problem with fitspo and fitness influencers

I actually wrote this post about 5 years ago for my first ever blog site! This was before fitness influencers were a huge thing, or at least they weren’t really on my radar, but I think it is more relevant than ever today. I’ve updated it a little but the core message is still the same. Enjoy!

This morning a friend posted this image on Facebook..

fitspo

I know she had the best intentions behind the post but it really got me thinking about the “fitspo” trend, fitness influencers and their effects on viewers’ body image.  The Urban Dictionary definition of the word fitspo is:

“Images of active, strong, and fit women that promote proper exercise and diet. May also include images healthy foods. Much like thinspo (images of dangerously thin women used by people with eating disorders to motivate) but healthier.”

From the definition it sounds like a great thing. Replacing the horrible trend of “thinspo” and encouraging women to be healthy and active.. both of those things get a great big TICK from me. However, what can’t be escaped is the fact that images like this still encourage women to focus on their body shape and size. They still provide a body ideal, a goal for women to aim for. They still encourage women to base their self-worth on their appearance and attach morality to food and exercise. And this results in the same feelings of unworthiness and disappointment for those women who don’t follow the rules and don’t look like the picture-perfect Instagram fitness models.

The image above does an amazing job at showing us that the number on the scale is, well only that really. A number. The point here is that body weight and BMI are pretty meaningless and bodies of the same weight can have completely different body shape and composition. That’s all well and good, but what does the image imply? That we should be focusing on getting lean and toned instead of skinny? That it’s much better to be heavier and look like the photo on the right? Yes it may be successful in shifting the focus away from the scale and obsessing over how much you weigh but to what… the way your body looks in the mirror or a photo?

Lots of women (myself in the past included) have fallen into the trap of shifting their health and fitness goals from trying to weigh as little as possible to eating clean and looking lean and muscular. Maybe it’s getting abs or building a booty. But what the fitspo images like the one above don’t show is how the woman is feeling in each photo and what her life really looks like. What kind of behaviours is she engaging in to maintain her body? What is her overall health like? How are her relationships and social life? Is she following her passions or is she spending every waking minute obsessing over eating healthy food, exercising and comparing her body to others online?

There could be a whole range of things going on behind the scenes. We often assume that just because someone looks “normal” that they are not suffering and this is not always the case. Disordered eating can take on so many shapes and sizes. Bulimia and exercise bulimia, orthorexia, food fears, laxative abuse, binge eating, compulsive exercise. All of these can often go unnoticed as people can maintain a normal BMI and not end up looking like the skeletal eating disorder stereotype. I am not saying by any means that the girl in the photos is suffering from any of these issues but what I am trying to say is not to take photos like this at face value. Images mean nothing unless we know the full story behind them.

For me personally, looking extremely lean and fit came at a great cost. I did all of the healthy things. I worked out daily. I ate clean. I drank plenty of water. But I didn’t feel good and I didn’t know why. I wasn’t healthy. My periods were totally absent. I started to wake up in the early hours of the morning for no reason. I felt fatigued all of the time and had to rely on more and more caffeine to get through the day. I know not everybody will have the same experience but I am sure I am not the only one. It took a lot of effort to unlearn all of the so-called healthy habits I had developed and get back to focusing on feeling good. Finally after going back to university to study public health nutrition, diving into my yoga practice and becoming a qualified teacher I found a balance where I could feel good and maintain a slim, healthy body without taking it to the extreme or letting it take over my life.

For those of us in the health and fitness world, food and exercise and shaping our body can easily become the focus of our life. Yes it is fun to experiment with food and of course moving your body feels great. But it doesn’t have to be your sole purpose. It is very easy to get caught up in the social media bubble and forget that there is an outside world. Real life connections and meaningful relationships where you can be yourself can do so much more for your health and wellbeing than following some online fitness guru and feeling connected to others by the restraints of whatever lifestyle they preach. My point in this article is to let you know that you don’t need to idolize anyone and your body is perfect whether you feel more like the “before” photo or the “after”. Remember to focus on the things that keep you feeling happy and healthy above all!

Over to you…

I hope you enjoyed this article from 5 years ago Amy. I would say my opinions haven’t changed much since then. Let me know in the comments below your thoughts on fitspo and fitness influencers, do you find watching them uplifting and motivating or does it make you feel bad about yourself and like you need to change?

  • If you want to follow along with this Real Health January series, like this post, check out the recommended posts below and follow my blog for daily updates. And please share with anyone you think might be interested!
  • If you are looking for guidance, support and accountability on your health journey, please contact me for information on the nutrition and holistic health coaching packages I offer. I would love to work together with you to get you feeling your best again.

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Why am I so interested in hormones? Part 1 – my battle with disordered eating

My journey with my hormones has been up and down to say the least. I started my period at age 12 with no major celebration.. my mum explained what to expect and how to use pads and tampons and that was that for a few years. I don’t really remember much from that time but I think my cycles were pretty “normal” coming each month with some pain and emotional ups and downs but it was no big deal. I was a happy, active kid. I played hockey in school and had competed in judo competitions since I was 10 years old.

I don’t remember ever being a fussy eater as a child but once I got to my final years of high school, I became pretty self conscious (like many teenage girls do) and started to manipulate my diet in the quest of “the perfect body”. It started off pretty innocently with me trying to eat more healthy foods and cut down on snacks (especially the buttery doorstop toast we used to have daily in the school canteen- yum!). But over time things spiralled and I became obsessive with my eating habits, trying to eat as little calories as possible and joining a gym to burn off anything I did eat. This carried on for a couple of years, all through my final exams and the summer before college. I some weight but I was still in the normal BMI range so no one was too worried.

High school2   High school   sophs

Looking back there were a few personal issues that most likely played a big part in me falling into this black hole of anorexia. At the time I wouldn’t have even called it anorexia as I was eating, just not a lot. But the official definition of anorexia is “an emotional disorder characterised by an obsessive desire to lose weight by refusing to eat” which is exactly what I was doing. I was so focused on dieting and weight loss and it never even crossed my mind that what I was doing could be impacting my hormones. Then at age 16 I decided to go on the birth control pill and that set off a cascade of events for the next decade.

I was having a regular period but I didn’t realise at the time but the periods you have on the birth control pill are not real, they are simply a reaction to the drop in synthetic hormones when you take a week break from the pill each month. I didn’t react well to the pill – like many women it made me anxious and emotional so after a year I decided to come off it.  And that’s when my periods went MIA. I saw a doctor after 6 months and was told that my body just needed to rebalance after the pill and that it would take a while for my body to settle out. But 12 months later.. still no period.

Back in the doctors’s office, after asking some questions and finding out that I was very active I was diagnosed with the “female athlete triad”.  I was told that losing your menstrual cycle  is common amongst women who exercise a lot and that it was nothing to worry about if I wasn’t trying to get pregnant. I felt something in my gut right there, my intuition telling me that is WAS something to worry about. I hadn’t been totally honest about my restrictive eating but I was in denial so I ignored the voice inside, accepted the doctor’s advice and carried on with my life. I tried to keep up my diet and exercise regime but after a while my body started to fight back with EXTREME HUNGER.

I still had my goal in mind though so I carried on working out and restricting my calories. But I would keep having these full on crazy binge eating episodes. I didn’t understand what was going on. Seriously I felt like something was invading my mind and forcing me to eat everything in sight! Then afterwards I would feel panicked and confused, guilty about everything I had eating and would vow to eat less and exercise more the next day. Always frustrated, angry at my body for not conforming to the size and shape I had decided it should be. Every time I binged I thought there was something wrong with me and I worked hard to make my body pay for its mistake. I spent hours researching how to stop binge eating, trying all sorts of tips to distracting myself from taking a shower or painting my nails to going for a walk or calling a friend but none of them could help me past the strong compulsion to eat when it came.

So my weight would fluctuate by up to 20lbs as I yo-yo dieted and the cycle continued until I was about 22..

Montpellier   bbq   Leaves   World challenge

croatia   cheer   euro   10616617_10154543788405654_85327801458386665_n

Don’t get me wrong I had some amazing times whilst all of this was going on. I made amazing friends, travelled Europe, volunteered in South America, got a job as a waitress, joined the university cheerleading team, had boyfriends, worked a year in industry and was on track to get a first in my engineering degree. But there was this underlying current of worry and anxiety and I was hiding the anorexia part of my brain leading me to go through periods of isolating myself from my friends and leaving me stuck in these mental patterns of criticising my body and myself, never believing I was good enough. I did seek help a couple of times with support from my mum but because I could go through periods of feeling ok again and because part of me was still in denial, I would discharge myself from therapy.

By my final year at university, my over-exercising and under-eating had spiralled into some pretty disordered eating patterns. I had been battling this whilst studying for my final exams and keeping up an active social life and eventually my body crashed hard. I was still in denial that I had a problem, believing that I “wasn’t sick enough” to need help (which I now know is a common symptom in disordered eating). So I carried on dieting and exercising until I was hit with chronic gastritis. This totally wiped me out and I wasn’t able to work out at all other than walking and some yoga. I put on some weight and funnily enough I got a period! It was only light and lasted a couple of days but after nothing for 5 years I was over the moon.

pub   chem eng ball  laos

I graduated from university and went travelling in South Eat Asia for 6 weeks before I started my new graduate job. Things were looking pretty good, I was exercising again but much more relaxed around food. I was maintaining a slightly higher weight that my body seemed happy with. But the story didn’t end there…

To be continued