Tag: eating disorder

Why we should NOT use BMI to diagnose eating disorders

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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 Using the BMI scale as a measure of disordered eating is so outdated and only continues this issue.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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Why am I so interested in hormones? Part 2 – veganism, PCOS and orthorexia

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Unfortunately after I graduated I slipped back to some of my old ways. I was still struggling with gastritis and other digestive issues and doing endless research online to find the “perfect healing diet”. This is where I found veganism, specifically the high-carb low-fat vegan diet. I started following all of these Youtube channels with skinny, shiny women promoting this diet where you can eat as much as you want and as long as it is vegan and low fat you won’t gain weight. I dived straight into this whole-foods based diet. I was convinced I was doing the right thing for myself as well as the planet and the animals. My diet took on this new moral value instead of simply being a way to control my body.

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On one hand it was great as after years of calorie counting and restriction I finally let go and allowed myself t eat as much as my body wanted. This meant loads of fruit, potatoes, grains etc. At first I felt amazing with this new found freedom and I genuinely believed I had found the golden ticket. However, in reality my eating disorder had just morphed into something new that I didn’t recognise: orthorexia nervosa. This is an obsession with eating healthy food to the point where it controls your life. I might have been allowing myself to eat more but food was still taking centre stage in my life. I spent so much time reading and watching videos/ documentaries on the vegan diet, talking about veganism, writing about veganism, taking photos of my food for instagram etc..

At the time it was fun and I genuinely enjoyed it. It’s crazy how eating disorders can shift and manipulate you. I know my parents were worried about me at this time thinking that I had switched from one restrictive disorder to another but I couldn’t see it. I was in denial and so defensive if they ever brought it up. I gained this self-righteousness that I was following the way and they just didn’t understand. I tried not to be preachy and annoying but I definitely was! I was always the odd one out at social events and had to bring my own special food. I pretended that it didn’t bother me but of course it did. I started to feel so isolated and dived into the online world and groups of vegans where I could feel like I belong. This only pushed me away from my real life friends and left me feeling insecure and lonely.

Around this time I also got back into exercise as a way to control the stress from my new graduate job. Again I thought that this time was different because I was weight lifting instead of spending hours on cardio machines. But I was still using exercise as a way to manipulate my body, following fitness influencers and trying their workout programs to look like them. I was still choosing to go to the gym instead of socialising and still pushing myself to exercise when my body was crying out for rest. By this time I was struggling with insomnia and feeling exhausted ALL of the time but instead of letting go and allowing my body to heal I continued to exercise on a daily basis using pre-workout and coffee to drag myself through.

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So it won’t come as a surprise when I tell you that my periods disappeared again (if you could count the couple of feeble periods I had as them returning). After a year I was back in the doctors office and this time something showed up on an ultra-sound scan that I hadn’t seen before. Small cysts over both of my ovaries. With this and blood test results which showed low estrogen and elevated testosterone, I was diagnosed with PCOS and the doctor told me I might never be able to conceive naturally. This was such a bombshell I literally cried for days afterwards. I was angry at myself thinking that my behaviours had caused this and I was screwed for life.

My doctor recommended that I took birth control pills to regulate my cycle but I knew straight away that this wasn’t something I wanted. It just didn’t seem to make sense to add extra synthetic hormones into my already imbalanced system. Plus I knew that it would be a fake period and was really only masking the problem. Once I’d calmed down I (again) turned to the internet. This time looking for natural ways to heal PCOS. I found an amazing community where omen were healing PCOS naturally via a plant-based diet. As I was vegan already I was like bring it on and jumped straight in to the 8 week program. 

This was only fuel for the fire of my eating disorder. Of course in the mindset I was in this was exactly what I wanted to hear and I carried on down my orthorexia path with my food choices getting stricter and stricter over time. I spent months trying to do various detoxes and cleanses – raw food, fruit diets, smoothie cleanses.. Foods that I had previously thought were healthy under the high-carb low-fat diet banner such as bread and pasta now moved into the “unhealthy” category. I became more and more attached to my healthy food choices so that it became part of my identity to be the “health nut”. I rewired my brain to think that ordinary foods were toxic for my body and I became afraid of them.

Am I saying that veganism is unhealthy or “orthorexic”? No!! Am I saying that exercising and wanting to tone up is unhealthy? Again, no!! What I am saying is that the mindset I had at the time was unhealthy. I was over-controlling and the reasons behind my choices were out of fear and anxiety about what would happen if I chose otherwise. Maybe you’re reading this and you think well I do these things and I’m perfectly healthy. Maybe that’s true and if it is then good for you. However, I know that there a a whole bunch of girls out there (guys too but this is aimed at women) who are trapped in this cycle of obsessive thoughts. The easy access to information that the internet brings only makes this worse. You only have to look at the number of “what I ate today” and body transformation videos on Youtube to see this collective pre-occupation with food and fitness.

In Part 3 I will talk about what finally motivated me to recover and what this process has been like for the last 5 years.

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

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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.

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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

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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.

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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