Health And Wellness

My Doctor Said I Was Obese Based Only On My BMI

Photo: Artem Oleshko / Shutterstock
woman stepping on scale

“You can take off your shoes,” the nurse said. “Just put them here.”

This was always the worst part of my doctor visits, and it often left me defeated. Over the past ten years, as my weight skyrocketed from a combination of taking anti-psychotic medicine and losing half my thyroid, I’d been repeatedly scolded for my BMI being too high. The lecture from the doctor was always the same: I’m too heavy for my height, and I need to lose weight.

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With a sigh, I did as instructed and watched as the number bounced back and forth before settling on three digits I knew would result in an obese diagnosis. The nurse said nothing as he made his notes.

“We’re going to room four on the right,” he said, letting me lead.

After he took my vitals, all of which were excellent, he left. I played with my phone while I waited, trying to distract myself from the inevitable discussion about how I needed to eat better, why I should lose weight, and how I’m shortening my lifespan by not fitting into the right spot on the antiquated BMI chart.

The first time I heard about the BMI chart, I must have been around twenty. My doctor complimented me for falling within the right perimeters for my height and weight. I walked out of that appointment feeling like I was the epitome of health. The only issue was that I sustained myself with a grab-and-go diet heavy on fast food and never exercised.

And that’s why the BMI chart is nonsense. Numerous studies have debunked its usefulness mainly due to its inability to distinguish muscle weight from fat weight. “Skinny fat” people often fall in the low-to-normal range, and it isn’t unusual for “muscularly thin” people to be marked as overweight or obese.

As an example, two people with the same weight and height may have the same BMI, but the more muscular person appears thinner due to one pound of muscle taking up less physical space than one pound of fat. There’s no reasonable way for a doctor to look at a BMI number alone and determine who is at greater risk of diabetes, heart disease, or other illnesses.

The door swung open, and the doctor stepped inside. She was in her mid-forties like me, and even though I had only seen her once before, I had been treated by other doctors in the practice and my complete history was in my file. She only glanced up briefly from her laptop to say hello before sitting on the rolling stool across from me.

“You’re here for a rash on your leg?” she asked, scrolling through her notes.

“Yes,” I answered. “I gave myself my monthly migraine injection, and now I have a rash. I’ve never had a reaction before.”

“Your weight is high,” she said and tapped the laptop screen.

“I know, but I’ve lost six dress sizes this year even though my weight hasn’t changed much.” After having COVID-19 in June of 2020, I had committed to improving my health by doing at least 150 minutes of cardio a week, walking 8,000 steps a day, doing strength training daily, and practicing yoga regularly. I was in the best shape of my life despite the number on the scale.

“Your BMI is in the obese category.” She shook her head. “You need to lose about sixty pounds.” She reached for a brochure. “This is a nutritionist you should speak to.” She pulled out another brochure and handed both to me. “And this is the contact info for a weight loss program.”

I expected the conversation to go like this, but it still stung. My hard work over the past year didn’t matter at all because my weight had barely changed. I was obese and that was that.

“Can you stand up?” the doctor asked. “Let me get a look at that rash.”

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Even though I was frustrated by the weight conversation, I said nothing. What was the point? According to the BMI chart, I was obese and I’d probably still be obese on my next visit and the one after that.

I stood and showed the doctor my leg. She ran her hand over the rash and pressed her lips together. “Cellulitis. You need penicillin.”

As she typed up her notes, I put my jeans back on, and instead of biting my tongue and just leaving with the prescription, I said, “I’m wearing size 27 jeans. I’m muscular from lifting weights and exercising.”

She looked up at me, and I think for the first time, she actually saw me and not my numbers or rash.

“Yeah, you look great. Keep doing whatever it is you’re doing.”

I cocked my head. “You just told me I’m obese and need to lose weight.”

The doctor finished typing. “The BMI chart says — ”

“That I’m obese,” I finished. “I know. But what do you think when you look at me.”

Her mouth dropped open slightly. “You look like you’re in great shape.”

“So why are you telling me to lose sixty pounds?”

When I shared my story with my friends, the universal response was that I needed to dump my doctor and I agreed. But will it actually change anything?

Every doctor I’ve ever seen for my physical health focuses on my weight even though better ways, like waist size and the waist-to-height ratio, exist. For some reason — maybe because it’s easier to calculate — my doctors still cling to the BMI. With all the information we now have regarding health and weight, it’s strange that so many doctors still overwhelmingly rely on the outdated BMI.

Something needs to change. We need to discuss health and not scale numbers.

Personally, I use a Bluetooth tape measure to track my fitness progress, and I don’t understand why doctors can’t do the same. It shows that my waist-to-height measurement falls within the normal range as does my waist circumference — two measurements that researchers feel better to assess health.

For me, the most difficult part about these conversations is that I’ve worked hard to put the numbers on the scale into perspective. I spent too many years obsessing over my weight, celebrating lower weights, and trying to drop weight if my number crept too high.

I had to retrain my brain to see my overall health — including my mental health — and not focus on just one aspect. However, when my doctors insist on using the BMI, it reinforces my negative thoughts about weight and makes me question if I should keep trying.

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Mia’s memoir Always Yours, Bee, about her husband’s accident and her subsequent spiral into mental illness, was selected by BookBub as one of “15 Powerful Memoirs to Read in 2021.” She is also the author of the women’s fiction series, The Waterford Novels.

This article was originally published at Medium. Reprinted with permission from the author.