Is Body Mass Index going to aid a body-positive revolution or buckle it at the knees? I put my own thighs on the line to find out…
(Note: this article contains images of women in their underwear alongside their BMIs)
After a couple of weeks that brought the controversial ‘skinny ban’ to fashion giants YSL and accomplice Elle UK magazine (who just months ago were smugly revelling in their ‘Feminist Issue’) and the news that teen eating disorders are rising at what medical experts are describing it as an ‘unprecedented’ increase — what have we learnt about the cause of eating disorders in the UK?
I’d have to assert: diddly-squat.
According to Radio 4′s Today Programme, the number of hospital admissions across the UK of teenagers with eating disorders has nearly doubled in the last 3 years, according to NHS figures obtained by the BBC. 4,610 girls and 336 boys aged 15–19 develop a new eating disorder in the UK every year. While some blame instagram and others catwalk models, I’m inclined to sniff a little closer to home. No, literally closer — round the corner.
When we look for causes behind eating disorders, it is reasonable to question what qualifies a person as a sufferer in the first place. The answer, according to the medical profession, is your BMI. Standing for Body Mass Index, it can be calculated by taking weight in kilograms and dividing it by the square of your height in meters. It props up the majority of UK media stats on both obesity and anorexia, as well as official NHS reports on weight gain. While the NHS claim in the small print that it’s not accurate for all, your BMI can be the difference between an eat-more-greens-and-come-back-next-week slap on the wrist or hospitalisation. For teens that struggle with extreme weight gain and weight loss — it’s often their medical fate.
At 14, I was diagnosed with PCOS, a common but unpleasant condition that lets cysts on your ovaries affect your ability to lose or gain weight, among a plethora of other things. The male, middle-aged doctor simply stood me against a wall chart, popped me on the scales, did his merry maths and declared me ‘Very fat. Should lose weight. Very fat’.
After that I had an understandable fear of encountering BMI, but a fleeting urge to ‘get healthy’ a few weeks ago lead me to knuckle down and give the medical experts another chance. I opened my laptop to find out my current BMI according to the NHS website’s official calculator. Now, don’t get me wrong — I could do with a few more jogs and a few less pain au chocolats. I am acutely aware that I am a little unhealthy and would probably benefit from losing some weight.
This much though?
Sure, perhaps I was feeling a little cuddly — but according to the NHS website, it would not go amiss for me to lose FOUR STONE.
That’s almost a third of my total body weight. Let’s look at that again(apologies to all who know me in real life — semi-nudity is a necessary evil in this case)
Worried that I was suffering from obnoxious levels of self-love and was in fact obese, I sent the picture with my screenshot result to a few steely, blunt friends. Friends that wouldn’t Bulls**t me. It was the intellectual, more informed equivalent of a ‘does my bum look big in this’ request. The response was overwhelming and a more importantly, a ‘no’ — and soon I took to a wonderful forum of women to see if my slightly extreme results were the exception. They weren’t.
I asked girls my age, of all body types and variations, to submit pictures they were willing to share in this context, along side screenshots from the NHS website. As they were, in that moment. These were the results (please note: permission has been given for the use of these photos).
In the interests of ‘proper journalism’, I’ve included a range of results — obviously all conclusions are subjective, but you can see that some results are more plausible than others. Especially comparing those with similar results and completely different body sizes.
Luckily, the BMI scale is universally recognised as a guide, not a rule book. However, what won’t be made as apparent to you is that the BMI scale, or (as they refereed to it in 1835 when the research was carried out — yes, EIGHTEEN-THIRTY-FIVE) ‘Quetelet Index’, was only based on a sample of 100 ‘countrymen’. Not only that but it’s inventor, Adolphe Quetelet, warns within the very paper in which the BMI scale is conceived that this calculation is not intended for individual diagnosis — it is only proven to be useful when assessing huge populations, not on one person.
For me, as with many, a huge part of my tendency to binge-eat or avoid food is the dysmorphic way I see my body. Growing, shrinking, growing again — and labels like ‘overweight’ can be the most triggering of them all. Body-shaming scales that compare one bodily ecosystem with another, without proper support or full explanation, can devastate a teenage mind on the verge of illness — or in some cases like mine, actually create one. Joseph Matthews, Lecturer in Health at Worcester University, comments that ‘by classifying someone as underweight or obese, you’re not instigating lifestyle change, you’re attaching stigma and judgement. Change in health behaviours stem from empowerment. Unfortunately classifying an individual on the BMI scale can have the opposite effect.’
A misleading BMI diagnosis doesn’t just have an effect on those whose extreme result that contrasts with their less-than-extreme body size. Those who are suffering are often denied treatment when the NHS turns to them, brandishing their BMI of 17, and says ‘you’re not ill enough’.
As a mental illness, it is surprising that a mathematically physical diagnosis should determine a patient’s access to psychological treatment. Moreover, natural warning signs from the body can often be overlooked in favour of the nation’s favourite Golden Cow, BMI. As featured in The Guardian last Saturday, at 15 years old Nancy Tucker and her mother approached their local GP with concerns that Nancy was developing an eating disorder. Her BMI result wasn’t low enough to merit referral and she was turned away. Just three months later she was hospitalised and continues to fight the illness today.
Now 21 and author of the The Time In Between: A Memoir of Hunger and Hope, Nancy is still speaking out against a 200-year-old measuring system gifted to us from an era that still believed hosing a woman down was the best way to treat her for hysteria. Speaking to me this morning she says, ‘In the grips of an eating disorder, you are terrorised by the conviction that weight is everything — that it determines your right to happiness, love, care, and even life itself. The current NHS practice of allotting eating disorder treatment according to BMI doesn’t just fail to undermine this twisted belief: it outright backs it up. When I was deeply, frighteningly enmeshed in bulimia, I went to an eating disorder psychiatrist for an assessment, clutching a letter from my private psychologist: ‘Nancy is bingeing and purging up to twenty times a day. Nancy is vomiting blood. Nancy has fainted eleven times over the past week. Nancy has tears to her oesophagus. Nancy reports feeling suicidal, and has clear plans for taking her own life.’ Mentally and physically, it was the sickest I have ever been (and my sickness standard is pretty high). The psychiatrist plonked me on the scales, tapped impatiently on her calculator, and scribbled away my right to treatment. Healthy BMI. I should have been hospitalised there and then. I was sent home on the bus, and put on a six-month waiting list for a course of four fifty-minute CBT sessions.’
The only warning on the NHS website that this is the case is a small line in a separate information window that reminds us that in extreme circumstances (like for rugby players) BMI won’t be entirely accurate — however it stresses that this fact ‘will not apply to most people’ and your BMI is on the whole a good measure. Above are pictures of ‘most people’. The NHS is there to serve ‘most people’. Where is the real science, the real rally for ‘most people’?
When you compare this to Instagram’s automatically programmed response (below) to any user searching the term ‘anorexic’ or ‘thinspo’— can we really claim that social media is the only problem?
In a social landscape where weknow these kind of issues are very near the surface, why make something so unreliable and a core part of public health examinations? BMI speculation (if you insist on them existing at all) should always be accompanied by a thorough and tailored medical examination. Any NHS employee should agree about that. Planting an arbitrary calculator on a ‘medical website’, accessible to any teenager or vulnerable adult without context, is surely the opposite of making sure that happens.
Why should we be expected to throw parties to rival Gatsby’s when underweight models are taken off the runway — yet sacrifice our sanity at the alter of ‘medical’ accuracy when it comes to our personal health? An informed medical website like NHS.co.uk is not the place to be posting speculative witchcraft of the highest (eating dis-)order.
Here are the instructions young girls will find accompanying this mathematical machine deigned to feed them with ‘answers’. Take a read yourself — but in my mind it’s far from good enough. If the BMI scale is ‘just a guide’, I’d like to ask ‘a guide to where?’. The grim reaper will surely see you to Hell quite efficiently, it doesn’t mean the destination is appealing. If a BMI ‘diagnosis’ should always be accompanied by medical advice, what business does its carcass-like calculating-system have hanging around on our National Health website? Who invited BMI and more importantly, now he’s crashed our party — who is going to tell him to leave?