One of the things doctors or nurse practitioners or any other health care providers talk about when at a visit is your BMI. It’s in the same part of your chart as all your vitals. Intermingled along with your heart rate and blood pressure and height and temperature is your weight and BMI.
And if your BMI is above 25 then you’re now considered overweight and the computer system turns your BMI from black to red….meaning, “look at the BMI because it’s concerning because it’s out of range.” Which is dumb.
I hate this about the electronic medical record. And I hate how we, as health care providers, are taught to pay attention to this in school. Here is a really great article on the nothingness of BMI.
And I wholly agree with that article. BMI is pointless. Even though we are taught to pay attention to BMI in nursing or medical or dietetics schooling, I think a lot of health care professionals would agree with me in that BMI is a crappy measure of health. So that’s not really my biggest frustration, it’s that we pay so much attention to weight. A side note for a second: if you have an eating disorder or restrictive eating behaviors and find yourself either trying to get thinner and maintain a low weight or you are recovering from an eating disorder….please know that an upward weight trend very much does matter. Not so much a “goal weight” in your recovery because that is arbitrary and the true “goal” is your body’s natural set point, but I want to emphasize that it is very important and critical to initially recover from a low weight that puts your body in a medically unstable condition. I say that because I want to protect and be sensitive to all my readers the best I can 🙂
Back to my soap box on how weight doesn’t matter… there is such a focus on “your weight” when you go to the doctor that it keeps people from actually going to the doctor. You go in, you get weighed, you get your vitals taken and then the doctor (or NP or PA) coms in. And 90% of the time, your weight will come up. Maybe it’s a simple, “your weight looks the same as last time you were here so that’s good.” or maybe it’s a little more harsh such as, “well, Mr or Mrs so and so….I see you put on a few pounds since the last time you were here, let’s talk about your weight.”
All I can think when I hear or see this happening is “WHY IS THAT THE FOCUS RIGHT NOW? WHY have we not asked one question about how they feel their eating or exercise behaviors are going?” Because weight shaming someone actually does nothing for helping them to make positive lifestyle changes to better care for themselves – mentally, physically, emotionally and spiritually.
Even more important than not weight shaming people is that people don’t die from being overweight or obese. This is a controversial topic…the questioning if obesity cause diabetes or heart disease or insulin resistance or inflammation. I’d be a liar if I said I’ve read all the research there is on this, because while I’ve read a lot, I haven’t read it all. But I am pretty confident in saying that we can’t make general statements like “overweight or obesity are the cause of such and such disease” Because it’s so much more complicated than that.
One, inflammation is what causes chronic disease. Not one particular food, not one health habit and not weight or BMI alone. Just like eating all the clean green things doesn’t save you from cancer or illness, “excess” weight does not get you a one way ticket to chronic disease. (The argument of what the hell is excess weight is a whole other blog post…) Yes, fat accumulation in the body can cause insulin resistance which leads to diabetes and metabolic syndrome and contributes to PCOS, but not all adipose (aka fat) tissue is the same. There are studies showing subcutaneous fat (the kind we find all over our body that insulates us) can actually be protective versus visceral fat (the kind that accumulates around the belly) which increases insulin resistance.
Without going down a science rabbit hole, my point here is that the focus in evaluating anyone’s health should not be on weight. What I think matters from an objective standpoint is your lipid levels and your A1C (your average blood sugar over 3 months) and your liver enzymes and your thyroid levels and your blood count and other lab values….I don’t really care about your overall weight. When we are take the Health at Every Size approach (which has tons of scientific backing) then weight because neutral and it’s no longer an area of focus.
I’ve seen people who are in a “normal” weight range with abnormal lab results. And I’ve seen people who are “overweight” with stellar lab results. I think we have a responsibility as health care professionals to dialogue with patients in a way that promotes health at every size and that empowers people to take care of themselves – body, mind, soul – in a unique way that harnesses their strengths and acknowledges their challenges rather than simply trying to manipulate the number on their scale. Micromanaging people’s weight certainly doesn’t accomplish that.
I think it’s a shame that insurance companies charge people more money if they have a high BMI.
I think it’s a shame that we are more concerned with lab values and objectives than listening and understanding people that come through those clinic doors so we can help motivate and encourage and walk alongside them to make realistic and sustainable changes to better their overall health, which is SO MUCH more than weight. I think we’d have a hell of a lot less chronic disease and eating disorders and metabolic issues and anxiety and stress to manage.
Because really, true health is not about weight. Yes it includes your lab levels and your blood pressure and your heart rate.
But what we should really be focusing on – whether as patients and people or as doctors and nurses – isn’t a number on the scale.
But rather a person’s relationship with them selves. How they think and feel about their body. How they feel physically. How they are doing emotionally. How they think and treat food. How they are sleeping and taking care of themselves. Because if we think about and focus on those things, all the other objective things will follow
Such a great reminder! Thank you:)
I am SO GLAD to see a post about BMI. I was so surprised during my eating disorder certification training to learn about how arbitrary BMI numbers actually are. The BMI scales/categories were actually changed from being higher than what they are now to better fit insurance companies and an overview of the population during that timeframe (a really long time ago, btw) (Source: Beyond a Shadow of a Diet).
This reminded me of my own experience at the doctor a while back when I CLEARLY told the triage nurse that I did not want to see my weight because it’s not good for me mentally. She looked at me puzzled and said, “Well, why not? It’s not really that bad. What do you THINK you weight?”
I was like, REALLY?? That is so not the point right now, Because #1) I pretty much knew what I weighed but was trying something new where I was trying to focus less on it. 2) Your perception of whether or not my weight is “good” or “bad” has nothing to do with my visit here and I don’t really need your input about it.
Thanks for sharing on this important topic!
I have found that triage nurses can often be the biggest instigators of weight focus and negative thoughts surrounding weight — I’m sorry on behalf of us all! hoping that changes in the near, near future. thanks for sharing!
LOVE this, Robyn! I’ve had my fair share of struggles around eating and exercise and I hated how doctors ONLY focused on BMI and weight. They had no idea what was actually going on inside, which was the most destructive part.
ughhh it’s so unfortunate. I’m so sorry carrie.
BMI is such crap. I have a history of disordered eating. I was never actually diagnosed, but had I spoken up, I believe I would have been. I went to a walk in clinic recently because I pulled a back muscle and was in a huge amount of pain and just wanted someone to tell me what was wrong. I got weighed and the nurse announced it loudly. In the future, I will ask to be weighed blindly. Then, when I was leaving, I glanced at my discharge report, which displayed my weight (which was probably still well below my set point) and BMI (“normal range”) and that I should be 5lbs lower. Really!? I was so ticked. I just wonder if, no matter what, they advise you to knock off some amount of weight. It’s so triggering and so unhelpful. I had to see that when I went there for a back muscle pull and when I was already struggling with accepting my weight. Such crap. Thank you for this. The more it’s out there, the more help.
my heart feels for you kristen <3 hoping you let that visit bounce off you like a ping pong ball 🙂 xo
This is so so true. I’m so happy there are people like you in the medical field who can advocate for a more holistic view of health instead of reducing it to numbers that don’t even matter. Keep fighting the good fight! 🙂
It is like you read my mind and wrote exactly what I needed to hear 🙂 I have been abroad in Australia for the semester, and I unexpectedly gained 10 lbs, yet I am still not getting a regular period and my energy levels are crappy. I know when I go to the doctor, his comment will be “wow you gained quite a bit of weight since your last visit,” instead of asking me about how my life is going. I know it is most likely due to the time difference after talking to my nurse of a sister, but it is frustrating to gain weight and not feel better or regain my cycle. Instead, I am just like great now I just need new clothes. I reread your post about gaining 10 lbs, which I love 🙂 It is not that I am “overweight” by BMI standards, but coming from and ED history, unexpected and fruitless weight gain is frustrating. Thank you for being you and sharing your heart with us<3
Just wanted to chime in after reading your comment – I also dealt with this after living abroad a few years ago and it was the best thing that ever happened to me. It was a step that eventually broke me free from a rock I’d been living under for years (aka diet mentality)- I now realize how much time I wasted worrying about food and exercise. Now I can focus on other more important things! What I found particularly helpful was following body positivity insta accounts. It gets better…hang in there!
<3 <3
I can understand how that is hard and frustrating and brings about a lot of mental adjustment — but remember this is a season, you’re body is doing what it needs to do in this moment and it will ebb and flow with the next season <3 thinking of you!
I was looking for a sign …anything to help me reach a point in my own personal recovery from disordered eating that I needed to let go once and for all of the numbers. Your post inspired me to finally toss that nasty scale in the garbage after writing in big black letters, “BULLY” on it, of course. While it was the most difficult thing I have really had to do thus far, as the scale had become a crutch…an obsession, I am excited to see what positive things will come out of this step of the process. I am more than just a number. I’m more than the food I choose to eat. Thanks Robyn!
YES YES YES ashley! thank you for sharing!!
Robyn, I’m so so so grateful for this post!
I work as a primary care PA (and am also just ending a many year battle with an eating disorder) and it’s incredibly difficult to help patients work through the fact that just because their BMI is high doesn’t always mean they’re unhealthy and going to develop disease.
I’ve found that it’s a really murky water to navigate: how do you tell patients they’re at risk for developing diabetes based on a borderline high a1c but then try to tell them they can find health at every size? And I have some patients who try like crazy, are super active and eat healthy and their labs still suck…
patient care is hard when it comes down to talking about health and weight. I badly want to tell people forget about your weight! But at the same time still want to try to talk nutrition with them and why it’s important. This has been a huge stumbling block for me since I started practicing two years ago! I truly loved this post though. My brain and my soul needed it.
Hi Kasey! Girl, I HEAR YOU on the murkiness and hard water to tread and then the limited time we do have with patients. I think the focus should ALWAYS be on the behavior and never on weight — ever. I always focus on nutrition, sleep, movement, STRESS and then if labs are still out of whack we can talk perhaps smaller tweaks (more plants etc etc) if I have time…and THEN we will talk meds but I always say “this is an adjunct to what you are doing, not a sub and sometimes are genes are against us so we have to work with them”
I think you can DEFINITELY talk about health and nutrition all day without ever once mentioning weight — focus on the behavior. hope that’s helpful!
Yes , yes, yes!
The weight shaming truly has to stop. A pediatrician pointed out my weight was “nearing overweight” on a BMI chart when I was 15 and I spiraled into eating disorders / disordered eating for 10+ years. I’m not just slowly crawling my way out and I would give ANYTHING to go back to the normal eating habits I had a 15 when I was a healthy and active teenager.
Thanks for all you do!
I worked with a pediatrician during my NP schooling that would walk in and say “mom! how did you let this child get so fat!?” after a few weeks I HAD to speak out — my skin was BOILING. sending lots of love to you as you continue on in your recovery!
Amen!
I work with elderly patients where we have to come up with “care plans” for people who have BMIs over 24. It’s absolutely nonsense, especially since elderly patients have better survival rates with BMIs between 28-32. It’s crazy how most health professionals will denounce BMI, but still use it in their practice?? Thank you as an RD and NP for speaking out against this!
and they are elderly by that point – let these people live!!
I distinctly remember going to a doctor when I was in college that told me “your weight looks good now, but you’re pretty close to what we consider over a week, so watch yourself.” Never went back to her again!
ughhh. so sorry for that – how frustrating!
Love how passionate you are about this! You’ll bring so much to the field. You could literally write a post on insurance companies. It’s ridiculous!
I am SO thankful that you posted on this, because for so long I struggled with really wanting my BMI to be in the ‘healthy’ range, but your reminders have constantly reminded me and so many others that health is not defined by BMI.
Preach! BMI should be the starting point, not focus, in determining one’s health or the health of others. Ultimately, it is just one metric, and an imperfect one at that,
Loved this article! I was wondering if you had these same stances on BMI/weight during your dietetics degree/internship? (I haven’t been following you for too long so sorry if you’ve answered this before). I’m starting my MS/DI in August and I’ve been learning a ton about intuitive eating and HAES and think it’s awesome, but am a little warry about going into my program because I know that’s not what I’m going to be taught (I mean we’re still getting taught to eat low fat so that’s annoying). I was wondering if you have any advice on how to deal with learning stuff you don’t agree with, thanks in advance!!
I love this! I agree, BMI is crap and it drives me INSANE that EMRs now make a “high” BMI red. I work as a clinical dietitian and I’m much more concerned about malnutrition, so it’s never made sense to me that the low BMIs aren’t also in red. It also drives me crazy that weight is automatically printed on the AVS. I recently had to go to urgent care, requested a blind weight, and was then really annoyed to discover it was printed right there on my AVS with my BMI and some little blurb about what that BMI meant…UGH!!!!
YESSS. So true, thank you for bringing this issue to the fore. I had a wonderful dietitian during my anorexia, but one thing that really messed with my recovery was giving me ‘goal weights’- a.k.a. ‘a weight that I cannot, under any circumstances, go over’. This happened to be the very bottom of the ‘healthy’ BMI range. Instead of letting that be the minimum, I did everything I could not to exceed it. If I’d just been encouraged to have a healthy relationship with food, it wouldn’t have been an issue for me.
This was amazing, Robyn! Your posts are truly so eye-opening and your stance in defending the Health at Every Size approach is just undeniably justifiable. I’m so thankful that you are a RD and NP because you have such strong influence and we NEED more people like you 🙂
I’d like to add to this conversation the following: you have every right to decline being weighed at the doctors office or to be blind weighed. For some medical procedures or dosing purposes, taking a weight might be necessary– but if you go in for a cold or something unrelated– your weight really doesn’t matter at all. Yo can opt out, you can say no! If your doctor doesn’t allow that, find a new doctor!
Thank you for being such a wonderful advocate and voice in our community, Robyn! You are so eloquent.
I wrote an essay about Health at Every Size for my master’s thesis and read it at my graduate reading. A lot of the audience members got these looks on their faces like…whoa…I didn’t even know you could *say* that in public. It’s surprising to me how many people have never even heard someone suggest weight doesn’t determine health.
Hi Robyn! Thank you so much for sharing! Thank you for always being so real. Your posts resonate with me so much.
This is not just true for people with a high BMI. Every year I went to the doctor growing up (age 10 to 18) for a sports physical/general check-up, my doctor always told me I needed to gain at least 10 pounds.
I was a very active kid who ate healthful, home-cooked meals everyday. I ate when I was hungry, and I ate until I was full.
I am so thankful my parents never emphasized weight as part of my “health”. I just laughed at the doctor’s advice and ignored him the rest of the year.
As a former NP (now researcher), I wish more health care providers would start visits by asking, “What brought you in here today? Do you have any concerns about your health or how you’ve been feeling that you would like to share with me? Are there things that you think are going really well for your health?” That centers the visit on what’s important to the person, NOT on an arbitrary number. I am still struggling with gaining weight, but made the big step of throwing out the scale when we moved a couple of months ago. I don’t miss it. At all.
I LOVE everything you said here. Something myself and the doc I work with think is so important and would love to see others do the same. Rooting for you and congrats on a huge step with throwing away the scale!!
Wow I’d love to read that!!
Yes yes yes
Your words mean a lot Haley. Thank you <3
Your weight doesn’t matter.
Your BMI doesn’t matter.
Your body fat percentage certainly does matter.