Tuesday, April 1, 2014

The Face of Obesity

I know it's April Fool's Day (which is why I have insulated myself from the masses of prank-playing humanity by hiding here...in the dark...under my bed), but this is no joke.  This is the face of obesity, although most guys probably aren't looking at her face...
The face of obesity, Anita Albrecht

Last week, professional body builder, Anita Albrecht, was told by a NHS (National Health Service in England, although it might just stand for "Not Horribly Smart") nurse that she was "eating too much" and needed to lose weight.  The nurse also recommended a 1000 calorie diet (What is that?  Like one graham cracker a day?  Sheesh.) as well as more exercise...and since Ms. Albrecht undoubtedly spends as much time in the gym as your average full-time office worker spends in the office...she might be losing some sleep if she plans to cram in any more.

Seriously...if Anita Albrecht is overweight, we all might as well just throw in the towel.

The nurse based her recommendations on the Body Mass Index (BMI) which uses math to measure assumed amounts of body fat based on an individual's height and weight.  (Just one more reason to hate math, people!)  By comparing nothing more than Albrecht's height and weight, she falls on the scale at a whopping 29% body fat, which categorizes her as borderline obese.

But I have to wonder if the NHS nurse looked up from her clipboard at all.  Did she even glance at Anita Albrecht during the course of the examination?  Or was she too absorbed in protocol and meaningless averages and sweeping generalizations?  Because certainly no person with decent eyesight could look at Anita Albrecht and think, "She's a little chunky...She might need to spend a little time in the gym...You know walk around the block a few times...and maybe go on a terribly unhealthy starvation diet...because, 'Moooooo'!"

See, BMI doesn't really work all too well for athletes and body builders, because their bodies tend to be more muscular than the average Joe (or Jane).  Muscle is denser than fat, so more muscle equals more weight.  Since amounts of fat and muscle aren't differentiated in the equation, it can become problematic.

"When I tried to explain to her about my body composition she wasn't interested at all," Albrecht complained.  Probably too interested in her clipboard full of statistics to listen to logic.  After all, she had a whole conveyor belt of other patients to push through the system that day.

According to Albrecht, the nurse told her, "You are obviously eating too much."  You know what they say about assumptions...  Actually examining the patient, and possibly asking a question or two, might have helped the nurse realize she wasn't talking to a midnight binge eater here.  But, I'm no medical professional, so I could be wrong.

Albrecht admits that she left the appointment feeling "belittled and insulted".  That's pretty much the standard reaction that women have when they are called "fat"...whether they actually are fat or not.

Because women are overly concerned with being thin.  They are programmed both blatantly and subliminally through "beauty" magazines and photo-shopped celebrities and anorexic fashion models that being thin is the ultimate goal.  The lower the number on the scale, the better.

But that digital number on the bathroom scale is no indicator of health.  A lower number doesn't necessarily equal better health.  One can be remarkably thin (like runway model thin...does their weight even register on your standard bathroom scale?) and dangerously unhealthy.  Consider modeling agencies who do their recruiting at eating disorder clinics.  (There is obviously something sinister and macabre about the fashion industry's obsession with Auschwitz chic.)  Body weight is just one very small (and often insignificant) factor in determining someone's overall health.  We can't boil health down to one single relatively basic mathematical computation, especially when it so blatantly fails a healthy fit individual like Anita Albrecht.   Because health is a complex and constantly changing concept.  And it's as individual as...well, an individual.

There are components to health like strength, flexibility, endurance and cardiovascular health that can't be measured in pounds and inches.  And then there's being disease-free and mentally stable and emotionally mature.  Also can't determine that with a BMI scale.

So look up from your charts and figures and math equations, health care professionals.  And look up from your bathroom scales, ladies.  Health is so much more than what you weigh.

You are so much more than what you weigh.

Just toss out the damned scale.  It would save us all a whole bunch of heartache and self-esteem and tears and medical misunderstandings laced with dangerous recommendations and misinformation.


CCONGER said...

As a Pitt County employee, my husband has a physical at the health department every year to help control the costs of his health insurance. While he is not the picture of perfect health as the woman you use an example, he is far, far from obese; at 6'0" and 170 pounds, no one would ever consider him overweight. However, each year, he is admonished for being obese....it has become a joke at my house any time he is charged with being a "pig."

Melissa P. said...

While weight is not the sole determinant of health, I do think it is often a sign of poor health. In both directions, actually. We also use weight to monitor the health of the elderly by seeing if they are losing a lot. The BMI is a good tool. This poor nurse unfortunately wasn't aware, and was just treating a number, but most health professionals are very aware that BMIs can't be used for the very athletic and muscular for the reasons you mentioned. That being said, most people who are cardiovascularly fit, are so because they exercise often and eat well; and most people I treat who are overweight, don't do much, if any, of that. The goal of the classifications is not to make people feel bad. It's to let us know that their risk of serious illnesses go up the more overweight they are. It's not based on models, but statistics. You're right that that weight is not the whole picture, but it is an important component and one we need to keep being reminded about. -friendly neighborhood family doc.