Exactly whose weight are you over?
I’ve never really liked the terms “overweight” and “underweight,” at least how they’re used by the medical establishment. But for the longest time, I really couldn’t put my finger on why. Part of it, I knew, were the way that these terms have so much judgment attached to them–that if you’re not “normal” weight, you’re doing something wrong and Dr. Whitecoat is going to tell you how to fix it. Sometimes that is the case, but sometimes it’s not.
More recently, though, I finally figured out what the issue was.
Underweight and overweight are relative terms, yet they are used by many medical professionals as absolutes.
So what the hell do I mean by that? Right now, I am sitting on top of (over) my couch and under my roof. If I moved, I could be sitting over my roof and my couch. If my couch were a little higher off the ground or I was shaped more like a pancake, I could be writing under the couch and the roof. Basically, “over” and “under” only describe your position relative to something else.
Of course, things like “normal weight range” could be something you’re relative to. And that would be an adequate use of the terms, if they were used that way (and if “normal weight range” were a little better at capturing all the aspects of health). Your current BMI is greater than/less than population norms. The problem with things like population norms is that they aren’t individual measures. They say that, on the whole, most people are healthier when their BMIs are between X and Y. Exactly what that X and Y should be is the subject of much debate in the medical community, but the precise values aren’t important to this discussion here.
I have no problem with the creation and use of population norms. I have LOTS of problems with these norms being used to determine an individual’s health. Say a doctor tells you that you’re “overweight.” This means that, ipso facto, you’re unhealthy and you must lose weight or you’re going to die of OMG TEH FATZ. Maybe you’re overweight relative to population norms.
The question to ask is: exactly whose weight are you over?
Certainly, if you’re completely sedentary, have velcroed your sweatpants-covered ass to the couch and do nothing all day but stuff Twinkies in your gob, then you might have some changes you wish to make for your overall well-being. But if you eat a varied diet, if you move your body, if all measures of health are good, and your weight is stable, then let me ask again: exactly whose weight are you over? You might be overweight relative to population norms but at a perfectly healthy weight FOR YOU.
And even if you’re not. Even if you are unhealthy, you don’t deserve judgment from doctors, nurses, me, or anyone else. You know far better than I about your life.
As it relates to eating disorders, and anorexia in particular, is that a BMI of 18.5 is generally used as some sort of magic number. Once you’re over that magic BMI, you’re considered no longer underweight and, therefore, no longer needing help. It’s how it worked with my insurance company. When I was IP, I was discharged the day (that very day) my BMI crossed over that magic number. I had no warning. Insurance just cut out.
Other people have been told that they don’t need to gain any more weight once their BMI is over 18.5. Why? Because they are no longer underweight. Their weight is normal, their eating disorder is fixed.
The problem is that only a very small segment of the population has a BMI that naturally falls at 18.5. Although someone might technically be within population norms at that BMI, they are still underweight FOR THEM. The problem is that the term “underweight,” again, is being misused as an absolute measure. Someone might be at a normal weight relative to the population but at a very unhealthy weight for them. My natural weight seems to fall at the upper end of what is considered a “normal” weight range. So I can be at a weight that is normal according to the CDC and WHO but is very underweight for me.
We need to stop using the terms underweight and overweight as these magical, absolute measures and instead start measuring them relative to each individual. Some people might have to gain an unhealthy amount of weight to match my BMI and build. And plenty of others would have to lose an unhealthy amount of weight. It’s all relative to you and your DNA and environment. I think we would improve the health of lots of people by stopping to say that there’s some universal weight at which you’re over or underweight and instead start measuring these things relative to each individual.